Sex and intimacy in older age

Sex and intimacy in older age-a man and a women, both older in age, are holding hands
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An expert from Texas A&M Center for Population Health and Aging discusses health concerns and stigmas associated with sex and intimacy for older adults.

Episode Transcript

Mary Leigh Meyer:       From allergies to zinc deficiencies, hangry to hay fever, we provide easy-to-absorb information to improve your health. It Sounds Like Health on Texas A&M Health Talk.

Mary Leigh Meyer:       Howdy, everybody. Welcome to another episode of Sounds Like Health. My name is Mary Leigh Meyer.

Sam Craft:                    I’m her co-host, Sam Craft.

Mary Leigh Meyer:       We are here today with Dr. Matthew Lee Smith from the Texas A&M School of Public Health. Thank you for joining us.

Matthew Lee Smith:     My pleasure. Happy to be here.

Mary Leigh Meyer:       Tell us a little bit about who you are and what you do.

Matthew Lee Smith:     Absolutely. I am the co-director of the Texas A&M Center for Population Health and Aging. I am also on faculty at the School of Public Health, as you mentioned. I am a researcher and evaluator of many evidence-based programs and policies and strategies associated with older adults. We do a lot of programs and interventions so that older adults can live a high-quality life.

Mary Leigh Meyer:       I think that’s so interesting, the idea of an evidence-based program. Can you tell everybody a little bit about what that is?

Matthew Lee Smith:     Certainly. An evidence-based program is an intervention or a program where older adults will come to, and it is shown to be effective. These programs have been highly researched. They’re very structured. They have a manual. They have a curriculum. They have training guidelines. They’ve been published in scientific peer reviewed journals, which really documents that evidence so that over time and space you would be able to get the exact same program whether you were in Texas, you were in Delaware, you were in New York. It would be the exact same program.

Mary Leigh Meyer:       I just think it’s crazy that a lot of community programs like that aren’t necessarily evidence-based, and so it kind of just surprises me.

Matthew Lee Smith:     Absolutely. There are so many evidence-based programs. I’ve had the great fortune to serve on a national evaluation team for these evidence-based programs for older adults, be them fall prevention, chronic disease self-management, physical activity, malnutrition awareness. There are those on caregiving, stress management, so many of these different suites of programs that are very, very beneficial for people.

Sam Craft:                    In addition to the evidence-based programs you talked about, what do you study over at SPH?

Matthew Lee Smith:     A lot of what we do is in terms of older adult health. We look at the whole person, and we try to understand a little bit about what they do to protect themselves to prevent disease, prevent the ramifications of disease, prevent negative consequences from their conditions, or just the natural parts of aging such as fall prevention, but really helping them to better manage what they can, so better manage their lifestyle, make healthier choices, and have access to the resources they need so they can do that.

Sam Craft:                    I think part of that is every, like every other natural human, sex and intimacy. Older age is part of that, right?

Matthew Lee Smith:     There is a large misconception that older adults do not have sex, that they do not want to have sex, and that they cannot have sex. I will tell you that all three of those misconceptions are incorrect. I do realize that not everybody wants to sit around and think about their parents or grandparents or great-grandparents having sex, but the reality is it is happening, and it is a natural part of life. Every human is a sexual being in some way, shape or form, and that’s quite all right. Just because you’ve gotten over a certain age doesn’t mean that those thoughts and those desires have stopped.

Sam Craft:                    Well, I guess for the person that that’s happening to, the older age person that’s there is—to them, this is just life. Nothing has changed. It’s the people looking outside looking in that are like, “This is taboo. This is weird. No, Grandpa. That’s gross. Don’t talk about that.”

Mary Leigh Meyer:       Well, and I think the topic in general more than just in the older adult population is somewhat taboo just across society, regardless of your age.

