Many, if not most, younger people find the idea of older adults having sex uncomfortable. Even middle-aged people avoid thinking that their parents are still enjoying sexual intimacy. They know it's likely, but they don't like thinking about it. It's their parents for heaven's sake!
This attitude is terribly sad. For most people, physical touch and emotional caring - which underlie good sexual encounters - are needed for true quality of life. Sex for older adults is simply normal.
This topic often brings up discussions about nursing homes and how to handle sexual encounters under group living situations. Education can help normalize the idea that sexual interaction is part of being human, and that extends to older adults, even the very old.
HealthCentral's mission includes educating people across all health conditions, so we asked an expert who has direct experience in how sexual encounters are handled in nursing homes for her insight about this delicate topic.
Susan Hodges, author of "A Breach of Trust," is an advocate for senior citizens navigating the world of geriatric care and assisted living. A retired long-term care administrator and licensed nursing facility administrator, Hodges previously maintained nursing homes in both Stamford, Texas, and Fort Worth, Texas, where she helped facilities face their daily challenges.
Hodges currently serves as president of Hodges Consulting, which works to protect the rights of nursing home residents. HealthCentral previously interviewed Hodges about guardianship issues in the article Elder Abuse: How Seniors And Their Money Can Be Legally Hijacked.
HealthCentral interviewed Hodges on the topic of sex and old age via email. The conversation has been lightly edited for clarity and flow.
HealthCentral: Should couples in nursing homes be given privacy for sexual intimacy whether that just means cuddling naked, actual intercourse, or anything in between?
Hodges: Residents in nursing homes still have the ability to consent to be active sexually. It is a right, and that right must not be taken away or ignored. When it's known that a couple is active, nursing home staff must provide a private place for them. Nursing staff must also provide them with items needed to make their time together not only safe but enjoyable. These items can include condoms, lubricants, soft music, fragrances, and other requests.
HealthCentral: I believe that a number of our readers are slightly surprised by your answer, if for no other reason than they've never thought about it!
Onward to our next question, which is one that is debated among experts: Do you feel that a marriage partner with advanced dementia is actually capable of consenting to sex?
Hodges: A marriage partner with advanced dementia can consent to sex. Persons with advanced dementia demonstrate a desire to be with a partner by using certain movements or actions indicating the desire to have sex. Examples of their expressions are cuddling; stroking a leg, arms, or hair; kissing a cheek; and hugging.
What's important is that the other partner understands what the person with dementia is expressing. If at any time during the encounter, the person with dementia displays any type of negativity, the encounter must stop.
Often, before an encounter begins, appropriate staff have discussed the situation with the resident's partner in a care-plan session. Most of the time the partner is a spouse or a person who has had a sexual relationship with the resident in the past. The actual sexual encounter usually differs from the norm, but the person with dementia still displays a sense of love and satisfaction during and after the encounter. The partner will learn the differences and usually conform to the changes.
HealthCentral: Sex is about more than intercourse. What is generally the most important part of sex for people with dementia, or other older adults for that matter?
Hodges: One needs to understand that the number one desire a (nursing home) resident longs for most (whether or not he or she has dementia) is human touch. Many residents feel that no one wants to touch them, much less hug or caress them.
They, like all of us, want to feel secure in someone's arms, to be kissed, and to feel loved and accepted as a good sexual partner. This gives them a feeling of dignity, belonging, and continuing to experience the human existence.
I have noticed that the residents are not embarrassed by their actions, but, instead, the nursing and other staff feel embarrassed and want to stop residents from any kind of sexual interaction. Training the staff is important to make certain that they understand they are working with people in their bedrooms - their home. Whatever goes on in a staff member's bedroom with their spouse or partner should be also allowed in a resident's bedroom. Staff do have a hard time with this issue, but progress has been made and hopefully will continue.
I have witnessed a couple lying in one bed with their arms wrapped around each other. Both had passed away. Both were nude, and both had frozen smiles on their faces. A very surreal and special event, this makes one not only cry, but gives one peace to know they really loved each other. What a blessing. Wouldn't it be wonderful if we could all go like that?