Relationships and sexual expression in later life: a biopsychosocial perspective

Objectives To examine the relation between health and several dimensions of sexuality and to estimate years of sexually active life across sex and health groups in middle aged and older adults. Design Cross sectional study. Setting Two samples representative of the US population: MIDUS (the national survey of midlife development in the United States, 1995-6) and NSHAP (the national social life, health and ageing project, 2005-6). Participants 3032 adults aged 25 to 74 (1561 women, 1471 men) from the midlife cohort (MIDUS) and 3005 adults aged 57 to 85 (1550 women, 1455 men) from the later life cohort (NSHAP). Main outcome measures Sexual activity, quality of sexual life, interest in sex, and average remaining years of sexually active life, referred to as sexually active life expectancy. Results Overall, men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex. These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex. Men and women reporting very good or excellent health were more likely to be sexually active compared with their peers in poor or fair health: age adjusted odds ratio 2.2 (P<0.01) for men and 1.6 (P<0.05) for women in the midlife study and 4.6 (P<0.001) for men and 2.8 (P<0.001) for women in the later life study. Among sexually active people, good health was also significantly associated with frequent sex (once or more weekly) in men (adjusted odds ratio 1.6 to 2.1), with a good quality sex life among men and women in the midlife cohort (adjusted odds ratio 1.7), and with interest in sex. People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55. This gender disparity attenuated for people with a spouse or other intimate partner. At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health. Conclusion Sexual activity, good quality sexual life, and interest in sex were higher for men than for women and this gender gap widened with age. Sexual activity, quality of sexual life, and interest in sex were positively associated with health in middle age and later life. Sexually active life expectancy was longer for men, but men lost more years of sexually active life as a result of poor health than women. Show more

The has been relatively little research on sexuality in later life, particularly among persons over 60 years of age. The existing literature consists of studies of small samples, much of it from a biomedical perspective. This literature suggests that age, hormone levels, specific illnesses, and various medications negatively affect sexual functioning in older persons. The study reports results from a survey of a large sample (N=1,384) of persons age 45 and older that included measures of a variety of biological, psychological and social factors that potentially influence sexual functioning. We report bivariate and multivariate analysis conducted separately for women and men. We find that the principal influences on strength of sexual desire among women are age, the importance of sex to the person, and education. In this sample of the population of older persons, attitudes are more significant influences on sexual desire than biomedical factors. Show more