Matthew Lee Smith:     You’re absolutely right. So many times this behavior, sex and intimacy, is stigmatized, and we have these certain stereotypes that we hold, especially of older adults. But generally, even though we like to think that we talk very openly about sex, a lot of times we don’t. We pass judgment onto others based on their preferences, their behaviors, the partners they choose, and unfortunately, that’s very stigmatizing, right? That’s very hindering of what a person wants, because if their desires are going to make them happy, then let them fulfill those desires as long as they don’t hurt themselves, they don’t hurt others and it’s totally consensual.

Mary Leigh Meyer:       They need these conversations to happen so they know those three things.

Matthew Lee Smith:     You’re exactly right. Now, one of the important things to think about is that over a person’s life course, they do change. As a person gets older, there are things about them that do change. Maybe their sexual drive, their sexual function might diminish, but it doesn’t necessarily go away. There’s a lot of reasons those change. But at the same time, that person is changing in many, many different ways. Maybe they’ve been in a partnered relationship, they’ve been married, and their spouse has died, or they’ve gotten divorced, so in older age, widowhood. Now they’re back on the dating scene. They’re back on the market potentially, if that’s what they want to do. A lot of times, this person has been working, and now they’re transitioning into retirement, or maybe they’re now in an empty nest at home, or maybe they’re assuming a caregiving role.

Matthew Lee Smith:     All of these things start to change, not only the amount of free time they have, but the people they interact with. Just like a middle school kid going into high school, now all of a sudden you’ve got all these new kids to play with and new kids to meet. All of the sudden, new social groups start to form. Naturally, with that, for people who are looking for relationships or intimacy, really start to find that, whether they just be in your local community setting or whether they be in assisted living communities or anywhere, for that matter. But a very important point to make is that even though we talk about sexuality and sex, everyone seems to focus on the behavior itself. The reality is it’s more than merely the physical act of sex. Intimacy, companionship, these are the concepts that individuals want, and they’re very important in all stages of life.

Matthew Lee Smith:     Just because you get to a certain age doesn’t mean you don’t have that desire to be intimate, and it doesn’t have to be in a sexual manner. It might just be sitting on a couch next to somebody holding hands, engaging in a very enriching conversation, having someone connect with you and really be able to support you and give you what you want, because, again, maybe sex isn’t necessarily what you’re looking for. With older adults, oftentimes that can be the case. Oftentimes, again, if someone’s been in a coupled relationship and they’re now widowed, it doesn’t necessarily mean that they have to find a new boyfriend, girlfriend, partner. They just need that intimacy, that companionship, somebody to show them that they are important and that they do have these feelings and validate those feelings.

Sam Craft:                    Just being a human being, just wanting all those things out of life that you’ve wanted all your life, and then all of a sudden you don’t have them, speaking of a widow situation…

Mary Leigh Meyer:       I bet that’s hard, especially if they have children as their caretakers. How do you have that discussion with your child that you’re struggling with this part of you? I just can’t imagine.

Sam Craft:                    Yeah. That’s got to be a tough conversation. Yeah.

Mary Leigh Meyer:       It’s a much bigger conversation than I expected walking in the door today.

Sam Craft:                    Well, yeah, you brought a good point, that intimacy is so much more than just than just sex or what people assume it to be. It’s all those other things that you described. I didn’t think of it like that.

Matthew Lee Smith:     Well, the thing is that sex itself can be very healthy, and it actually is an indicator of those who are among the most healthy, because when you think about the blood flow and the things that occur when you get sexually aroused, it’s an engorgement of blood for males and females. Therefore, with those who have cardiovascular disease, those who are on certain medications, et cetera, you can imagine that that functional aspect maybe is hindered or diminished a little bit, et cetera. With that said, even though a person can engage in these behaviors, it’s not as if they’re—just because they can engage in those behaviors doesn’t mean that they always can when they prefer or to the degree that they prefer or with the frequency that they prefer. With that said, we really need to think about what a person wants, what their preferences are.

