The first comprehensive national
survey of sexual attitudes, behaviors and problems among older adults in the United
States has found that most people ages 57 to 85 think of sexuality as an important
part of life and that the frequency of sexual activity, for those who are active,
declines only slightly from the 50s to the early 70s.
Data from the University of Chicago’s National Social Life,
Health and Aging Project (NSHAP), presented in the August 23, 2007, issue of
the New England Journal of Medicine, showed that many men and women remain sexually
active—participating in vaginal intercourse, oral sex and masturbation—well
into their 70s and 80s.
The survey also found that sexual activity was closely tied
to overall health, which was even more important than age. As health declined
steadily after the early 70s, so did the prevalence of sexual activity, particularly
for women. Among those who remained sexually active, nearly half reported at
least one sexual problem, such as lack of desire (43% of women), vaginal dryness
(39% of women) or erectile dysfunction (37% of men).
"We found that older adults remain interested and engage
in sex, yet many experience bothersome sexual problems that can compromise both
health and relationships," said Stacy Tessler Lindau, MD, assistant professor
of obstetrics and gynecology and of medicine-geriatrics at the University of
Chicago and lead author of the study.
With the first baby boomers turning 60, older adults make up
the fastest growing segment of the US population. Yet the "lack of reliable
information about how sexual activity and function might change with age and
illness, combined with taboos around discussing sex in later life, contributes
to worry or even shame for many older adults," she added.
"I am especially happy that we now have in hand reliable
and comprehensive information on sexual function and activity among older adults
based on a scientifically drawn representative sample of Americans 57 years
of age and older," said co-author Edward Laumann, PhD, the George Herbert
Mead Distinguished Service Professor in Sociology and co-director of the 1992
National Health and Social Life Survey, which surveyed persons aged 18 to 59.
"Social relationships are known to contribute to health
and well-being in older men and women," says Richard Suzman, PhD, director
of the Social and Behavioral Research Program at the National Institute on Aging,
which primarily funded the study. "This pioneering research gives us valuable
insight into intimate social relationships, providing data clinicians may now
draw upon to open better informed conversations with patients about sexuality
and health."
Many medical conditions and treatments can interfere with sexuality.
American men spend more than a billion dollars each year on medications to improve
sexual function. Despite such frequent problems, few older men (38%) and even
fewer women (22%) had discussed sex with a physician since age 50, the researchers
found. Men were more likely to do so, perhaps because effective drugs are available.
Nearly 1 in 7 men (14%) reported taking medication to improve sexual function.
The survey documented another significant gender difference.
While 78 percent of men ages 75 to 85 have a spouse or other intimate relationship,
only 40 percent of women that age do, a consequence of the age disparity of
relationships coupled with women’s greater longevity.
"Sexuality is an important part of a healthy and engaged
life at older ages for both women and men," said co-author Linda Waite,
PhD, the Lucy Flower Professor in Urban Sociology at the University of Chicago
and Director of the Center for Aging at NORC. For the vast majority of men,
aging is a partnered experience, "but women’s sexuality," Waite said,
"is more often affected by the death or poor health of their spouse."
NSHAP, funded by the National Institutes of Health, was created
to discover how social relationships, especially intimate relationships, influence
health as people age. Between July 2005 and March 2006, the researchers interviewed
3,005 people ages 57 to 85 in their homes. They asked about social and marital
history, sexual activity and function, and physical and mental health.
While there have been other surveys focused on the older population,
"they have typically been based on convenience samples with low completion
rates or clinical samples with unknown biases in representing the population
at large," Laumann said. Such surveys typically over- or under-estimate
the prevalence of sexual problems. "NSHAP provides us with a much more
reliable guide to strengths and weaknesses of sexual health in the older population
of the United States."
Another new element of NSHAP is the collection of physiological
specimens such as spots of blood, saliva and vaginal swabs. In follow-up studies,
the researchers will use these specimens to extract various "biomarkers."
These will provide evidence about hormone levels, prevalence of diseases such
as heart disease or diabetes, and the frequency of human papillomavirus, a sexually
transmitted disease.
The NSHAP team also gathered data on how older adults perceive
the world of social relationships, assessing participants’ sense of touch,
taste and smell as well as vision and hearing.
Despite the personal nature of many of the questions, study
participants were very forthcoming, as expected from prior clinical and research
experience with older adults. Seventy-five percent of those approached agreed
to participate. Overall, only 2 to 7 percent declined to answer direct questions
about sexual activities or problems. (Fourteen percent did not answer questions
about masturbation on a self-administered questionnaire.) “Participants
were more likely to refuse questions about income than they were about sex,”
Lindau said.
Many of those who were sexually active found ways to remain active, despite
worsening health. The proportion of sexually active couples that engage in oral
sex, for example, hovered at around 50 percent for those under 75. More than
half of men and a quarter of women, whether they had a sexual partner or not,
acknowledged masturbating.
"Although sexuality has long been thought to deteriorate
inevitably with age, we found that health is a more important indicator for
many aspects of sexuality than is age alone," Lindau said. "This suggests
that older adults with medical problems, or those considering treatment that
might affect sexuality, should be counseled based on health status rather than
just their age."
The most common reported reason for sexual inactivity among
individuals with a spousal or other intimate relationship for men (55%) and
women (64%) was the male partner’s physical health. Women, especially those
who were not in a current relationship, were more likely than men to report
lack of interest in sex.
Despite the unprecedented shift in the age of the population,
the public, physicians and policymakers lack information on sexual behavior
at older ages and on how sexual activities and problems change with age and
illness.
"We hope our findings improve public health by countering
harmful stereotypes and allowing older individuals to view their experience
relative to others," Lindau said. "It may comfort people to know that
they are not alone in enjoying sexual activity as they age or in experiencing
sexual problems, some of which could be alleviated with medical attention."
This report, according to the authors, provides the first such
reference for clinical decision making. It "should improve patient education
and counseling," they conclude, and help identify "health related
and potentially treatable sexual problems."
The National Health, Social Life and Aging Project is supported
by the National Institutes of Health, including the National Institute on Aging,
the Office of Research on Women’s Health, the Office of AIDS Research, and the
Office of Behavioral and Social Sciences Research. NSHAP is also supported by
the National Opinion Research Center, whose staff was responsible for the data
collection.
Additional authors of the study include Philip Schumm and Colm
A. O’Muircheartaigh of the University of Chicago and Wendy Levinson of
the University of Toronto.
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