Feature ArticleSexuality and Quality of Life in Aging: Implications for Practice
Section snippets
Literature Review
Lindau et al,1 in a study published in the New England Journal of Medicine, reported on a survey of 3005 respondents ages 57-85 who were queried as to prevalence of sexual activity, behaviors, and problems. The prevalence of sexual activity in this sample was 74.8%. Reported sexual activity declined with age; it was 73% for 57- to 64-year-olds, 53% for those 65-74 years old, and 26% for those 75-85 years old. Women were much less likely to report being sexually active than men. Half of the
The Effect of Aging Changes on Sexuality
For most people, age-related changes begin in midlife (around age 45) and increase over time. The physiological changes are multifactorial and can be related to diminished blood flow and hormonal and neurologic changes. In men, testosterone and estrogen levels start to decrease just about the same time that women experience menopause and a concomitant decrease in circulating androgens and estrogen.6 This decrease in hormones affects muscle strength, integument, bone mass, and inflammatory
Sexual Health Inquiry in Primary Care
Health care practitioners are mandated to obtain a complete health history from patients—both yearly and when a new patient presents to the practice. The health history includes a thorough review of systems, including a comprehensive sexual and reproductive history. Younger women are most likely to be asked about safer sex practices, menstrual cycles, last normal menstrual period, dysfunctional vaginal bleeding, abnormal discharge, number of sexual partners/preferences, obstetrical history,
Senior Sex: Recommendations for Men
Because erectile dysfunction (ED) is associated with medication side effects, diabetes, coronary artery disease, and other disorders, male patients should be routinely screened for ED in the primary care setting to determine potential causes. Although testosterone replacement is indicated for men with primary or secondary hypogonadism and documented low testosterone levels, it is not indicated for men with normal testosterone levels.12 According to the American Urological Association (AUA),
Senior Sex: Recommendations for Women
Women's problems with sexuality as they age are also both physical and psychological. The occurrence of sexual dysfunction in all women has been estimated at 25%-63%.17 Ambler et al,17 in a review of the literature on sexual function in older women, noted the paucity of studies and reported that the prevalence of sexual dysfunction may be as high as 68%-86.5%. These authors provide an extensive discussion of the possible physical and psychological factors contributing to these estimates. The
Sexually Transmitted Diseases in Older Adults
It is essential that NPs counsel older sexually active women and men that age is not a barrier to sexually transmitted infections, including human immunodeficiency virus (HIV)/AIDS. Surprisingly, the incidence of sexually transmitted diseases, including HIV/AIDS, is growing faster among people over the age of 50 than any other age group.31 The Centers for Disease Control and Prevention (CDC)32 in the US estimated that 24% of AIDS infections in the US in 2011 occurred in people aged 50 years and
Summary
The first step in improving sexual health for older adults is recognizing that sexuality is an important consideration for many elders. From an NP perspective, the most critical aspect to consider in optimizing the sexual health of the older patient is to ask about it. Applying Hillman's theoretical perspectives can guide the NP clinician in assessing sexuality from a holistic perspective18 (ie, looking at biological, psychological, social, cultural factors, environmental, and institutional
Terry Mahan Buttaro, PhD, APRN, is an assistant clinical professor at the University of Massachusetts College of Nursing and Health Sciences in Boston, MA, and can be reached at [email protected].
References (37)
- et al.
How important is sex in later life? The views of older people
Soc Sci Med
(2003) - et al.
The changing age of HIV: sexual risk among older African American women living in rural communities
Prev Med
(2004) Sexual function and the older woman
Clin Geriatr Med
(2003)- et al.
A national study of sexuality and health among older adults in the U.S
N Engl J Med
(2007) - et al.
Sexual behavior in later life
J Aging Health
(2007) - et al.
The Normal Bar
(2013) - et al.
Sexuality in older adults: behaviours and preferences
Age Ageing
(2005) - et al.
The role of androgens and estrogens on healthy aging and longevity
J Gerontol A Biol Sci Med Sci
(2012) Screening for Cervical Cancer: U.S. Preventive Services Task Force Recommendation Statement
(2012)- Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline....
Sexuality in older age: essential considerations for healthcare professionals
Age Ageing
Nurses' knowledge and attitudes towards aged sexuality: validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale
J Adv Nurs
Hormonal testing and pharmacologic treatment of erectile dysfunction: a clinical practice guideline from the American College of Physicians
Ann Intern Med
Increased risk of non-fatal myocardial infarction following testosterone therapy prescription in men
PLoS One
Association of testosterone therapy with mortality, myocardial infarction, and stroke in men with low testosterone levels
J Am Med Assoc
Yohimbine in the treatment of orgasmic dysfunction
Asian J Androl
Cited by (11)
Top 10 Pitfalls to Avoid When Caring for the Older Adult: Part II
2020, Journal of Emergency NursingCitation Excerpt :Symptoms of a urinary tract infection, abdominal pain, unusual rash, or joint pain must include a differential diagnosis of sexually transmitted infection, the incidence of which has increased by 23% in older adults compared with 11% for the rest of the population over the last 4 years.14 Older adults may not share information about their sexual activities unless one specifically asks, and oftentimes, providers are hesitant to ask.14,15 A second consideration is related to the use of phosphodiesterase-5 inhibitors (PDEi-5s).
Rethinking the Well Woman Visit: A Scoping Review to Identify Eight Priority Areas for Well Woman Care in the Era of the Affordable Care Act
2016, Women's Health IssuesCitation Excerpt :The WWV is also an important venue for preconception care regarding the ways to best promote fertility and a healthy pregnancy when a woman wants to conceive (Cooksey, Bellanca, & Stranger-Hunter, 2014; Donnelly, Foster, & Thompson, 2014; Gavin et al., 2014; Halpern, Lopez, Grimes, Stockton, Gallo, 2013; Lopez, Tolley, Grimes, Chen, & Stockton, 2013; Paterno & Jordan, 2012). In addition, the WWV is an opportunity to educate about sexual health in general as well as regarding STI prevention (Buttaro, Koeniger-Donohue, Hawkins, & Mahan, 2014; Moyer & USPSTS, 2013b; O'Connor et al., 2014). Screening for STIs and intimate partner violence (IPV) or reproductive and sexual coercion should also be considered depending on a woman's age and risk factors (ACOG, 2013; Paterno & Jordan, 2012).
Women and Positive Aging: An International Perspective
2016, Women and Positive Aging: An International PerspectiveWhen Allie Forgot Noah: Perspectives of Healthy Partner Considerations in Cases of Dementia
2020, American Journal of Family TherapyEnhancement of Hong Kong Nursing Students’ Knowledge and Attitudes Regarding Sexuality in Older Adults
2020, International Journal of Sexual Health
Terry Mahan Buttaro, PhD, APRN, is an assistant clinical professor at the University of Massachusetts College of Nursing and Health Sciences in Boston, MA, and can be reached at [email protected].
Rebecca Koeniger-Donohue, PhD, APRN, is a professor of nursing practice at Simmons College School of Nursing and Health Studies in Boston, MA.
Joellen Hawkins, PhD, RNC, is professor emeritus at Boston College and writer-in-residence at Simmons College School of Nursing and Health Sciences.
Readers may receive 0.83 continuing education contact hours, including 0.27 contact hours of pharmacology credit, approved by the American Association of Nurse Practitioners, by reading this article and completing the online posttest and evaluation at https://cecenter.aanp.org/Program?area=JNP.
In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.