Matthew Lee Smith:     Unfortunately, a lot of times when older adults have interactions with their adult children, we start to treat our parents like they’re children again, telling them what they can do, what they shouldn’t do, and they almost revert back to a childhood stage. That’s not fair. These are grown adults. As long as they’re cognitively capable and they’re not hurting anybody in terms of monogamy, polygamy, et cetera, and that’s all their preferences, then we should support them. But what we need to know is, “What does that older adult really think about with their wants and desires, and how is it that they can express those desires to their adult children, to their partner, so that we can have a very fulfilling relationship so that one person doesn’t have a set of expectations and the other person has a totally separate set?” Therefore, they need to match so that we can have a very healthy and supporting relationship, an exchange of intimacy and sexual behavior and pleasure, however that’s defined, but also that communication with health care providers.

Matthew Lee Smith:     Unfortunately, the conversations with health care providers don’t always occur as frequently as we need them to. The main reason for that is because a lot of times, there’s a sense of uncomfort. People are uncomfortable talking about sex with older adults. A lot of times, clinicians have not necessarily been trained to have these conversations, or they come into an appointment and their chief complaint or the reason for that appointment is not sexual activity. It’s actually because of their diabetes, their arthritis, any other of their health conditions.

Mary Leigh Meyer:       Yeah. I can see how that could kind of get pushed aside, just the topic of it.

Sam Craft:                    I feel like it’s one of those, “Oh doctor,” on your way out kind of conversations that we have. You definitely don’t tell a nurse. You wait until the doctor gets halfway out the door and you’re like, “Maybe I should just mention this.”

Matthew Lee Smith:     I think, again, one of the hardest things to that conversation is really understanding, “In what depth do we need to have this conversation?” As a clinician, all I would want to know, and I am not a clinician by the way, but what I would want to know is, “What is it that you’re wanting to engage in, and how can I make sure that you’re doing so in a safe way?” You need to be able to listen. You need to be able to not pass judgment but listen. Once you hear and understand, go ahead and try to make those recommendations. For example, we all know for males that there can be certain types of dysfunction, and there are now these medications that make those dysfunctions less noticeable or you can overcome them, right, so that we have erectile dysfunction pills.

Matthew Lee Smith:     Well, with that said, there are certain medications that those interact with, which you should not be taking them or they can cause risk. With that said, there needs to be an open communication about what you want to achieve in terms of your intimacy, your sexual health, so that then that clinician can help you meet that goal. But the other thing being is that just because a male goes in and talks to his physician and wants to get that pill, maybe they should talk to the partner as well and make sure that that partner wants them to have that pill because—

Sam Craft:                    So that everybody’s on the same page.

Matthew Lee Smith:     That’s exactly right. That communication is so key. How can I get what I want out of life and what I want out of a relationship if I can’t tell and communicate that with the people who need to know about it, my partners, my clinicians, my adult children so that they understand and when I do bring it up, that they don’t just slap me down and pass judgment and suppress my feelings and my desires?

Mary Leigh Meyer:       I also think about the possibility for STD/STI transmission too in older adults because they’re a lot of times post-menopausal, and I bet if you use the phrase birth control, that implies it’s about birth control.

Sam Craft:                    That’s pretty much birth control at that point.

Mary Leigh Meyer:       Yeah.

Matthew Lee Smith:     You bring up a great point. STDs, sexually transmitted diseases, and STIs, sexually transmitted infections, oftentimes interchangeable. We oftentimes talk about STIs, so that bigger range of different conditions that can fall in there. We oftentimes know that sexual activity can be risky, and there’s a lot of reasons where. In the news you’ve probably seen older adults are getting sexually transmitted infections at a larger rate than ever before. It’s usually happening in these residential communities and these groups. That, as I described earlier, you have a lot of people who are now coming to a community, living within proximity, having some life changes in terms of their relationship status, their work status, their family status, their wants, desires, et cetera. Well, with that said, you now have also a gender disparity. Women live longer than men. Therefore as we get into older age, there are fewer and fewer men relative to females.

