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 activeparticipating in vaginal intercourse, oral sex and masturbationwell 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 Tesser 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.