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Caregiving Chronicles

News and analysis on caregiving topics in MetroWest and beyond.

Caregiving Chronicles


Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.

Caregiving Chronicles Q&A: Discussing the issues involved in the sexual activity of older adults
By Douglas Flynn / March 12, 2018

Editor’s note: The Caregiving Chronicles blog has partnered with the Natick Visiting Nurse Association to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org. The Natick VNA has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts.  

In this entry, we discuss some of the important issues involving sexual activity of older adults. Providing insight is Juanita Allen Kingsley, Wilderness EMT, who is the Director of Business Development for Natick VNA. 

A health educator, she trains more than 2,000 people in the MetroWest region annually through her First Aid, Wilderness First Aid, CPR and AED classes in addition to the variety of health and safety programs she teaches. She holds a Bachelor of Science degree in Business Administration from Boston University and completed EMT training at Northeastern University. She received her Wilderness EMT training certification through Mountain Aid Training International. 

For more information, visit www.natickvna.org or call 508-651-1786.

Caregiving MetroWest: Discussing topics related to sexual activity can be awkward for anyone, but many find it especially difficult to discuss the subject with a parent or other elder loved ones. What should caregivers know about their loved one’s sexual activity and how can they discuss the subject with them?
Juanita Allen Kingsley:
Even though our bodies and minds age, we can still feel desire. Whether your loved one is single or married, he/she may still want to engage in some level of physical intimacy. My suggestion is to talk about sexuality with your family member with the same openness as you talk about anything else that’s important.

CGMW: What are some of the physical issues or limitations older adults may face in terms of sexual activity?
Certainly as we age, things change. The physical changes that occur with male aging include decreased production of testosterone. This usually stabilizes around age 60, but men may continue to feel the effects on libido, penile sensitivity, and the ability to orgasm as quickly or as often as in the past. Up to half of older men experience sexual problems related to enlargement of the prostate, and medications can play a role in arousal and orgasm as well. It is important to have a physical exam to learn whether any of these or other medical issues are affecting sexual enjoyment. The most common sexual concerns of women of all ages include loss of sexual desire, problems with arousal, inability to achieve orgasm. Although aging may affect sexual function, physicians should rule out disease or side effects of medications as contributing to those symptoms.

CGMW: Are there any dangers with sexual activity for older adults with specific health conditions such as high blood pressure, heart disease, diabetes, etc.?
A loved one should consult their healthcare provider before engaging in sexual activity, especially if it’s been awhile. Sexual activity can be an important part of a healthy lifestyle. Patients often ask about safety and sex after a heart attack or diagnosis of heart disease, but if you’re fit enough for sex, it’s encouraged. Your blood pressure will go up during sex and it goes back down afterward.

CGMW: Can medications cause problems or affect older adults in regard to engaging in sexual activity?
Medications that affect the nervous system will affect sexual function. Selective serotonin reuptake inhibitors (SSRIs) are commonly associated with sexual dysfunction in women, mainly decreased libido.  Sildenafil citrate (also known by its brand name Viagra) has been successfully used when sexual dysfunction was caused by antidepressants, most commonly SSRIs. Diuretics can decrease forceful blood flow to the penis, making it difficult to achieve an erection. They can also deplete the body of zinc, which is necessary to make the sex hormone testosterone.

CGMW: Do older adults still need to worry about having safe sex? What should they and their caregivers know about sexually transmitted diseases or other dangers?
Older adults most certainly need to be concerned with having safe sex. In Florida alone, in the past 10 years the rate of sexually transmitted diseases in seniors have risen over 70%. Doctors rarely test for sexually transmitted diseases (STDs) during an elder’s annual physical – they should be having a conversation with their patient about sexual activity and safe sex. You and your doctor may confuse the symptoms associated with sexually transmitted infections (STIs), even HIV, as signs of the aging process or other illnesses. If you’re sexually active, ask to be tested. Many older men may not have used a condom for decades when they meet a new partner and engage in sexual activity. Have the condom talk long before the heat of the moment. When the sparks and kisses signal that sex is likely in your future, have the safe sex conversation. Agree to be prepared when you’re ready for the next stage, whether that means next weekend, weeks from now, or in an hour. Herpes, Chlamydia, Gonorrhea, HPV, Hepatitis B, Syphilis and HIV are all a concern if safe sex isn’t practiced. 

CGMW: What should someone caring for a loved one with dementia know about that loved one’s sexual activity? Can someone with dementia give consent to have sex?
For many couples coping with dementia, physical intimacy continues to be a rich source of mutual comfort, support and pleasure for years. Depending on what part of the brain is affected by dementia or what medication a family member is on, sexual behavior and desire may change: more or less interest in sex, more or less ability to perform and  change in inhibitions. A partner may do or say things they wouldn’t have said before the illness or even become sexually aggressive. This can be very difficult for adult children to witness in their parents. They should understand that this is a function of the disease and not their parents’ character.

There is no one standard or law for the abilities needed to consent to participate in sexual activity. However, the Alzheimer’s Organization has a list of four requirements that must be present in any sexual encounter: 
•         The ability to voluntarily participate (free of coercion). 
•         The ability to say “no” (verbally or non-verbally). 
•         The ability to be safe from harm. 
•         The ability to be free from exploitation or abuse.

We should remember than at any age, sexual desire and activity varies from person to person. Dementia does not end a man or woman’s desire for physical intimacy. There are many new products and medications available to make sex as satisfying as possible. The website www.safersex4seniors.org is a wonderful resource.

CGMW: Is there anything else that an older adult or a caregiver should know about this subject and how it relates to sexual orientation?
Remember that coming out is ageless. Many seniors seize the opportunity to come out as gay or lesbian when a life change occurs, such as children leaving home or a spouse dying. They feel circumstances have aligned to give them permission to act on their true attractions.

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