Matthew Lee Smith:     For heterosexual populations and those homosexual male populations, basically there is a gender gap where there’s not enough partners that it would be a one-to-one relationship. As individuals age, and now you see that there’s fewer men, more females, and those males aren’t necessarily functionally performing in the same way, when they find a viable male, they are willing to engage in that activity, and they’re willing to share that male. Oftentimes, love triangles, love hexagons, love whatever shape you can come up with starts to emerge because oftentimes this happens. Well, the problem is this. You’re right. Pregnancy is not a concern for this age group, but also if they’ve been in a committed relationship, a marriage, partnered, whatever it is for the last 50 years, when was the last time they used a condom, if ever? The last time they got a sexually transmitted infection or even thought about it, it was something that could be very easily cured with a shot of penicillin.

Matthew Lee Smith:     There’s also some issues with manual dexterity, of arthritis and other things, of actually vision, that manual dexterity of applying a condom. A lot of times, that’s not even a thought. There’s also a stigma of buying condoms at that age because now the clerk is going to pass judgment. Then of course there’s the non-negotiation of, “We don’t even talk about it. It’s just the way we’re doing this.” Maybe these two couples haven’t even talked about it, or these two individuals. What we end up having now is that if a sexually transmitted infection, an STI, is brought into this circle, it’s not just about the two people. It can be about the three people, the four people, the six people, and oftentimes, those triangles or hexagons overlap. Now what you actually start to see is a bit of an epidemic spread.

Mary Leigh Meyer:       The idea of a nursing home kind of reminds me of a college dorm. The circles live together pretty much.

Sam Craft:                    They’re just layers at that point. They’re not circles. Just layers of people.

Mary Leigh Meyer:       Yes.

Matthew Lee Smith:     That’s not to say that all of these older adults are engaging in these fun shapes.

Sam Craft:                    Well, yeah, but I don’t know if people don’t realize that this is—

Mary Leigh Meyer:       No, my grandparents wouldn’t.

Sam Craft:                    —a thing. A lot of people don’t realize that this is a problem or this is happening.

Matthew Lee Smith:     It shouldn’t be so surprising. It really should not be so surprising. I think anybody who’s been out with their parents, with their grandparents, or anything else, they can still say, “Well, that’s a handsome young man.” Why are they not a sexual being? They still—

Sam Craft:                    No, they’re still a human.

Matthew Lee Smith:     That’s exactly right. Unfortunately, we now have put the idea that they should not be doing something in our minds because we’re uncomfortable with it. They’re actually very comfortable with it. But the reality is, much like anything else, if I’m in a situation, I want to listen. I first want to know myself. If I don’t know myself and what I want, how am I supposed to find a partner who’s going to give me that? With self-reflection and understanding what you want, is it physical, is it mental, emotional, is it other types of support? What do you want out of this lifestyle of yours? Then, of course, to find another person so that you can convey that to them and do so in an open and healthy way, because that’s only going to be the most maximized pleasure or maximum support intimacy that you can get is if express it and they’re willing to listen. Then after that, it’s not a negotiation. It’s a plan and trial and error and exploration and experimentation, and on your mark, get set, go.

Sam Craft:                    Well, it just sounds like any other relationship in life. We’re talking about the thing that I think everybody wants to have in a relationship, most people. Again, it’s the taboo factor of it being elder in age or in life, and it’s just such a stigma to some people.

Mary Leigh Meyer:       Yeah. I think what you said earlier hits the nail on the head, about how the older somebody gets, the more people tend to treat them almost as children.

Sam Craft:                    Like the Benjamin Button effect.

Mary Leigh Meyer:       You lose the autonomy to drive yourself places. Your children start to come with you to all your appointments.

