Sexuality and the Older Adult: An Overview with Guidelines for the Health Care Professional

Research emphasis in sexuality and aging has progressed beyond earlier questions of whether sex exists and whether sexual capacity is maintained as one ages. Clinical research is thus moving into the practical realm of (1) educating health care professionals who work with, and must deal with the sexual issues of older adults, and (2) addressing neglected areas such as widowhood sexuality and homosexuality. This paper provides a current overview, along with guidelines for program development within the area of sexuality and aging. It is emphasized that any educational or therapeutic intervention should reflect a respect for the continuity of one's sexual lifestyle, and a readiness to explore alternative methods of meeting sexual and affectional needs of older adults who remain interested in their sexuality but who are disabled, without partners, or find themselves in a restricted environment.     

Sexuality and HIV/AIDS: An Exploration of Older Heterosexual Women's Knowledge Levels

Sexuality research tends to ignore older populations, and little is known about older women's sexual health knowledge. To fill this research gap, 186 Canadian heterosexual women 50 years and older were surveyed about their knowledge regarding sexuality and HIV/AIDS. Respondents had moderate levels of overall knowledge of sexual health and aging, correctly answering, on average, 60% of the 35 questions. They had lower levels of HIV/AIDS knowledge, correctly answering just over 50% of the 25 questions. Results indicate the need for social awareness and education in this group regarding both general sexual health later in life and HIV/AIDS.     

Forever young: Visual representations of gender and age in online dating sites for older adults

ABSTRACT

Online dating has become increasingly popular among older adults following broader social media adoption patterns. The current study examined the visual representations of people on 39 dating sites intended for the older population, with a particular focus on the visualization of the intersection between age and gender. All 39 dating sites for older adults were located through the Google search engine. Visual thematic analysis was performed with reference to general, non-age-related signs (e.g., facial expression, skin color), signs of aging (e.g., perceived age, wrinkles), relational features (e.g., proximity between individuals), and additional features such as number of people presented. The visual analysis in the present study revealed a clear intersection between ageism and sexism in the presentation of older adults. The majority of men and women were smiling and had a fair complexion, with light eye color and perceived age of younger than 60. Older women were presented as younger and wore more cosmetics as compared with older men. The present study stresses the social regulation of sexuality, as only heterosexual couples were presented. The narrow representation of older adults and the anti-aging messages portrayed in the pictures convey that love, intimacy, and sexual activity are for older adults who are “forever young.”     

Cognitive Functioning and Aging in Women

SUMMARY

Deficits in cognitive function may impact one's ability to attend to stimuli, think clearly, reason, and remember. Impaired cognitive function is a common complaint among older women presenting for treatment in both mental health and medical care settings, and differential diagnosis of type and extent of cognitive impairment is important for appropriate treatment planning and prognosis. Although overall gender differences in prevalence of cognitive dysfunction are minimal, it is important when treating older women to take into account unique challenges they face in the aging process that impact the cause, type and extent of cognitive complaints with which they present in clinical settings. The current paper provides an overview to guide accurate diagnosis, particularly in women, of different types of cognitive impairment under the broad category of dementias, including Alzheimer's, Lewy Body Disease, Vascular Dementia, and due to general medical conditions such as coronary artery bypass surgery, head injury, menopause, hypothyroidism, breast cancer treatment, Fibromyalgia, and chronic fatigue. In addition, emotional factors such as depression in older female patients complicate differential diagnosis of cognitive impairment and must be addressed. Given the multiplicity of causes of cognitive difficulties for women across the life span, careful assessment is crucial; the current paper reviews assessment strategies to prepare an integrated, biopsychosocial strategy for identifying particular cognitive deficits and related psychological and medical problems. In addition, prognostic indicators and treatment planning are discussed to help the practitioner organize an empathic, reasoned and multifaceted treatment approach to maximize recovery, minimize deterioration, and manage symptoms for older women in the context of their social support system and living environment.     

Influence of Family,Religion, and Social Conformity on Client Participation in Sexual Reorientation Therapy

This study examined the likelihood of participating in sexual reorientation therapy (SRT) based on actual or expected family reactions to the disclosure of one's same-sex sexuality, religious fundamentalism, social conformity, and several demographic variables. A sample of 52 SRT participants and 211 SRT nonparticipants who had ever identified as gay, lesbian, or bisexual completed a survey either online or in hardcopy format. Actual or expected negative family reactions, high religious fundamentalism, and identifying as spiritual significantly increased one's odds of participating in SRT. The findings are essential for preparing practitioners in any clinical practice setting to work with clients struggling with their sexuality.     

