Seeking sexual senior

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Abi Taylor, Margot A. It offers an overview of the evidence for healthcare professionals who had not ly considered the sexuality of their older patients. It also describes some of the sexual problems faced by older people, especially the difficulties experienced in disclosing such problems to healthcare professionals.

It examines why healthcare professionals routinely avoid discussing sexual problems with older patients, and how this can be improved. It also offers some recommendations for future research in the area, as well as a word of caution regarding the temptation of over-sexualising the ageing process. The population is ageing and this trend is expected to continue. Therefore, issues affecting older people are becoming increasingly more important.

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Inthe UK Department of Health published The National Service Framework for Older People [ 2 ], setting out a programme of action and reform to address problems in the management of elderly patients. There was, however, no mention of sexuality or the problems older people may face related to sexual issues. Likewise, The National Strategy for Sexual Health and HIV [ 3 ] is primarily aimed at younger people, with no mention of how sexual issues may affect older people.

Research suggests, however, that many older people enjoy an active sex life [ 4 ], although they may face several problems. If healthcare professionals Seeking sexual senior do not accept that older people may enjoy sex, then it is unlikely that sexual problems will be effectively explored, diagnosed and treated. Research into such a deeply personal area is fraught with difficulties including embarrassment in one-to-one interviews, self-reporting biases and poor response rates to postal questionnaires.

As such, there is limited good-quality research into the sex lives of older people. Large, global studies such as one by Nicolosi et al. However, the available research consistently suggests that increasing age is associated with a decreased interest in sex.

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An Italian study [ 7 ] looking at quality of life found ificantly less interest in sex among the older participants—all 38 centenarians had lost interest in sex. It is interesting, however, that the centenarians did report greater satisfaction with life and family relationships than the younger age groups. Gott and Hinchliff [ 8 ] used questionnaires and face-to-face interviews with a smaller sample size in the UK 44 people aged 50—92to investigate how important sex is to older people. Although the s were small, this study did show some interesting findings.

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There are also gender differences, with the greatest difference being in the older age groups [ 9 ] In a study of sexual behaviour in elderly institutionalised patients with dementia, the men nearly always initiated the sexual interactions rather than the women [ 10 ]. Of cases directed towards staff, it was always a male patient towards female staff. Research also suggests that interest in sex among older men has increased over the last 10 years [ 9 ], possibly due to the effective and well-publicised drugs for erectile dysfunction ED starting with Viagra in As well as older age groups having less interest in sex they actually had sex less often and sexual functioning was less [ 4 ].

The survey of Swedish men mentioned above [ 6 ] also looked at sexual function across four domains desire, erection, orgasm and ejaculatory functions and found a decrease in all with increasing age. There are multiple causes for this decrease in sexual interest and frequency of sexual activity. These include general physical health, psychological causes, male or female sexual dysfunction and practical problems. In reality, these combine—sexual desire and function are Seeking sexual senior by a complex interaction between psychological factors and physiological functioning.

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Gott and Hinchliff [ 8 ] suggested that it was not age per se that led to a decrease in the importance placed on sex, but more the health problems experienced by the participant or their partner which led to reprioritising the value placed on sex. Poor physical health as self-reported is associated with decreased interest in sex odds ratio 1. Psychological problems such as depression and its treatment are associated with poor sexual function in all age groups [ 11 ]; however, sexual dysfunction in depressed older people may be less well recognised and less appropriately treated than in younger patients [ 12 ].

This study showed that psychiatrists are less likely to take a sexual history from older patients presenting with depressive symptoms compared with younger patients, and they are also less likely to refer to appropriate services if sexual dysfunction is identified. Of the causes of male sexual dysfunction, ED and hypogonadism are most prevalent, and increase with age [ 13 ]. There are many recognised causes of ED, including medications [ 11 ], prostatic surgery or disease [ 14 ], diabetes [ 41516 ] and vascular disease [ 13 ]. The researchers could not explain this decrease solely by medications or illnesses, suggesting that age may be an independent factor.

The treatments for ED are beyond the scope of this article but include oral phosphodiesterase inhibitors e. Viagra and less commonly intraurethral suppositories, penile injections, vacuum devices and penile prostheses [ 13 ]. Unlike male ED there is some ambiguity over the diagnosis of female sexual dysfunction, which includes decreased desire or arousal, anorgasmia and dyspareunia. As with male sexual dysfunction the diagnosis covers the various ways in which an individual is unable to participate in a sexual relationship that they would wish; however, there is not such objective criteria for the diagnosis of female sexual dysfunction as there is for ED.

