Same-sex intimacy and long-term care were among the topics addressed in "Sexual Expression, Older Adults and Long-Term Care Settings," an LGBT-related forum held during the American Society on Aging's 2013 Aging in America Conference, held recently at the Hyatt Regency Chicago.
Among those speaking at this 60-minute talk were Robin Dessel, director of memory and vision care services and sexual rights educator at The Hebrew Home for the Aged at Riverdale; Mark Brennan-Ing, Ph.D., a senior research scientist with ACRIA: AIDS Community Research Initiative of America; and Hilary Meyer, J.D., director of the National Resource Center, Services and Advocacy for GLBT Elders (SAGE).
The talk aimed to, among other things, dispel myths about the sexuality of aging people and increase knowledge about the staff in long-term care facilities about same-sex intimacy.
Meyer mentioned the importance of same-sex intimacy. One of the things she stressed was that "People don't lose their interest and ability to have sex when they become older, thank goodness." She also said that sexual dysfunction cannot be exclusively attributed to age, and that dysfunction is not necessarily an inevitability.
She said that, although a minority of LGBT seniors chooses abstinence, "the vast majority regularly engages in some sort of sexual experience and expression." Meyer added that there are various factors that contribute to sexual activity, such as gender differences (with men being more active), health status, relationship status and hormonal changes.
To underscore the fact that seniors are engaging in sex, Meyer cited a 2007 published study that examined 3,000 people. The results revealed that half of people 65-74 remained sexually active. In a group of people 75-84, 54 percent said they had sex two to three times a month.
There are changes in desire as one ages, Meyer said, adding that the plateau lasts longer although the orgasm may not be as powerful.
Brennan-Ing spoke of research findings of sexual health in older LGBT adults, which he called "an understudied topic." Factors in disparities involving LGBT and non-LGBT older adults include lack of access to health care, fear of disclosure/discrimination/stigma, and risky behavior, he added.
He cited a study prepared for Chicago's Center on Halsted that involved 210 subjects. (The paper, "Health and Psychosocial Needs of LGBT Older Adults," is at www.centeronhalsted.org/SAGE.pdf. ) Of the individuals, 71 percent were men, 24 percent were women, and 5 percent were transgender or intersex; in addition, one-third reported being HIV-positive.
On average, older LGBT adults reported 11 people in their social networks, consisting of parents, family members, friends and neighbors. However, older LGBT adults tend to have friend-centered networks and there's less involvement with biological family members, compared to their heterosexual peers.
The study also dealt with sexual activity and risk. Results included that age was significantly related to the likelihood of sexual activity in the past year, with those under age 60 more likely to report being sexually active than their older. In addition, older LGBT adults with HIV reported significantly more sexual relationships in the past five years compared with their peers who were not infected. Two-thirds of the survey group said they had sex two or three times monthly, comparable with the study Meyer mentioned.
Brennan-Ing also said that subjects were asked about condom use, stating the "surprising" result that usage was low. For anal intercourse, 42 percent said that condoms were always used, and 7 percent indicating that they usually used them. With regard to vaginal intercourse, 44 percent indicated that they always used condoms, while 20 percent said that they usually used protection. Also, there were no significant differences concerning frequency of sexual activity and gender.
With regard to precautions during oral sex, older LGBT adults with HIV were significantly more likely to use condoms or dental dams than HIV-negative counterparts. Brennan-Ing mentioned that one factor for low usage was "condom fatigue." Lastly, 41 percent of older LGBT adults indicated that they had avoided sexual activity, either because of lack of interest or physical problems (e.g., erectile dysfunction).
"We need to think a little more broadly about prevention because clearly the messages we've been using for the past couple of decades are wearing out," Brennan-Ing concluded.
Dessel spoke about the obligations in long-term care environments regarding sexual consent in older LGBT adults with dementia. (According to the conference's website, "The Hebrew Home at Riverdale is the first facility of its kind to develop a policy to recognize and protect the sexual rights of nursing home residents, while distinguishing between intimacy and sexually inappropriate relations.")
Dessel said that when she first explored the topic of sex and older adults in facilities, it was in the early 1990s: "There are very little recognition. There was no precedence. The industry and the audience at large didn't feel this was a viable area for study."
However, she added that times have changed and that rights should not change regardless of factors such as age or sexual orientation (which she called "sexual preference" during the talk). She said that it was believed that any overt sexuality connected to dementia was a consequence of the disease.
Dessel said that various aspects are being examined, such as third parties being involved and determining if there's an "in-between" stage regarding the disease. "With incoming baby boomers, they're going to expect that their rights come in tow," she said. "They don't want to cross the threshold and find out that their sexuality is being scrutinized and that professionals are paternalizing older adults.
"One of the foremost issues is that we're held back because there's no ready testing to determine sexual consent. … With dementia and with sexual preferences that are not necessarily mainstream in a society that's a bit ageist and a bit sexist, it becomes very challenging.
"They say by the year 2050, there'll be 13.8 million Americans with Alzheimer's disease. …We can't say that if those 13.8 million can't appreciate their actions; if we paternalize, we're withholding, instead of upholding, their rights."
Dessel also discussed Hebrew Home's paradigm shift, which policy influenced. The home is dedicated, she said, to the rights of the residents. She added that the staff members "get it. It's about supporting the welfare and personhood of the residents. But they're also on the front lines when a family makes a protest or when someone second-guesses a relationship or when the New York state Department of Health comes in and says, 'I don't see enough supporting documentation.'
"Life pleasures. It can't be about all things medical. It can't be that all we talk about are blood pressure, bedpans and medication. People want to live their lives. … Get the dialogue going; ask the questions.
Among the many other LGBT-related workshops at the conference were "The Other Side of 40: Gay Men and Ageism," "Religious Affiliation and Successful Aging Among Transgender Older Adults" and "Health Enablers, Minority Stress and Coping: Midlife and Older Gay Men's Mental and Physical Health."
The 2014 conference will take place in San Diego, Calif., March 11-15; see www.asaging.org/aia.