Regrets in Later Life

ABSTRACT

With the various options of life choices in the American culture and the great opportunity for choosing one's own path in life, there is also great opportunity for regretting paths taken and not taken. Information on regrets in later life was collected both qualitatively and quantitatively through interviews and mailed questionnaires from 140 retired individuals. Regret was measured using the Life Revision Index (LRI) (DeGenova, 1992) and the Regrets Self Inventory (Klein & Gotti, 1992). Both men and women reported they wish they would have pursued more education, but women had significantly higher regrets in this area. In general, the desire to have spent more time understanding the self and developing the mind and intellect was especially evident among women.     

Homosexual Experience,Desire and Identity Among Young Adults

ABSTRACT

Is young people's sexuality becoming more fluid and less tied to steady, stable identity patterns? Are we developing into a society where sexual relationships between individuals of the same sex are no longer reserved for the small minority of gay men and lesbian women? Adherents of so-called queer theory have promulgated such views. Using a population-based sample of young adults (aged 19 to 26, N 2753), we investigated homosexual experiences, desire and identity. We found that levels of prevalence of homosexuality were primarily a function of the criteria we used. Using the most restricted (“narrow”) definitions, we found that about one percent of both genders reported “exclusive” homosexual interest and identity. Using the most inclusive criteria, we found that one of ten young men and one of four young women reported having some homosexual experience, interest or identity. Still, the most striking finding involved the substantial gender-specific differences: homoerotic activity and interest are far more interwoven with heterosexual activity for women. There are strong indications that homosexuality is a lot more threatening and potentially in conflict with traditional male gender roles than we find to be the case for women. In other words, while there may be signs of more fluid sexual identity categories, this phenomenon primarily applies to women.     

Posttraumatic Stress Disorder and Older Women

SUMMARY

This article examines the literature related to the identification and treatment of posttraumatic stress disorder in older women. From this review, several key findings emerge. Consistent in the research literature is the fact that American women are more at risk for PTSD than are men as a result of the high frequency of sexual and domestic physical abuse that women experience. Studies on older women and PTSD indicate that older women are under-diagnosed and are more typically perceived as suffering from depression, anxiety or poor physical health. It was found consistently that older women who present with age-related stressors may not be asked about earlier trauma history or it may not be understood within the context of trauma-related variables. In several research studies, trauma history was often not identified either as a result of current assessment practice or because women from certain age cohorts did not disclose trauma-related data to health professionals. Key researchers emphasize the necessity of clinicians, staff and medical personnel to attend to the historical variables present in trauma histories of older women. Researchers underscore the importance of understanding the impact of early and repeated trauma, especially interpersonal trauma, on the physical health and social functioning of older women–even though a significant amount of time may have elapsed since exposure. These findings indicate that further study of PTSD in older women is warranted. The paper concludes with a discussion of assessment and treatment options.     

Introduction: the need to address older women's mental health issues

Women are the primary consumers of mental health services. Ironically, research addressing their unique needs lags behind that of men's issues. The aging process introduces an important variable that accentuates the relative lack of information and specific treatment guidelines for older women who are confronted by mental health problems. This volume offers a comprehensive overview for the health professional who is seeking a greater depth of understanding with respect to the study of mental health problems in general, and how these issues pertain specifically to women and the aging process. A second goal of this project is to provide the practicing therapist and counselor with a research update and a broad clinical perspective offered by seasoned clinicians. Using current psychiatric diagnosis as a framework, the contributions address the range of mental health problems, including dementia and cognitive impairment, schizophrenia, alcohol abuse, mood and anxiety disorders, traumatic and dissociative conditions, sexual and eating disorders, and personality disorders. It is hoped that this book will inform, inspire and encourage students and health professionals in their work with middle aged and older women who are facing mental health challenges.     

Sexual health-related training of Canadian midwives and its association with practice outcome

BackgroundAlthough promoting sexual health should be an integral part of midwifery practice, little is known about midwives’ preparation to address their clients’ sexual health concerns.AimsTo assess the formal and self-directed training on sexual health topics relevant to midwifery practice of Canadian midwives as well as the association between training and various practice outcomes.MethodsForty midwives registered in the Province of Ontario, Canada completed an online survey assessing their formal and self-directed sexual health training, knowledge, comfort, and practice related to 10 sexual health issues.FindingsIn terms of formal training, three of the 10 topics were coved in-depth and seven were covered in general terms only or not at all. Participants had received an average of 26.0 hours of formal training related to sexual health. Almost all (90%) participants had engaged in self-directed learning on at least one topic. Participants had asked at least one client about only 5 of the 10 topics and been asked by at least one client about 4.5 of them. Participants who reported more extensive formal training had been asked about more sexual health topics by their clients. More self-directed learning was associated with more positive attitudes toward midwives’ role in addressing sexual health concerns, feeling more knowledgeable, and being asked about and asking about more sexual health topics.ConclusionThe midwives in this sample had limited training in some important sexual health issues relevant to midwifery practice. Likely as a result, they often did not address these issues in practice.     

