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I.  Older People and Sex: 

You may have read about Abraham Maslow in other courses but I think the theory warrants a review here since sexuality is very much related to life satisfaction. Sex is considered, by Abraham Maslow,to be one of our most basic human needs.  The link below is taken from the Sociology of Aging lecture and will enhance your understanding of this week's materials.  Please review it before proceeding.

Abraham Maslow's Theory

"Sexual expression can be seen as a quality of life issue. Once survival needs are fulfilled, for example, for food and shelter, the needs for intimate relationships and feelings of being loved are vital. In fact, studies show that babies who are deprived of physical touch and emotional stimulation suffer serious gaps in emotional and physical development." Just put in the key terms babies, touch and study into any search engine to see all the work done on this topic.

The need for intimacy does not change in old age. In fact, the desire for intimacy can intensify. As people lose their partners or peers they become attracted to others (remember a person’s self-concept remains intact by taking part in activities that mimic the activities of middle age). Relationships develop and sexual feelings may become activated. For many people, these feelings are a gift and bring a sense of pleasure and a feeling of being alive".

Quoted from: Porter, Lisa and Douglas Holmes: Staff Educational Manual: Resident Sexuality In The Nursing Home,National Alzheimer Center of The Hebrew Home for the Aged At Riverdale, 2005.

Yet, our views of older people and sex are often shaped by societal myths and stereotypes. These myths have created sexual invisibility of older adults. 

It's a Fairy Godmother joke

Two statues, one of an old  man and the other of an old woman, have been on an old building's entrance, facing each other for more than 100 years.

They are granted the wish of being human for 30 minutes. So they jump down and rush into the bushes. 
The bushes shake, rattle and roll. After a few minutes they come out. 

The Fairy Godmother says, "You still have 10 minutes left." The old couple look at each other, and the man asks, 
"Want to do it again?" The woman says, "Yes, but this time you hold down the pigeon and I'll poop on his head!

 

Why is this joke funny? Would it be as funny if the statues were young Romans aged 19 or 20? Probably not. 

Stereotypes of asexual (no sexual ) behavior in older adults are ageist. These jokes affect older people. For example: older people seldom speak of enjoying sex for fear of ridicule. Women may think their are abnormal if they continue to a enjoy sexual relationship.

        Misinformation about older people and sexuality is passed from one generation to another. Today's older cohorts 
        are more private about their sexual expression than younger cohorts -- can you     
        imagine why?

        Older adults today were raised during a time when sexual expression was not 
        talked about openly. This attitude is left over 
        from repressive Victorian era (remember the  society of women who  
        proposed putting clothes on the legs of tables ?)

Inability to talk openly about sexuality results in little information regarding sexuality,  how to express one's self, or what to  expect in terms of performance in later life.

Masters and Johnson's study (read about Master's and Johnson in your text p.198)  found that women experience more physiological changes (how they work) of sexual organs than men do.

1. The Period of Climacteric (cli-mack-ter-ick) and Menopause
   This time usually begins around the age 40 and is complete in most women by age 55. The time it takes for all of the productive changes to occur differs from woman to woman.

While it is true that the pre-orgasmic phase (the phase where sexual tension is building) is extended in duration. this can actually be a time when a woman can take time to enjoy herself. The pressure to respond quickly is relieved and hugging and closeness can be enhanced.

3. Some physicians believe that the symptoms such as hot flashes and headaches, that accompany the climacteric may be lessened by hormone replacement therapy (also know as HRT) in which women take a low dose of estrogen and progesterone. HRT is now recommended only for a short period of time as it may increase the likelihood of breast cancer.  

Each woman must outweigh the risks based on her family history, lifestyle, and beliefs. Some women are not candidates for HRT because of other medical conditions or family history of certain types of cancers. The forms that estrogen is given include: birth control pills, patches, creams and suppositories.

For a great discussion on menopause from the Mayo clinic visit this site. http://www.mayoclinic.com/health/menopause/DS00119

3.  Physical Changes In Men

Reproductive changes in men are less dramatic. Sperm production declines gradually, but testosterone does not stop completely as estrogen does in women. A man may father children way into old age. At age 80 he may still be half as fertile as he was at age 25.

Most men need more time to get an erection and feel less of an urgency to ejaculate (nice that it correlates with a woman's slowed response). Many find that in older age they have better ejaculatory control. The penis may not be as firm as when younger and most men experience a longer resolution phase during which time an erection is impossible. This resolution phase can last from 12 to 24 hours or more. Most men become flaccid sooner after ejaculation. These changes might allow for more pleasuring time. The pressure to perform can be less if the man and woman are educated about these physiological changes.

1. Special Concerns:

Picture courtesy of http://www.healthsquare.com/pdrfg/pd/chapters/fg4ch07.htm

The prostate gland is often the problem when urinary problems arise in older men. These difficulties are often due to nothing more than prostate enlargement or infection; but cancer is a possibility. Take any urinary irregularity as a signal to visit your doctor or urologist (Health Square.com).

