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Addressing Ageism in Elderly Sexuality
by Jennifer Hillman, Ph.D.
Learning Objectives
- Learn the risk factors and health issues of HIV for the elderly.
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Learn the practitioner’s role in addressing sexuality with elderly clients.
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Understand the reality of sexual attitudes and diseases in the elderly population.
One out of every six Americans
will be over the age of 65 by the year 2020. As a result of our country’s
aging demographics, it is only a matter of time before the substantial
need for clinical expertise in elderly sexuality becomes apparent. However,
the extent to which practitioners are prepared to deal with this issue
is unclear; many have never received formal or informal education in
elderly sexuality. Due to recent changes in our knowledge base regarding
elderly sexuality, clinicians working with any older adult patients
in their practice should seek continuing education through focused readings
or formal programs.
An overarching theme in
recent literature is that clinicians must not ascribe to the pervasive
societal stereotype of older adults as helpless, passive, asexual beings.
A wealth of studies suggest that many men can and do engage in sexual
intercourse well into their 80’s and 90’s; that elderly women tend to
continue to enjoy satisfying sexual relations in their later years if
they enjoyed them in their younger years; and, that the majority of
older adults are healthy, non-depressed members of the community and
society.
In contrast to these glowing
reports, however, other recent findings suggest that up to one third
of older women experience pain during intercourse and do not understand
why or how to treat it (Bachmann, 1995), and that impotence, the most
common cause of sexual dissatisfaction among older men, may affect up
to 50% of that population (National Institutes on Health, 1993). Older
men and
women, who take significantly more prescription and over the- counter
medications than their younger counterparts, are at increased risk for
sexual problems due to adverse drug reactions, including loss of libido,
incontinence and impotence. However, it is unclear to what extent physicians
and other health care providers are cognizant of the potential side
effects of the medications they prescribe.
Most alarming of all is
the rapid increase of AIDS cases among older adults, with heterosexual
activity the primary mode of transmission among older adult women. Recent
studies suggest that mental health care professionals, as well as physicians
and nurses, have limited knowledge of certain aspects of elderly sexuality,
including information about HIV among older adults (e.g., Hillman, 1998).
Unfortunately, clinicians can no longer regard HIV and AIDS as a disease
of youth and young adulthood. According to the Centers for Disease Control,
more than 11 percent of all new AIDS cases in the U.S. occur among men
and women over the age of 50, with more than 7 percent of those cases
reported among adults over the age of 60.
Throughout most of the last
decade, the number of new AIDS cases increased at a faster rate among
older adults than among teenagers, and more elderly adults have died
of AIDS than soldiers have died in the Vietnam War. AIDS now represents
the 15th leading cause of death among the elderly in the U.S. Specific
areas of the country in which older adults have increased in number,
such as Florida, California, and Arizona, also report substantial increases
in AIDS cases among older adults. In Palm Beach County, Florida, for
example, approximately one half of all new AIDS cases are among adults
aged 50 and over.
Ageism exists when health
care providers fail to ask, or even consider, whether an older adult
patient is at risk for HIV infection. The oldest person to have a documented
case of AIDS was an 88 year-old white widow; she is believed to have
contracted the AIDS virus through sex with her husband, a secretive
recreational IV drug user (Rosenzweig & Fillit, 1992). What is particularly
disturbing is that the woman was a widow for more than 7 years before
her health care providers made the correct diagnosis.
To make an accurate diagnosis
regarding HIV status among older adult patients (as well as to assess
any sexual disturbances or problems), it is vital that practitioners
ask candidly and directly about a variety of issues including: sexual
history (including extramarital and multiple partners); current sexual
behavior (including vaginal, oral, and anal intercourse); potential
IV drug use; sharing of needles for insulin; use of blood transfusions
or blood products for hemophilia (especially before 1985); caregiving
activities for children or grandchildren with AIDS; and current or prior
sexual assault. It is also vital to assess changes in mental status
including apathy and confusion: the first, neurological symptoms of
HIV infection in older adults (i.e., HIV Associated Dementia Complex)
are often misdiagnosed as Alzheimer’s disease or vascular dementia,
or dismissed entirely as a "normal part of aging". (Also see Hillman
& Stricker, 1998 for a review.)
As practitioners, we cannot
assume that our elderly patients are free from any form of sexual discomfort
or dysfunction, including the risk factors associated with HIV infection.
The potentially negative countertransference associated with asking
elderly patients about their sexual activity and sexual history is well
worth the effort if it reveals an underlying, untreated problem. At
worst, our older adult patients will learn that psychotherapy provides
them with an open forum for any topic. Thus, practitioners should be
encouraged to talk with their elderly patients about sexuality (regardless
of how it is defined), to remain up-to-date regarding the sexual side
effects of various prescription medications, to learn about elderly
sexuality through continued interest and study, and to remain vigilant
about the impact of pervasive, societal stereotypes about elderly sexuality
upon our patients and our own performance as clinicians.
REFERENCES:
Bachmann, G. A. (1995).
Influence of Menopause on Sexuality. International Journal of Fertility,
40, 16-22.
Hillman, J. L. (1998). Health
Care Providers Knowledge about HIV-induced Dementia Among Older Adults.
Sexuality and Disability, 16, 181-192.
Hillman, J. L., & Stricker,
G. (1998). Some Issues in the Assessment of HIV Among Older Adults.
Psychotherapy, 35, 483-489.
National Institutes on Health.
(1993). NIH Consensus Development Panel on Impotence. Journal of the
American Medical Association, 270, 83-90.
Rosenzweig R., & Fillit,
H. (1992). Probable Heterosexual Transmission of AIDS in an Aged Woman.
Journal of the American
Geriatrics Society, 40, 1261-1264.
AUTHOR
Assistant Professor of Psychology,
PA State University, Berks-Lehigh Valley College; Published "Clinical
Perspectives on Elderly Sexuality" by Kluwer Academic/ Plenum Publishing.
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