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Oakland University, ude. For many individuals, involvement in casual sexual activities begins during adolescence Manning, Longmore, and Giordano

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Print this Close window. Learn how to help your older patients down a safe PATH involving advocacy, communication, and education on topics related to sexuality and intimacy.

Young adult casual sexual behavior: life course specific motivations and consequences

How do we define sexuality? Regardless of whether we're young or old, it's an integral part of who we are. Sexuality is a combination of the emotional, psychological, social, and spiritual makeup of an individual. It influences our thoughts, feelings, actions, and interactions and, therefore, our mental and physical health.

Sexuality also encompasses gender identity; sexual orientation; and social norms as they affect physical, emotional, and spiritual life. Next to sleeping and eating, sexuality is one of the most important drives that we encounter as humans.

We're involved in a lifelong learning process about our sexuality. The right to sexual expression exists across the lifespan and should be supported. The expression of sexuality and desire for intimacy is complex, no less so for an older adult than a teenager.

The expression of intimate and sexual behaviors also directly links to health and quality of life throughout our lifetime, making it an integral part of health as we age. Many health benefits are linked to sexual expression, including increased relaxation, improved cardiovascular health, lower levels of depression, decreased pain sensitivity, increased self-esteem, and better relationships.

More important, older adults who remain interested in a sexual relationship and intimacy with a partner find this to be an important source of well-being.

As older adults age, they may shift their ideas of sexuality to include more intimate behaviors, such as kissing, touching, and hugging, redefining sexual relationships to emotional intimacy. Medicare eligibility begins at age 65 or older. Social Security benefits can be received beginning at age The U. Census Bureau predicts that by the yearthere will be Whether someone is young-old age 65 to 74middle-old age 75 to 84or old-old age 85 and upsexuality is a natural part of what makes us human. Today, broad assumptions about aging, including intimacy and sexuality in later life, are being challenged.

It's increasingly clear from the most recent research that the desire for sexual contact and closeness can last for a lifetime, yet older adult sexuality is often ignored.

Older adults still crave sex, intimacy

Existing research on the sexual activity of older adults lacks adequate descriptions of who the older adult is, particularly across cultural and ethnic groups, as well as across economic and educational status. The current research is generalized and limited.

Sex and intimacy shouldn't be ignored, especially because people are living healthier and longer lives. Many older adults remain physically active and even old-old adults engage in intimate and sexual relationships. According to a survey conducted by AARP insex and intimacy are still an important part of the older adult's life, with the majority of interviewees indicating that sex is actually critical for a good relationship and important to their quality of life.


Unfortunately, nurses are often unsure of the sexual needs and desires of older adults. Healthcare professionals may manifest conventional beliefs and behaviors, such as thinking that older adults are asexual, and worry about discussing sexuality with the older adult because of embarrassment and lack of knowledge.

If we understand the issues concerning sexuality and aging, and challenge our own views on sexuality, we can assist the older adult to reach a satisfying level of sexual expression and intimacy. The shift in attitudes about sexuality and aging, combined with advances in medicine that prolong a sexually active life, has led to the challenge of meeting the unique needs of older adults who want to stay sexually active.

Rates of sexually transmitted infections STIssuch as chlamydia, gonorrhea, and syphilis, have doubled for people in their 50s, 60s, and 70s in the last 10 years. On the other hand, the promotion of safe sex practices among older adults is practically nonexistent.

According to the CDC, there were reported cases of syphilis in individuals age 45 to 65 in ; inthere were more than 2, reported.

The of older people with HIV nearly doubled in those 10 years. In fact, the of new HIV infections is actually growing faster in individuals over age 50 than those age 40 and younger. Researchers indicate that it's hard to know just why STI rates are on the rise among older adults because there has been so little research on their sex lives.

Some primary care providers surmise that erectile dysfunction ED drugs and biologic changes as women age may be responsible for the rise in STIs among this population. Easily attainable prescriptions for ED allow men to have intercourse at older ages than before.