Subsequently, there are fewer good-quality trials and treatments for women suffering from sexual problems. It has an effect not only on sexual functioning, but also emotional well-being, interpersonal relationships, body image and Seeking sexual senior activities such as bike riding or prolonged sitting [ 18 ].

One study used focus groups to more carefully assess women's feelings about their symptoms [ 18 ]. Many women were frustrated by what they saw as an inadequacy of treatments for female sexual problems such as dryness, compared with male ED. As noted above, female sexuality in older age is also heavily influenced by psychosocial factors and physical health problems including urinary incontinence, cancers and their medical or surgical treatments [ Seeking sexual senior ].

Practical problems, including lack of a partner or a partner's poor health, are another cause of decreased sexual activity and interest in sex with increasing age [ 8 ]. Another practical problem occurs when elderly people become institutionalised and are unable to have any privacy with their partner [ 10 ]. Seeking treatment for sexual dysfunction is commonly inhibited by embarrassment [ 20 ].

Older people regard GPs as the main source of professional help regarding sexual difficulties [ 21 ]. However, many older people are reluctant to seek help for sexual problems even if they have a severe effect on quality of life [ 1820 ]. A focus group study of women with urogenital atrophy [ 18 ] noted that the reasons for not seeking help earlier were mainly embarrassment, feeling that they were the only one experiencing the symptoms and incorrect beliefs about the aetiology of their symptoms.

Many of these women had also delayed discussions with their partner for the same reasons. This is an interesting issue and probably varies across nations with different healthcare systems. Kaas [ 23 ] coined the term Geriatric Sexuality Breakdown Syndrome to describe the steps involved in internalising societal attitudes towards Seeking sexual senior in older age.

As the stereotype of an asexual old age seems fairly pervasive and ingrained in society it may be beneficial to include information on elderly sexuality in schools during sex education classes [ 24 ], which may allow greater acceptance of sex in older age. HCPs find sex a difficult topic to talk about, and this is compounded when discussing sex with an older person [ 2526 ]. Gott et al.

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Although the GPs recognise that they are the main point of contact for older patients regarding sexual health, they feel undertrained in this area and are not proactive in discussing sexual issues with older patients. Their attitude to discussing sexual health with older people was primarily based on stereotypes and prejudices, rather than what they had personally experienced with patients.

These stereotypes included those relating to the asexuality of older age, and the monogamous and heterosexual nature of older adults in relationships.

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The GPs interviewed did not discuss with older adults the risks of unprotected sex, rationalising their responses by referring to decreased rates although not negligible of sexually transmitted infections among this age group. This mirrors the government policy as noted above whereby The National Sexual Health Strategy and sexual health clinics are aimed at younger people. Some GPs were also concerned about causing offence to older patients by bringing up sexual issues although none could think Seeking sexual senior an occasion where they had caused serious offence by doing so.

Research from the USA [ 27 ] describes how a ificant proportion of physicians may not discuss information about morally controversial issues. If individual physicians do not think it is right for older people to be sexually active then issues may not be discussed at all. Interestingly, the GPs, but not the nurses, were concerned that the professional relationship with elderly patients might be jeopardised by discussions about sexual issues. Doctors treating women with gynaecological cancers do recognise that sexual problems may occur but few discuss these with the women [ 28 ].

Reasons given include embarrassment and lack of knowledge or experience. The patients interviewed by the researchers said they would have liked to have been told about the changes in sexual function they could expect and to have opportunities to ask questions [ 28 ]. An Israeli study [ 10 ] examined the reactions of staff in psychogeriatric care homes to sexualised behaviour among their elderly institutionalised patients with dementia.

The staff were accepting and encouraging of behaviour at the level of love and caring. Behaviour at the level of romance evoked mixed reactions including amusement. Behaviour at the level of eroticism evoked strong feelings of anger and disgust among staff. Although the expression of sexuality is a basic human right, many members of staff found it disturbing.

There are of course also issues surrounding consent in patients with dementia and there must be careful consideration Seeking sexual senior ensure older adults are safeguarded against non-consensual sexual activity. Although it is important to be aware of older people's sexuality, care must be taken not to over-sexualise the ageing process, nor to over-medicalise declining sexual function and interest.

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The heavy involvement of drug companies in the definition of female sexual dysfunction as a medical diagnosis is potentially worrying [ 17 ]. They describe how changing attitudes in the s among geriatricians meant that sexual activity began to be seen as a healthy and even necessary part of successful ageing. Some older women feel that there is too much pressure on them from society to remain interested in sex [ 18 ]. HCPs should screen for sexual dysfunction in their older patients [ 30 ], especially those with chronic diseases, on certain medications, or men presenting with lower urinary tract symptoms [ 14 ].

Seeking sexual senior

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Sexuality and Aging