Challenges and barriers to sexuality expression in older people
Module 2.1
Health and Social Care Professionals perspectives/own attitudes on older persons
Learning outcomes
After reading this module you should be able to…
- Identify the barriers faced by health and social care professionals in discussing sexuality with older patients.
- Explore the communication barriers surrounding sexuality and the impact on older patients’ access to proper care.
- Examine the role of health and social care professionals’ attitudes, beliefs, knowledge, and self-efficacy in facilitating discussions about sexual health.
- Understand the significance of creating a supportive environment through self-reflection on biases, seeking peer consultation, and recognising negative countertransference.
Introduction
Sexuality is closely linked to physical and mental health, highlighting the crucial role of health and social care professionals as gatekeepers in this particular field. However, research has revealed a variety of issues that challenge the inclusion of sexuality in the comprehensive care of older people, which they deserve to receive.
Many health and social care professionals, including nurses, lack knowledge and information about sexuality in general and in particular with regard to old age. In addition, some health and social care professionals may consider sexual health to be a private matter and not a priority in their scope of practice. Many Health and social care professionals feel uncomfortable discussing the topic with patients, and they may face various barriers related to time demands, unclear areas of responsibility, and a lack of organisational support (Fennell & Grant, 2019).
In order to effectively promote and support healthy sexuality in older people, it is crucial to be aware of the challenges and barriers you may encounter in your practice. The following will discuss the key challenges and barriers faced by health and social care professionals in relation to facilitating and addressing sexuality expression in older people, drawing on research from the fields of nursing and gerontology.
Attitudes towards sexuality and ageing in the professional context
Older people are less likely to seek help with sexual problems (Hinchliff & Gott, 2011), and when they do, they are often met with assumptions that sexual problems are a natural part of ageing. Research has shown that there is a pervasive stigma attached to sexuality in old age, with societal attitudes often dismissing or downplaying the sexual needs and desires of older adults. This stigma can extend to healthcare settings and impact the attitudes and beliefs of health and social care professionals, making them reluctant or uncomfortable in addressing issues of sexuality with older patients. In spite of the fact that older individuals are often sexually active, health and social care professionals rarely assess their sexual history (Gewirtz-Meydan et al. 2018). A review of research related to patient-doctor interactions by Hinchliff and Gott (2011) revealed that a major barrier to seeking medical help for sexual problems was the medical practitioner’s reluctance to address sexuality, as they frequently assumed that sexual changes were age normative and no longer of relevance to the patients well-being.
The importance of health and social care professionals taking an active approach by including sexuality into their practice is shown in the observation that patients are more likely to bring up issues in or with their sexuality when the medical practitioner had asked about sexual function during a routine visit within the previous three years (Hinchliff & Gott, 2011).
In order to avoid neglecting or overlooking the sexual health needs of your clients due to unintentional stereotyping and discrimination based on age, it is important to recognise which ageist beliefs one might hold.
Dig in deeper:
- For a deeper understanding on how beliefs about old age are shaped and might influence your practice please refer to Module 2.2: Views on Ageing and Ageism of this course.
- For guidance on how to overcome personal and systemic barriers to the inclusion of sexuality into your comprehensive care please refer to Topic 3 of this course.
Knowledge about older persons sexuality and sexual health
In a systematic review conducted by Haesler and colleagues (2016), it was found that many healthcare professionals particularly older care workers, believe that the sexuality of older people falls outside their scope of practice. In addition to attitudinal challenges such as recognising that sexuality remains an integral contributor to physical and mental health and well-being, a lack of knowledge surrounding issues in sexuality is one of the major barriers to including sexuality into care practice (Engelen & colleagues, 2019).
Health and social care professionals often receive inadequate education and training on the topic of sexuality in general and old age in particular. This knowledge gap can lead to discomfort, uncertainty, and a lack of confidence when addressing sexual health concerns with older adults. According to Cesnik and Zerbini (2017), many health care workers report discomfort discussing sexuality due to a lack of knowledge in the area. A lack of understanding about the normal physiological, psychological, and social changes that occur with aging can impede professionals’ ability to provide appropriate guidance and support regarding sexual health in older people. This includes changes such as menopause, erectile dysfunction, and the impact of chronic health conditions on sexual functioning.