1. The prostate gland is located beneath the bladder and surrounds the urethra.  It may become increased in size and stiffen as a man ages. This may make it more difficult to urinate. 
   
   The  gland's purpose is to create fluid in semen that helps sperm survive in the acidic environment of the vagina. Unless the prostate gland gets infected it is not a serious condition. If it becomes enlarged and blocks urination it is treated by a procedure called a TURP, or trans urethral repair of the prostate. Surgeons insert surgical repair instruments up through the penis .

2. Cancer of the prostate becomes a serious threat during middle age and peaks between ages 60-80. Enlargement of the gland does not cause cancer (we do not know what the cause is); however, enlargement may be misdiagnosed as cancer until further diagnostic tests are done.

3. Pathologies:

Enlargement of the prostate gland for any reason can be misunderstood and stimulate a fear of impotence. There is a fear that  the risk of surgery for any reason might bring permanent dysfunction.

 

Check out this handout- To Your Health, A Prostate Primer- What You Need To Know

Penile implants

Before Viagra, most erection problems were treated with penile implants. They are still used today for nerve damage or other erectile problems when Viagra is not indicated. 

Most implants are inflatable prosthetic devices that have a reservoir, filled with silicone, that is implanted under the abdominal muscles. An inflatable cylinder in the penis can be inflated using a pump that is implanted inside the scrotum. 

A man can compress the pump to fill the cylinders from the reservoir producing a 
penile erection. A small release valve in the lower portion of the pump bulb releases fluid to return the penis to a flaccid state.

If you would like to read more on erectile dysfunction you might start here http://www.healthline.com/health/erectile-dysfunction

 There is even a video broadcast on penile implants. 

Some early studies (1948) measured orgasm and found that there is a gradual decline in sexual interest with age. Problem is that sexual interest was defined as orgasm. As you have seen sexuality is more than  just orgasm. These early sexual studies looked at sexual function in adults. The major problem with these studies is that adults were defined as aged 16-20. In Master and Johnson's study, not many people over the age of 60 were studied.

1. What might be other problems with studies that say there can be a gradual decline in sexual interest with age?
   

2. Studies that show that interest declines with age are not based on any physiological reasons. Why might women researched say they lose interest more than men do? Here are some of the reasons:
   

Another reason for the invisibility of the older adult's sexuality is the uncomfortable feelings of adult children and staff with parents and patients' sexual activity. Were you uncomfortable with the thought of your grandparents or parents being sexual active? 

These attitudes make older people uncomfortable in telling family members about their activities or it reduces their behavior to sneaking and hiding. People often tease and ridicule older adults sexuality and facilities control relationships with other residents. 

Scholars suggest useful guidelines in assessing residents' competencies regarding intimate relationships:

I have heard stories of adults in Florida who keep two apartments side by side so children are not aware that they are living together. Portable telephones make it possible for them to live in one apartment but answer the telephone in another. 

Approaches to Sexuality: Taken from http://www.amda.com/caring/february2002/sex.htm

Several approaches to sexuality in nursing homes have been reported:

Religious & Ethical:
Many nursing homes are operated by religious groups as ministries of service, and many nursing home staff, even in non-sectarian nursing homes, see their work as religiously motivated. They draw support from their beliefs for their sometimes thankless efforts. These staff may approach sexual issues from the standpoint of the moral teachings of their faith or from a general ethical perspective.

Clinical:
Some nursing homes, especially those with academic affiliations, approach sexuality from a clinical standpoint. They seek to understand biological, psychological, and sociological aspects of sexuality. They promote behavioral interventions, and recommend drug treatment when necessary for intractable, disruptive behaviors. The clinical approach to sexuality, including drug therapy, was recently reviewed by Hosam Kamel, MD, of St. Louis University's Division of Geriatric Medicine (Ann Long Term Care 2001;9:64-72).

Advocacy:
Some nursing homes and professionals frame sexuality as a matter of resident rights. They emphasize an approach that seeks to reduce the restrictive effects of institutions and staffs on sexual expression (Kelly WA. Nursing Home Medicine 1995, cited above).

Staff Education:
Most approaches identify a key role for staff knowledge and attitudes, and, thus, rely heavily on staff education. Dr. Kamel's review outlines strategies that can be used by facilities--and reinforced with staff education--to protect the sexual rights of residents. These strategies include such simple practices as always knocking before entering a resident's room. Studies have demonstrated the effectiveness of education on staff's ability to handle sexual behaviors (Steinke EE. Journal of Continuing Education in Nursing 1997;28:59-63).

Want another chuckle: Check out How to Be A Good Wife at the electronic handouts for this week. It was taken from a 1950's high school economics book. 

The vast majority of adults want their love relationships to result in marriage, although Americans are taking longer to get there. The median age of first marriage for adults in the U.S. has been rising for several decades. From 1960 to 1988 the median age for men rose about 3 years (from roughly age 23  to 26 years), and the age for women rose  nearly 4 years (age 20 years  to 24 years). More than 90% of American adults are likely to marry. 