And postmenopausal changes to the vagina make older women more vulnerable to infections. During menopause, estrogen levels are reduced. As estrogen decreases, it alters the thickness of the female reproductive organs, including loss of elasticity, thinning of the vaginal tissue, and decreased lubrication easily fixed by using a water-based lubricant. A AARP survey found that longer lives and more divorces may be leading older adults to have more sex partners than in years past. The older adult generation's view of condoms and safe sex may also be less well informed than younger adults at present.

Some older adults may never have used a condom. Others may think condoms are old-fashioned; they may not be informed about how condoms have changed, their availability, or how to use them. Older adult women don't worry about getting pregnant because they're postmenopausal and they may be more eager to please their partners.

Health education campaigns promote safe sex for teens and young adults, but they rarely target older adults. It's a common assumption that STIs only happen to young people; however, the older adult is just as vulnerable.

Age doesn't protect a person from STIs. Strategies aimed at STI prevention include adequate health assessment, comprehensive screening, early treatment, education, and reeducation for both the patient and his or her partner. As impossible as it is to classify young and middle-aged people into one standard of behavior or level of health literacy, it's equally impossible to generalize when dealing with older adults. It's vital to remember that patients are people first before identifying them as a particular age or cultural group.

Then we must investigate how patients' behaviors and values are shaped by variables of age, race, cultural identity, life experience, and sexual expression. To do this, we must understand our own beliefs and attitudes about sexuality and intimacy in older adult patients, and examine the barriers that may be preventing us from providing optimal care to these individuals. Many nurses admit to feeling uncomfortable discussing sex with their older adult patients. Some fear that discussing sexuality with an older patient can be viewed as an invasion of privacy. And even nurses have biases because just as our patients are products of a specific upbringing, culture, and belief system, so are we.

For example, if a nurse's religious belief is that sexual activity is only for the purpose of procreation, he or she may experience a conflict when addressing the needs of the older adult-heterosexual or lesbian, gay, bisexual, or transgender LGBT -whose views allow for sexual pleasure. Although there are healthcare providers who are uncomfortable discussing sex with older patients, older adults may be just as uncomfortable talking about sex with their healthcare providers.

Questions such as: "I'm old enough to be his grandmother, what will he think of me? Older adults may be uncomfortable sharing information regarding sexual orientation due to fear of being shunned by the healthcare provider. An individual's health status may affect the ability to have sexual intercourse.

For example, diabetes can lead to ED in men and decreased vaginal lubrication in women. If this information isn't presented, the older adult may not know that these are common effects of the disease. Medications, such as antidepressants, diuretics, and beta-blockers, may negatively affect a person's ability to have sex.

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Older adults may find certain sexual positions more comfortable than others. For example, if an older adult is experiencing chronic pain from osteoporosis or osteoarthritis, then a side-lying position may decrease discomfort for both partners. Education is key; however, the healthcare provider needs to be comfortable sharing information first and not necessarily wait to be asked. Does your older patient wish to discuss sex and sexuality or is he or she too uncomfortable to address the issue?

Begin your assessment with a clear definition of the concepts. How does the patient define sex? What's the patient's past medical history? What acute or chronic illnesses are present? Are there comorbidities that prohibit sex?

What medications is the patient taking both prescription and over-the-counter?

Letters to the editor

Is his or her environment conducive to a sexual encounter? If an older adult lives in a family member's home, he or she may not be comfortable having a partner spend the night. What if the patient lives in an assisted living or long-term-care facility?

How do other family members, especially adult children, feel about the patient having sex? Based on your assessment, you can develop a care plan. What are reasonable short-term and long-term goals? Does the care plan need to be revised to allow the older adult to have sex safely?

Characteristics of sexually healthy adults

For example, can medications be changed that may decrease the chance of orthostatic hypotension during sexual intercourse? Is your patient in need of education about STIs? Men may still need to be educated about the risk of pregnancy in a younger partner.