Matthew Lee Smith:     As the older adult ages, not only does their social structure possibly change and their interactions with others, but their bodies are changing. Now all of the sudden, in addition to what everyone else experiences in a traditional relationship at any given age, we now have body image issues, where people aren’t necessarily wanting to just get naked in front of anyone or they just want to get naked in front of everyone. But at the same time, there might be physical functioning issues or other health-related issues that make people self-conscious, and that they might actually have these types of desires, but they need to be very open with others to understand that, “This is who I am and this is where we’re going to be with this, so either you’re okay with it and we can work with this or not.” We’ve already seen that folks with physical limitations and functional limitations actually engage in more sexual activity and intimacy in their older ages if they have more understanding partners and better communication skills.

Mary Leigh Meyer:       Do you have any advice for adult children when they need to talk to their parents about this type of stuff?

Matthew Lee Smith:     I think there are a lot of recommendations that I can give to older adults and their children because, remember, that conversation doesn’t have to start from the adult child or the older adult. It’s whenever it needs to come up. The older adult can start that conversation, or the adult child can start that conversation, whoever wants to. But the key is, is that you need to acknowledge, “Hey, I’m not a physician, I’m not a clinician, but I’m just going to talk to you because you’re my parent. I love you. I want you to be healthy. I want you to be safe.”

Mary Leigh Meyer:       Yeah. They’re people.

Matthew Lee Smith:     With that said, what you can truly do is be very understanding and clear about what they are saying to you. If they are expressing something to you, then that’s what their want is, that’s what their desire is. It’s not your time to pass judgment. It’s not your time to go ahead and say, “That’s not right. Do you know what I would do?” That’s not your time. Be mindful, listen to them, and after you listen to them, clarify and confirm that you understood what they said. Then if there’s any indication of risk, make sure that we certainly try to prevent that risk, whether it be in terms of physical harm, cognitive coercions. There’s so many different ways. Sexually transmitted infections.

Matthew Lee Smith:     We need to make sure that they’re safe. After they’re safe, and we’re pretty sure of that, and we can only do what we can, encourage them and check back in on them. Just because you’ve had that conversation once and then they’ve gone about their lives in their assisted living community doesn’t necessarily mean that the conversation’s over. This should be a conversation that is ongoing and one that will change as their romantic interests change or as their levels of intimacy and feelings and desires change, because that can change over time as well. Remember, it is not just the act of sex. Intimacy, connectivity, that emotional connection is so very important in all ages but especially among older adults.

Mary Leigh Meyer:       That’s why you have to listen and then hear what they’re saying to you, because you can’t just think it’s the physical problem or the social problem because it’s a combination. But before we wrap up, are there any last thoughts?

Matthew Lee Smith:     When we think about sexuality and sexual behavior and intimacy among older adults, in our changing society, we can’t ignore technology. Technology can be something that is very protective but also very risky for this population. With that said, we know there’s a lot of apps out there, and everyone has a smartphone in their pocket. With that said, a lot of older adults craving intimacy or some sort of relationship can find it in an easier way than they once were able to. However, there’s also now a lot of opportunities for scams and basically mistreatment or abuse in that same way. We’ve all heard about the catfishing or just somehow manipulating somebody. While technology is fantastic and can certainly play into this equation, we need to be mindful, not regulate their use of these products, but have an open communication so that they understand what these apps do, and when they meet someone for the first time that they don’t know what should they do and what’s safe and unsafe about them.

Mary Leigh Meyer:       We’ve all heard about those scams that specifically pray on the older adult population. Do you?

Matthew Lee Smith:     There are many of them, a lot of them financial in nature. Older adults certainly need to be trained and educated and consumers of that safety behavior because it is a changing world out there. Technology has made this big world of ours very small.

Mary Leigh Meyer:       Okay. Well, Dr. Smith, thank you for coming on the show.

Matthew Lee Smith:     My pleasure, and I appreciate you having me on.

Mary Leigh Meyer:       Of course. Everybody, thank you for listening. This has been another episode of Sounds Like Health.

Tim Schnettler:            Thank you for joining us on Texas A&M Health Talk, a production of the Texas A&M University Health Science Center. Visit us on the web at vitalrecord.tamhsc.edu, where you’ll find answers to all of your health questions. Until next time, stay healthy.