Older Women and the Health Care System: A Time for Change

SUMMARY

In spite of women's active involvement in a woman's health care movement, the mainline health care system continues to hold tight to its androcentric focus. If women are to be subjected to a health care system that employs sexist and ageist practices, the quality of life in their later years will continue to be jeopardized. The purpose of this paper is to first, recognize the existing health care practices which limit the health care opportunities and choices of older women; and secondly, to discuss how such basic feminist principles as education, egalitarianism, empowerment, and inclusion can be used to improve an older woman's experience.     

Chronic Pain and Older Women:

Drawing upon the available research literature, this article highlights the research and practice issues that must be addressed if we are to be responsive to the chronic health problems, and subsequent pain, that often codront individuals as they age. This list should by no means be 'seen as exhaustive, but rather as a starting point from which to further our understanding of chronic pain in the lives of older women.     

Promoting Older Women's Health and Well-Being Through Social Leisure Environments: What We Have Learned from the Red Hat Society®

ABSTRACT

The purpose of this study was to describe the ways that participation in a leisure organization contributed to the health and well-being of middle-aged and older women. We analyzed 1,693 members' responses to a query about meaningful experiences garnered through participation in the Red Hat Society®. Results suggested that older women's lives have been enriched and changed by their experiences, with the women in this study citing multiple psychosocial health benefits from their participation in the Red Hat Society®. Main themes encapsulating these health benefits were creating happy moments, responding to transitions and negative events, and enhancing the self. These findings are related to research on positive psychology, social support and coping, transformative leisure processes, and social identity formation. We conclude by providing suggestions for applying these findings to leisure and health promotion programming to enhance women's health and well-being in later life.     

Older Women's Body Image and Embodied Experience: An Exploration

ABSTRACT

This paper presents and analyzes findings from unstructured interviews with women aged 61 to 92 regarding their perceptions and feelings about their aging bodies. The data are discussed in light of the existing literature on women's body image which has largely ignored the experiences of women in later life and which has tended to focus on adolescent and middle-aged women. Given the fact that beauty is equated with youthfulness and thinness in our society, older women face unique challenges as they strive to construct and maintain positive evaluations of self. The women in the study exhibit the internalization of ageist beauty norms even as they assert that health is more important to them than physical attractiveness and comment on the ‘naturalness’ of the aging process.     

Reasons for women's non-participation in follow-up screening after gestational diabetes

BackgroundDue to the increased risk of type 2 diabetes, follow-up screening after birth is recommended to women with previous gestational diabetes. Low participation in such screening has been shown to delay detection of diabetes with potentially serious consequences for the women's future health. The women's experiences of treatment and care during their pregnancies may affect participation.AimThis study aimed at understanding the women's experiences with treatment and care during pregnancy and to understand how these experiences influence participation in follow-up screening.MethodsA qualitative study was undertaken drawing on a phenomenological methodology. Seven women treated for gestational diabetes at a university hospital in the North Denmark Region participated in interviews.FindingsThe women experienced lack of continuity in care between hospital departments and health sectors. We identified the following causes for low participation in follow-up screening: poor coordination, little elaboration of information, a lack of clear coordination of responsibility for follow-up screening among health care professionals and absence of focus and inclusion of their individual needs and preferences.ConclusionThe women wished to be reminded of screening to increase their sense of safety. The women's experiences seem to reflect a lack of patient-centeredness during the pregnancy, which may be remedied by increasing the focus on the women's need for improved continuity in treatment and care. Participation in follow-up screening after gestational diabetes may be increased by sending reminders to the women. Raised awareness of the women's individual needs and preferences for treatment and care offers potential for improvement.     

The Influence of the Built Environment and Other Factors on the Physical Activity of Older Women from Different Ethnic Communities

ABSTRACT

Inactivity has been identified as a major contributor to the burden of disease in older women. Study aims were: (a) to assess the personal, social, and environmental facilitators and impediments to physical activity in older women from ethnic communities; and (b) to determine the factors associated with physical activity participation. Older women (aged 60–84 years) were recruited from the local Italian (n = 20), Vietnamese (n = 26) and Anglo-Celtic (n = 26) communities. A survey questionnaire was administered in the participants' preferred language. The most common barriers were: “I am not in good health,” “I am self-conscious about my looks,” “I am too tired,” “I don't have time,” and “The weather is bad.” When comparing the ethnic groups, the Vietnamese women reported fewer barriers than the Italian women (2.6 vs. 5.9). While the Vietnamese women were much more likely to report being “self-conscious about my looks,” the Italian women more commonly reported poor health, being too tired, and not liking exercise as barriers. Overall, those living alone were more likely to be active and those who reported fear of injury, less active. Recognizing ethnospecific differences in the prevalence of barriers may be important when devising strategies to increase activity levels of older women.