Presentation on theme: "Ageing & Intimacy: Sexuality in later life. Dr Allyson Waite"— Presentation transcript:
1Ageing & Intimacy: Sexuality in later life. Dr Allyson Waite Ageing & Intimacy: Sexuality in later life Dr Allyson Waite Registered Clinical Psychologist Co-Director Sex Therapy New Zealand
2Programme Background Myths and Reality of Ageing Intimacy & Sexuality in later lifeBiological factors and sexual functionPsychosocial factors and sexual functionCoping with changeDementia and sexualityRaising the issue
3Preparation to be Sexual What sex education did you receive as you grew up?How well did this prepare you forbecoming a sexual being?dealing with sexual concerns as a professional now?
5Myths of Ageing & Sexuality You have to be beautiful to be desirable.You have to be young to have sex.You have to have a partner to have sex.If you’re widowed it’s the end of your sex life.Older people should be looking after their grandchildren.Older people can’t change.Ageing and sexual dysfunction are inevitably linked.Mixed messages – all in the mind/all declineDerogatory terms – expressing sexuality
6The Reality of Ageing Biological changes – impact on sexual function. Chronic illness or disability; medications.Losses:role, function, significant attachments & relationships (bereavement/divorce), identity, income (retirement)Women outlive men (approx 7 years)Unresolved past issues – trauma; attachment needsLife stage issues - EriksonTraditional beliefs and values testedAnxiety – dependence, disease, death.Diversity
7Domains of Intimacy Psychological Emotional Physical Operational SocialSpiritual
8Health Benefits of Sexual Expression Mitchell,S. & Owens, A. F. (Eds) Raising self esteemRecharging batteriesRepair relationship distance/damageRise in oxytocinLower cancer riskImproved immunityImproved fertilityDecreased vaginal atrophy and increased testosteroneLower mortalityAnalgesic effect
9How important is sex in later life. The view of older people. (Gott, M How important is sex in later life? The view of older people (Gott, M. & Hinchliff, S., 2003)All with current sexual partner - some importanceThose rating greatest importance - context of emotional intimacy in their relationship as a wholeThose rating sex not particularly important - not in a sexual relationship/partnershipMinority - sex more pleasurable/greater importance with ageExperiencing barriers to being sexually active: (e.g. no partner or partner’s health problems) – some reprioritised importance of sexImportance of non sexual touching to maintain physical intimacy
10Sex for the Mature Adult Weeks, D.J. SRT 17/3, 2002 Need to challenge myths re ageing and sexual dysfunctionPhysiological changes exceeded by psychological, emotional issues and ageist beliefsNo fixed biological limit to a satisfactory sex life during old age.Correlation with sexual activity and enjoyment before, during and after middle years.More > less sexual activity related to increased sexual satisfaction within a relationshipAssociation between psychological health and sexual pleasure.Sexual satisfaction - major contributor to quality of life, maintaining self esteem & good self concept.Most prevalent problems partner/relationshiprelated, lack of tenderness, partner problems
11Sex & Nursing Home Care Lack of partner Lack of privacy Lack of opportunityAttitudes of staffChronic illnessDementia and urinary incontinence.Loss of interestLoss of feelings of attractiveness
12Biological Variables Impacting on Sexual Functioning in Older People. Physiological changes – sexual functionIllness, disability, painMedical and surgical interventionsMedicationsTiredness, stressObesity
13The Couple Sharing Long Term Illness (2004) d’ArdennePhysical and psychological effects of illness – for both partnersWhen one becomes caregiver, the other dependent - nature of intimacy changes.Caregiver may have to provide personal careMay lose free time and income; social isolation.May have stress of watching suffering.May be grieving ‘loss’ of companion.May have huge frustration.
14Psycho/social variables Impacting on Sexual Functioning in Older People. Partner related problemsRelationship issuesPast traumatic sexual experiencesUnresolved emotional experiencesSelf esteem, body imageLack of education, knowledgeSocial expectations/sexual culture
15Coping with change and maintaining intimacy Open communicationAcknowledging losses/changes - self/partner/relationshipGrief workChanging expectations - rescripting – sex/intercourseBroadening concept of sex and intimacyProblem solvingMaintaining non sexual touchUnderstanding changesDealing with potential sources of pressureDealing with anxiety and rebuilding confidenceDealing with past issues – emotionally/sexually
17Impact of Dementia on Marital Relationships Baikie (2002)Majority of people with dementia live in community, often cared for by a spouse.Relationships under these conditions require social support.Carer stress“Being neither a wife nor a widow”.Loss of personality, not being recognised.Demands on spouse:Find a way to deal with their love of their partnerDeal with frustration, anger, grief etc.Watch the devastating effects of the diseaseFace the loss of their relationshipAssume major responsibility for care.How spouse has experienced relationship before illness affects how they see role of caregiver now.Partner has to change, person with dementia cannot.Partner has to find a way to handle a sense of obligation to be sexual.