As anyone who has tried it knows, marriage is hard work. Most of us have an intuitive sense that certain factors, such as similarity of interests and values, age of the couple, and so forth, make a difference in the probability that a marriage will succeed. But we may not be aware of other important determinants.

One of the clearest factors for marital success is a basis of similarity of values and interests - this extends across a wide variety of cultures and societies.

A second important factor in enduring marriages is the relative maturity of the two partners at the time they are married. In part, the age issue relates to Erikson's belief that intimacy cannot be achieved until after one's identity is established.

Another reason that marriages may or may not last is the degree of financial security present. Financial difficulties have a negative affect on marriages and increases the likelihood they will end in divorce. 

VIII. DEVELOPMENTAL ISSUES IN MARRIAGE

A. Change

XI. MARITAL SATISFACTION

1. Overall marital satisfaction is highest at the beginning of the marriage, falls until the children begin leaving home, and rises again in later life. This "U" shaped pattern depicts satisfaction at the top of both sides of the "U" shape

                                                                            Level of Marital Satisfaction

1. In its early days marriage is at its most intense. During this honeymoon phase the couple spend considerable time together, usually resulting in high satisfaction.
   
2. As the bliss of the honeymoon phase becomes a monotony, marital satisfaction tends to decline, especially for women. This decline in satisfaction holds for couples of diverse educational, religious, 
   employment, age, and racial backgrounds.
   

1. The most common reason given for this drop is the birth of 
   children. For most couples having children means having 
   substantially less time to devote to the marriage.
   
2. The fact that even childless couples experience a modest decline 
   in marital satisfaction means that the drop is not totally due to 
   having children.

3. By mid-life marital satisfaction hits rock bottom, and some differences between husbands and wives emerge.
   

1. Husbands at all stages of the marriage tend to describe it in 
   positive terms, whereas middle-aged wives tend to be more critical.
   
2. A 1975 study (Lowenthal, Thurnher, & Chiriboga) found that 80% of 
   husbands, but only 40% of wives rated their marriages favorably in 
   mid-life.
   
3. Wives' chief complaint about their husbands was that they were too 
   dependent and "clingy"; interestingly, this difference in feelings is 
   sometimes noted in newlyweds, but it is the husbands who describe their 
   wives in such terms.

4. Marital satisfaction usually begins to rebound, at least temporarily, following the launching of adult children. The improvement is especially noteworthy in women, and it stems partly from the increased financial security after children leave, the relief from the day-to-day duties of parenting, and the additional time that wives have with their husbands.
   
5.  For some middle-aged couples, however, marital satisfaction continues to be low. These couples tend to be ones who have grown apart but who continue to live together. In essence, they have become 
   "emotionally divorced". For these couples more time together is not a welcome change.

2. Overall, marital satisfaction ebbs and flows over time. The pattern of a particular marriage over the years is determined by the nature of the dependency of each spouse on the other.
   

1. When dependence is mutual and about equal the marriage is strong 
   and close.
   
2. When the dependence of one partner is much higher than that of the 
   other however, the marriage is likely to be characterized by stress and 
   conflict.
   
3. Changes in individual lives over adulthood shift the balance of 
   dependence from one partner to the other; for example, one partner may 
   go back to school, become ill, or lose status. Learning how to deal 
   with these changes is the secret to long and happy marriages.

X. LONG-TERM MARRIAGES

A. Researchers know very little about long-term marriages especially from a developmental perspective.

1. One of the only longitudinal studies of long-term marriages was conducted by Weishaus and Field (1988) who followed 17 couples in the Berkeley Studies. These couples had been married between 50 and 69 years and had been interviewed from time to time since their children were born in 1928 and 1929. The 1982-1984 interview revealed the following:

They found these couples fit into four categories:

1. stable-positive marriages, which had maintained moderately high 
   to high levels of satisfaction throughout heir duration.
   
2. stable-neutral marriages, in which couples had never experienced 
   high emotionality or intimacy.
   
3. stable-negative marriages, in which couples had experienced 
   primarily negative emotions throughout.
   
4. curvilinear marriages, which had showed the typical drop in 
   satisfaction in mid-life but which had risen in later life.

Twelve of the 17 marriages showed either the curvilinear or stable-positive patterns.

All of the couples demonstrated shared and separate interests, and all showed commitment to the marriage, and acceptance of each other.

Couples with curvilinear or stable-positive marriages also demonstrated understanding, affection, love, and were uncritical of their mates and their marriages.

These findings point out the importance of a willingness to work at the marital relationship to keep it going. The continued sense of commitment to the relationship and to one's spouse is also key.

XI. Divorce and Re-Parenting

1. Many unions do not survive, ending in desertion, separation, annulment, or divorce. Every social system has some way of ending a relationship; the forms and consequences reflect the values and options of the time and place.
   
2. Just as marriage involves a change in social role and status from "single" to "married", so does the process of divorce .
   

1. This transition involves not only shifting back to a single life again, 
   but also reformulating a range of social ties--the ex-spouse, 
   children, relatives, and  friends.

The END

See you at the discussion board!