Seniors and Sex: Elder Care Facilities Attempt to Tackle Taboos

Seniors are having sex.

More than a quarter of adults aged 75-85 and over half of adults aged 65-74 are sexually active, according to statistics from the New England Journal of Medicine.

A healthy sex life is important for all adults, and becomes even more essential as a person gets older, according to Robin Dessel, director of memory and vision care for Hebrew Home at Riverdale, a continuing care center in Riverdale, NY. "Loneliness is one of the foremost reasons of depression in the elderly," she says. "We experience a greater need for camaraderie, intimacy and touch as we age."

But sexually active seniors aren't often offered enough educational or emotional support from the elder care facilities where they live or society in general. Dessel points out that the premium placed on youth is extremely detrimental to senior sex lives. "Society as a whole is the number one enemy to sex and seniors," she says.

Further complicating matters is the reality that more and more aging adults are living with, and being cared for, by younger family members.

Who among us would volunteer to sit down to discuss, "the birds and the bees: version 2.0," with mom and dad?

Shying away from the tricky topic of sex can create problems—especially when it comes to older adults. While recent generations have been inundated with educational messages on how to practice, "safe sex," few seniors had access to such knowledge when they were younger.

This is leading to some disturbing statistics.

The prevalence of sexually transmitted diseases in people 45 and over has doubled over the past decade, according to the Centers for Disease Control and Prevention (CDC). The highest concentration of these outbreaks occur in the so-called Sunbelt states (Alabama, Arizona, Florida, Georgia and Texas, to name a few) where many seniors go to retire.

Sexual expression as an aspect of holistic care

As more and more baby boomers enter in to elder care facilities, sex will become an increasingly prevalent issue. The aging of a massive generation that was raised on free love and infused with the principles of Woodstock will make it all but impossible to sweep the sexual activity of elders under the rug.

Indeed, the senior sex debate was recently re-ignited due to rumors of prostitutes being hired to attend to the sexual needs of elderly residents in European nursing homes. The facilities in question respond to their detractors by arguing that helping a senior safely and legally express themselves sexually is an essential facet of providing holistic care—a philosophy which focuses on treating the whole person, rather than a collection of symptoms, according to Francine Lederer, Ph.D., clinical psychologist and life transitions specialist.

Prostitution is illegal in the United States, but assisted living facilities and nursing homes have made changes over time, attempting to shed their bad reputations by adopting a more holistic approach to senior care.

Many are beginning to argue that a truly well-rounded care philosophy means taking into account a senior's right to sexual expression, something often overlooked among the aging adult population.

"Right at the heart and soul of the holistic care model are sexual rights," says Dessel. "You carry along your need for sexuality and intimacy as you age, they don't get abandoned when you turn 60 or 70."

Senior living facilities are faced with the daunting task of how to help a senior to experience the intimacy they desire in a safe, healthy way.

Making senior living safely sexy

Senior care facilities are charged, first and foremost, with attending to the clinical needs of older adults—their diet, their medication regimen, their rehabilitation routine. The primary concerns of families searching for an assisted living community or nursing home for their loved ones typically revolve around what levels of care a community can provide, how well-trained their staff is and what social activities they offer.

Adding the issue of sex into the mix definitely makes things more complicated. 

Lederer says that in order to ensure a safe (and private) sex environment for residents and their partners, communities must keep lines of communication open between staff, a senior and their family members. Steps should also be taken to educate sexually active elders about safe sex practices.

Allowing a person to appropriately exercise their right to sexual expression, while still safeguarding the physical and mental health of everyone involved (the senior, their family, and the care staff) is a tricky tightrope to walk. It's a constantly-evolving balancing act that can pit family members against the care staff as well as one another.

Even Hebrew Home, which began its sexual rights program back in the early 1990s, is constantly reexamining and tweaking their policies regarding sex among their elderly residents.

There are certainly challenges and obstacles introducing sexual rights and practices into facilities, Dessel admits. But she says, "The older adult's voice is what is foremost, that trumps everything we do." This is an approach that can be uncomfortable for well-meaning family members.

It's not that families don't want the best for their aging loved ones—quite the opposite. Family caregivers want to protect their parents and spouses, and so they take a paternalistic approach. Out of concern for their loved one's safety, they say "no" to sex instead of exploring all of the possibilities.

This is especially true when Alzheimer's or some of the form of dementia comes into play.

How much sexual freedom should a cognitively-impaired elder be allowed to exercise? Is a person with severe memory loss truly capable of engaging in consensual sexual activity? What happens when an Alzheimer's stricken person is married, but starts to develop amorous feelings for a person who is not their spouse?

There are no easy answers to these complex questions. The only way to work through these issues, according to both Dessel and Lederer, is to engage in an ongoing dialogue, both on an individual basis and industry-wide.

"You experience loss as you age, but the essence of who you are remains," says Dessel. "There's still life to be lived and sexuality is a part of life. It shouldn't be just bedpans and call bells."

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