Our ageist attitudes toward sex in old age impede quality of life and the detection and prevention of elder sexual abuse.
As the 77 million baby boomers who brought us the sexual revolution inexorably age, they will face a striking paradox. The ignorance, prejudice, and silence about sex and sexuality they fought so hard to upend are still alive and well in old age. We are a people reluctant to contemplate sex and aging together in the same thought, and even more reluctant to speak of it. Yet experience and emerging evidence indicate that such reticence can have significant implications for the health, rights, safety, and well-being of the large and growing older population in ways that are just becoming clear.
In May 2011, in a colloquium sponsored by The Harry & Jeanette Weinberg Center for Elder Abuse Prevention, the Roosevelt House Public Policy Institute at Hunter College served as an historic backdrop for a daylong discussion about sex and aging, examining the subject across a spectrum-as a health, human rights, social service, criminal justice, victim assistance, and ethical issue. That horizontal analysis revealed a "perfect storm" of ageism and squeamishness about sex, resulting in a deficit of understanding and a pervasive silence about the issues that attend sexuality and aging. Consider the following examples:
* Healthcare providers infrequently offer information to or ask older patients about sex or sexuality, thereby overlooking critical health-related data in taking histories, and missing opportunities to address issues that could enhance their patients' health, safety, and well-being.
* When sexual abuse is alleged or suspected, responders rarely ask the right questions or take necessary and appropriate steps to assist victims, preserve evidence, or comply with reporting requirements. When reports are made and investigated, few cases result in prosecution, even when compelling evidence of sexual assault exists.
* Physical intimacy is rarely recognized as a core individual right that does not diminish with old age.
* The complex medical, legal, social, ethical, and practical issues that arise at the intersection of aging and incapacity-particularly cognitive incapacity-are rarely addressed, leaving practitioners and families experiencing them with little meaningful guidance or support.
This article examines how our ageism-fueled reluctance to talk about-or even acknowledge-sex, the desire for physical intimacy, sexual identity, and sexual assault in aging can undermine the health, safety, and well-being of older people. We urgently need more data and study on these topics. In the short term, we already know enough to take some relatively simple steps that could yield meaningful change.
Sexuality and Health in Aging
Mark Lachs, M.D., co-chief, Division of Geriatrics and Gerontology, Weill Cornell Medical College, routinely asks his patients about their sexual health because "in the course of asking, I believe I'm educating people that it's okay to talk about sex.... You have this sense that people are going to be frightened when you raise the issues, but...the responses are more like 'Wow, this person thinks I'm a human being who is actually sexually active' " (Lachs, 2011). Notwithstanding research showing that sex remains an important part of life for most older people, and is strongly correlated with health (Lindau et al., 2007), Lachs is in a stark minority. Most physicians never raise the issue.
Study yields dramatic data
In the largest ever study on sex and aging, researchers interviewed 3,005 communitydwelling people, ages 57 to 85 (1,550 women and 1,455 men), about their sexual practices, assessed their health status, and examined the correlation between the two (Lindau et al., 2007). The findings were dramatic: people who rated their health as "very good to excellent" were more likely to be sexually active than those who reported their health to be "poor or fair" (Lindau et al. …