Study sheds new light on intimate lives of older Americans

A majority of older Americans are sexually active and view intimacy as an important part of life, despite a high rate of “bothersome” sexual problems, according to a new report in the Aug. 23, 2007, issue of The New England Journal of Medicine. The findings come from the National Social Life, Health and Aging Project, research supported by the National Institutes of Health (NIH). The findings shed new light on the intimate social relationships and health of people ages 57 to 85, informing health care providers and patients about sexual norms in the older U.S. population.

The project is the first comprehensive, nationally representative survey to assess the prevalence of sexual activity, behaviors and problems in relation to health status among people in their late 50s and beyond. The study provides information about a number of important aspects of health and sexuality with age, including sexual problems in relation to specific chronic health conditions such as arthritis, diabetes and hypertension; relationships between physical health problems or limitations generally and sexual activity; and physician communication about sexuality at older ages. Physical health, the researchers found, was more strongly associated with many sexual problems than age alone.

The study has implications for health education efforts to prevent sexually transmitted disease in older people. Although data from the Centers for Disease Control and Prevention suggests stability in HIV diagnoses among Americans aged 50 and older, the number of older people diagnosed with AIDS and living with HIV is increasing, as individuals who were infected with HIV at younger ages are living longer before progressing to AIDS. However, sexual activity among older adults poses risks for new cases of HIV, as approximately 15 percent of newly diagnosed HIV infections are among Americans over age 50.

Led by Stacy Tessler Lindau, M.D., who conducted the study with Linda Waite, Ph.D., and others at the University of Chicago, the research was funded primarily by the National Institute on Aging (NIA), a component of NIH. Additional funding came from NIH’s Office of Research on Women’s Health, Office of AIDS Research and Office of Behavioral and Social Sciences Research and from private-sector sources. Data collection was supported by the National Opinion Research Center at the University of Chicago. Georgeanne E. Patmios of NIA’s Behavioral and Social Research Program is program officer for the project.

“Despite the aging of the population, little had been known about the intimate lives of older adults,” said NIA Director Richard J. Hodes, M.D. “This study expands our knowledge by reporting, on a national scale, data about sexual functioning and health among older adults.”

Dr. Lindau expects the study to help open a dialogue between older patients and their doctors as older Americans were very receptive to the survey and its questions. This openness suggests that, when asked, many older people want to talk about this part of their lives. “We found, despite the high prevalence of problems, that most older adults have never discussed sex with a physician. From a medical and a public health perspective, we have an opportunity and an obligation to do better patient education and counseling about health-related and potentially preventable and treatable sexual problems,” Dr. Lindau said.

The researchers gathered information from a nationally representative sample of 3,005 men and women ages 57 to 85 years, asking about each person’s marital or other relationship status, frequency and types of sexual activity during the past 12 months, physical health, and communication with a physician about sex. They also queried sexually active respondents about the presence of sexual problems.

“This study breaks new ground in social and behavioral research,” said Richard Suzman, Ph.D., director of NIA’s Behavioral and Social Research Program. “Its portrait of this aspect of older Americans’ lives suggests a previously uncharacterized vitality and interest in sexuality that carries well into advanced age, which perhaps has not been appreciated as an important part of late life.”

The study found that many older adults are sexually active, but about half of the men and women surveyed reported at least one sexual problem and about a third report at least two problems. Specifically:

-- In general, older adults are sexually active. A large portion of respondents said they were sexually active in the preceding 12 months, but the percentage declined with age—from 73 percent of those age 57 to 64, to 53 percent of those age 65 to 74, to 26 percent of those age 75 to 85. Older women, however, were significantly less likely to report sexual activity than older men and less likely to be in intimate relationships, due in part to women’s status as widows and the earlier mortality, on average, of men.

-- Healthier people are more likely to report being sexually active. Eighty-one percent of men and 51 percent of women reporting excellent or very good health said they had been sexually active in the past 12 months. Of those in fair or poor health, a considerably lower percentage (47 percent of men and 26 percent of women) reported activity in the previous year. Diabetes and hypertension were strongly associated with some sexual concerns.

-- About half of sexually active older adults report at least one “bothersome” sexual problem. Thirty-seven percent of sexually active men said they had erectile difficulties. Women most often reported low desire (43 percent), difficulty with vaginal lubrication (39 percent), and inability to climax (34 percent).

-- Most older adults have not discussed sex with their doctors. Despite the high prevalence of sexual problems, only 38 percent of men and 22 percent of women said they had discussed sex with a physician since age 50.

Reference: Lindau, S.T., et al. A national study of sexuality and health among older adults in the U.S. New England Journal of Medicine (2007), 357(8):762-774.

Source: National Institute on Deafness and Other Communication Disorders