Challenging the Sex Taboo

One of the privileges – and challenges – of doing my job – is being invited to speak at a range of events and conferences. Yesterday I was taking part in a seminar in —– East Dunbartonshire —– Health and Social Care Partnership on ‘Capacity,
Sex & Relationships.’ I was asked to reflect on the issue of older people’s sexuality in care settings.

My preparation for the seminar highlighted for me the relative dearth of literature and academic study on what is one of the most fundamental parts of what constitutes our identity and what it means to be human. There are some good pieces of work not least from Alzheimer Scotland, the Terence Higgins Trust etc. but not a lot.

This might be because there are still massive social taboos around the issue of older people and sexual expression. Its almost as if older people and sex is for our age ‘the love that dare not speak its name.’ But people are living longer and healthier lives and why should sexual expression end when we reach a particular age, almost as if our sexual selves have a use-by date attached.

But pervasive negative attitudes serve to consolidate the taboo. People consciously and unconsciously suggest that sex is unimportant to older individuals; that it is somehow abnormal for older people to be interested in sex; that older people have no desire for intimacy; that older persons are not physically attractive and are not desirable. And of course the endemic cultural presumption is that sex is for the young and fit.

Nevertheless for many individuals sexual expression remains an important part of their quality of life. According to a 2013 Saga survey, 71 per cent of over 50s reported having a healthy sex life. Such expression is a basic human right.

Some 18 months ago Taylor-Jane Flynn and Alan Gow, professor of psychology at Heriot-Watt University in Edinburgh, carried out research on sexuality and older Scots which was published in the journal Age and Ageing. They interviewed and spoke to 133 Scottish adults aged 65 and over. Half of these lived with a spouse or partner.

What they discovered was that between 75 and 89 percent said they’d engaged in kissing, hugging and holding hands or touching. Men and women scored about the same for frequency and importance of sexual behaviours overall, and for quality of life.

Participants reporting more frequent sexual behaviour rated their social relationships as higher quality, while people who found sexual activity to be important had higher scores for psychological quality of life.

Critically they found that older adults who value sexual activity and engage in it have better social lives and psychological well-being.

So if that is a given there are clear challenges and implications for providers of care and support and for those who work in supporting older individuals.

So how important is sexual expression within the care sector?

There are obvious challenges not least with individuals with declining and reduced capacity and physical abilities in ensuring that there is a balance between protection and safety on the one hand, and enabling expression on the other. But beyond this – and there are good guides already available to help staff work with individuals who might have dementia and portray disinhibited behaviour or language – beyond that are we doing enough?
Are we able in care homes, for instance, to create places and spaces for people to be intimate and private?

Do we manage well those situations where the wishes of family members might not be the wishes of an individual resident who desires to form a new relationship?

Do we train and resource our workforce in such a way that they have confidence in dealing with what can be a challenging issue and to do so in a manner which is non-discriminatory and respectful of individual rights?

Is the regulatory framework and work of scrutiny too restrictive in this area?

Do we commission in such a way which would enable the provision of facilities to enable couples to live together or someone to initiate or form a relationship whilst in a care setting?

Do our services have sexuality policies whether in the community or in a residential location?

Do we properly understand issues of consent and capacity in the sexual relationships of the old?

Are we aware of the growing issue of sexually transmitted diseases amongst our older population, in and out of care environments?

All of us who support and work with those who are older need to not only start challenging the conspiracy of silence which surrounds this issue but proactively to start working to address some of the challenges I have just outlined.

Donald Macaskill

@DrDMacaskill