“They tell you they are going to lay out all the cards, but you find out that all the cards are not face up.” Vince is talking about his interaction with medical providers since his wife was diagnosed with Alzheimer’s. He is referring to the lack of openness about how his and their sexual lives will change as her disease progresses. This lack of openness and information left him feeling isolated, frustrated, and, at times, guilty.

For the elders in long-term facilities, physical expressions may be interpreted as sexual by the caregiver who then reacts with distaste or reprimand. Stereotypes confine our view of the elderly: one is either a “cute (i.e., asexual) old man” or “dirty old man.”

Stanley, a dapper 91-year-old, was admitted to the nursing home. The staff teased about “finding him a girlfriend” but when Stanley touched the staff during care, they decided he had a problem worthy of a staff conference. During the discussion, someone asked if anyone had mentioned this concern to Stanley and the staff responded with surprise, “well, no.” Soon after, Stanley was told the staff had a problem with his touching and his desire for physical contact needed to be addressed differently. He responded, “Okay, I won’t do it,” and there was no more problem. When an elder makes sexual advances toward caregivers, a direct, non-punitive, and caring statement is often all that is needed.

Assumptions that the elderly are not sexual, coupled with the reluctance of many professionals to address sexuality, leave many elders feeling like Vince and Stanley. Sexual references and images abound in our society, but frank and candid discussions are in short supply, especially for elders.

While physical changes of aging influence sexual behavior and responsiveness, research tells us that most older people remain interested in sex. There’s no reason, based on age alone, that individuals cannot enjoy sex throughout life. Research on age-related changes in sexual function is sparse, but generally sexual function in late life correlates with behavior in early years. Individuals with a high sexual interest and activity retain these in older age, although patterns of expression change.

Older individuals grew up in a time when sexual issues and questions were not readily addressed, and they rarely raise the subject of sex. Most older individuals are relieved to be given the opportunity to express their needs and concerns, but many are not provided factual information about the normal changes in sexual response that accompany aging. Ignorance of these changes can lead to anxiety, depression and feelings of inadequacy.

In addition to normal changes in sexual behavior, physical health problems and the disease itself and/or treatment of it can alter sexual function. Certain medications can decrease sexual function, while others can increase sexual interest. The single most common sexual problem for elder adults is lack of an available partner — as a result of a death or an illness that affects physical or cognitive functioning.

The awareness of sexual health as an important component of well being, a source of intimacy and pleasure, no matter the age, is vital for those involved in the care of the elderly. Consider biases and stereotypes. Seek information and counsel from professionals who are open, frank and comfortable in addressing sexual issues.

Updated from an original post in 2010.