18Aspects of Dementia which Challenge Intimacy Verbal communication difficult.Visual and hearing difficulties.Complex tasks become more difficult.Lack of initiative or withdrawal from usual activities.Emotional and personality changes.If fronto-temporal dementia:Loss of the ability to empathise,Behave inappropriately or in an uninhibited way,Easily distracted.
19Dementia’s Impact on Sexual Behaviours Desire may decrease as a result of dementiaDesire may increase as a result of dementia.They may be uninhibited - inappropriate“Challenging behaviours” – carer stressThey may make unreasonable demands.They may forget they recently had sex.They may brood in response to refusals.Co-ordination problems make caressing, penetration difficult.They may forget to caress.
20“Opening a can of worms…” Barriers to managing sexual dysfunction in primary care:Concerns about lack of knowledge, expertise, opening a floodgate, personal embarrassment, lack of time, sensitivity and complexity of issues, gender, culture, orientation22 GP’s – how do they perceive and manage sexual health concerns of older peopleSexuality generally not proactively pursued – sexual health seen as related to younger people – e.g. STI’s and contraception, discomfort with raising with this generation and not wishing to cause offenceBarrier’s from patients – 45 patients – aged 50-92Most saw GP as most appropriate person to approach. However, barriers included personal characteristics of the GP, shame embarrassment, fear of disapproval, judgement, attribution of problems to normal ageing,
21PLISSIT Permission Limited Information Specific Suggestions Intensive Therapy
22What you can do to helpOpen the door - “Its okay to talk to me about sex.”Encourage to talkGive informationListen – under rated!normalisereassurespecific solutions – practical, PDE-5i’s, aidsClarify expectations/fearsDifferential diagnosis: disease/treatment side effect/psychogenic.Know where to refer on when needed
23Raising the Topic of Sex Find an opportunity:When discussing lifestyle issuesWhen prescribing medicationIn a general checkup, review etcCreate an opportunity:GeneralisingNormalisingLink to a diagnosed conditionUse statistics
24Where to from here? Referrals: Sex Therapy New Zealand (STNZ) Further training:The Good Fellow unit, University of AucklandResources:Sexuality – key facts for men over 50Sexuality – key facts for women over 50
26ReferencesBaikie, E. (2002) Impact of dementia on marital relationships., Sexual and Relationship Therapy 17, 3,d’Ardenne, The Couple Sharing Long Term Illness. (2004) Sexual and Relationship Therapy, 19/3,Gott, M. & Hinchcliff, S. (2003) Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people. Family Practice, 20,6,Gott, M. & Hinchcliffe, S. (2003) How important is sex in later life? The views of older people. Social Science and Medicine, 56 (8)Gott, M., Galena, E., Hinchcliff & Ellford, H. (2004) “Opening a can of worms:. GP and practice nurse barriers to talking about sexual health in primary care. Family Practice, 21, 5,Gott, M., Hinchcliff, S. & Galena, E. (2004) General practitioner attitudes to discussing sexual health issues with older people. Social Science & Medicine 58,Gott, M. (2005) Sexuality, Sexual Health & Ageing, Open University Press, New YorkHill, J., Bird, H & Thorpe, R. (2003) The effects of rheumatoid arthritis on sexual activity and relationships. Rheumatology, 24,Trudel, G., Turgeon, L. & Piche, L. (2000) Marital and Sexual aspects of old age. Sexual and Relationship Therapy. 15, 4,Watters. Y. & Boyd, T. (2009) Sexuality in later life: opportunity for reflection for health providers. Sexual and Relationship Therapy, 24, 3-4,Weeks, D.J.,(2002) Sex for the Mature Adult: self esteem and countering ageist stereotypes, Sexual and Relationship Therapy, 17/3 ,
27Assessment Sex Coaching for Physicians Assessment Sex Coaching for Physicians. MA Perelman (2003) International Journal of Impotence Research 15,5.The brief sex status exam:Potential for cluster problems.Personal distress.Ask specific questionsFactors to look out for:Lack of attraction or erotic energy.Anxiety, anger, drug/alcohol effect.Masturbation style, frequency & attitude.Sexual expectations.Get a comprehensive description of actual behaviour and cognitions: immediate, intermediate and remote causal layering.GP’s can manage current obstacles to success (organic and psychogenic)-Managing time crunch.
28Treatment: general aspects (Perelman, 2003) Modifying expectations.Using drugs as a therapeutic probe.Use follow-up to manage noncompliance and improve outcome:schedule f/u appt day first prescribemonitor side effect, assess success, alter dose if necessary,ongoing education where necessary,ensure compliance from patient and partner.Bio psychosocial issues which can evoke non-compliance:fear of complicationschange associated with aging, chronic disease/injurychanges associated with medicationsalcohol, smoking, life stressorsloss of partner,partner’s attitude.relapse prevention strategies.