Sexuality and Aging

Sexuality is a very important life issue for the elderly, but is often overlooked, according to Cynthia L. Ardito, Psy.D. Ardito frequently speaks on this subject to various health care provider groups in the United States and Canada. Most recently, she presented the topic at the Eastern Massachusetts Alzheimer's Association's Interdisciplinary Professionals Conference, the Massachusetts Association of Older Americans' Conference and the Cambridge Hospital Conference Series.

Ardito, who received her doctorate in clinical psychology from the University of Hartford in 1992, is the director of the Geriatric Group Psychotherapy Program at McLean Hospital in Belmont, Mass., and is an instructor of psychology in Harvard Medical School's psychiatry department. She has also been clinical consultant to McLean's Nursing Home Program and maintains a private practice in Belmont, Mass.

In a telephone interview with Psychiatric Times, Ardito discussed the issue of sexuality and aging.

PT: What do we know about rates of sexuality in later life, and what factors might interfere with remaining sexually active in late life?

Ardito: Our society seems to have the prevailing belief that sexuality is meant primarily for the young. The reality, however, is that sexual feelings, interest, activity and capacities are lifelong. In fact, research has repeatedly shown that the overall best predictor of sexual activity in late life is the level of sexual activity in midlife. We don't have a lot of data about levels of sexual activity in elders, however, and data that are available often don't take into account all elder populations, such as residents in nursing homes, so it is difficult to generalize.

Physically, after age 50, one can expect a general slowing down of sexual responses, but this would not necessitate cessation of all sexual activity. There are, however, some issues that become more prevalent in late life that can negatively impact sexual functioning. One issue is the lack of available partners that significantly limits opportunities for sexual expression, especially for older women. A recent American Association of Retired Persons' [AARP] sexuality survey [Jacoby, 1999] found that 50% of the women surveyed who were between the ages of 60 and 74, and four out of five women age 75 and over, were widowed. This was contrasted with one out of five men age 75 and older who were widowed. An even more poignant fact in this survey was that many of the women without partners also reported being deprived of intimate kisses and hugs. You can see that lack of a partner can significantly limit sexual expression.

Another issue is that, as people age, there is a greater incidence of illness and progression of chronic diseases that can negatively impact sexual functioning. Many of the pharmacological treatments for these medical problems carry side effects that can also have a negative impact. This is very significant when we keep in mind that, as a group, the elderly are the largest consumers of prescription and nonprescription medications.

Some of the medical problems that might have a large impact on sexuality are diabetes, hypothyroidism, neuropathy, cardiovascular disease, urinary tract infections, prostate cancer, incontinence, arthritis, depression, dementia, chronic alcohol(Drug information on alcohol)ism and heavy smoking.

Medications known to have side effects that may contribute to erectile dysfunction include some antihypertensives, antidepressants, diuretics, steroids, anticonvulsants, ß-blockers, estrogens(Drug information on estrogens), opiates and others. We have less research on the impact of medications on women's sexual functioning, but studies have shown that antidepressants can inhibit orgasm, and some antihypertensives, anticholinergics and antihistamines have been found to negatively impact sexual functioning in women.

There are also a number of psychosocial issues that can impact sexual activity in later years, including changes in roles and finances after retirement; anxiety and depression related to age-associated losses and transitions; and personal, religious and moral beliefs regarding one's sexuality in late life.