Dig in deeper:
To catch up on health related changes in old age check out Module 1.2: Health related changes in Sexuality and Ageing
Knowledge and training on sexuality vary significantly within the field of health and social care professionals (Gewirtz-Meydan et al. 2018). Studies have found that age and professional background are critical factors in addressing sexuality with older persons (Haboubi & Lincoln, 2003). Whilst it is noteworthy that younger health and social care professionals are more likely to have received education on sexuality and sexual health than their older colleagues, most professionals express a need for more training on sexual issues to be able to address them. Among nurses, therapists and medical doctors, therapists feel least prepared to include sexuality related issues into their practice, while doctors had the most experience talking about sexual health.
Knowledge about age-related changes and awareness of the importance of sexuality in all life stages is one of the keys to enable practitioners to incorporate them into their routine, thus “breaking the ice” on the stigma surrounding sexuality in old age and creating a safe space to communicate about issues relevant to health and well-being. This can lead to improved patient outcomes and better overall healthcare experiences. For institutions it is crucial to provide ongoing education and training to health and social care professionals to improve their skills and comfort level in discussing sexuality with their clients.
Communication barriers
While ageing should not be over-sexualised (Taylor & Gosney 2011), it is important to acknowledge that old age is not asexual. Effective communication is vital for addressing sexuality issues, yet health and social care professionals may feel uncomfortable or lack the skills to initiate conversations about sexual health with older adults. A review on sexuality in older age by Taylor and Gosney (2011) highlighted that issues in communication can arise due to health and social care professionals’ hesitancy or embarrassment in discussing sex with older patients, even when it is highly relevant, such as in assessing depression.
As sexuality is a culturally sensitive topic, it is worthwhile investigating the roots of discomfort and questioning the validity of social norms for shaping professional conduct. Similarly to other socially sensitive topics such as toileting or personal hygiene, it takes a professional approach to sexuality.
In many cases a reluctance to approach the subject of sexuality can emerge from the well-intentioned concern of not disturbing the other person’s level of comfort. Whilst concerns about causing embarrassment or invading privacy are valid and should be considered, they can hinder open dialogue and limit the support that can be offered. A sensitive and professional approach, however, can break the ice.
Privacy and confidentiality are crucial when discussing sensitive topics such as sexuality. However, professional settings may lack private spaces, leading to limited opportunities for confidential discussions. This can inhibit older adults from openly sharing their concerns and seeking appropriate support (Bauer et al., 2019; Taylor & Gosney, 2011).
Taylor and Gosney (2011) point to the need to be aware of personal subconscious feelings and to avoid making assumptions. This can be illustrated with an example of potential effects in intergenerational or opposite sex interactions. In some cases these interactions can be hindered by negative countertransference (Hillmann, 2008). For example, when a younger professional works with a client of an older generation or opposite sex. In some cases they may feel uncomfortable discussing sexuality with a significantly older patient of the opposite sex, as their patient might remind them of their parents or grandparents. Such feelings must not be ignored, by seeking consultation and support, the professional may find ways to communicate effectively with their patient again.
Conclusion
The challenges and barriers faced by health and social care professionals in addressing sexuality expression in older people are multifaceted. Stigma, ageism, insufficient education, and communication concerns all contribute to these challenges. To overcome these barriers, it is crucial to promote awareness, provide comprehensive education and training opportunities, and create supportive healthcare environments that prioritise privacy, confidentiality, and non-judgmental communication. By addressing these challenges, professionals can better meet the sexual health needs of older adults, promoting their overall well-being and quality of life.
Module 2.2
Views on Ageing and Ageism
After reading this module you should be able to…
- Understand the impact of views on ageing and ageism on the work of health and social care professionals in their interactions with older adults.
- Recognise the complex nature of views on ageing, including their multi-directionality and multi-dimensionality.
- Examine the implications of ageism on discussions about sexuality and the neglect of sexual health needs in older populations.
- Understand how exposure to vulnerable older individuals can reinforce stereotypes and bias in health and social care professionals.
- Explore strategies to combat ageism.
Views on ageing and ageism can significantly influence the work of health and social care professionals in their interactions with older adults. Ageing is a natural process that should be approached with respect and without prejudice. However, research in the fields of gerontology and nursing has highlighted the presence of negative views, stereotypes, and ageism that can hinder the delivery of quality care to older individuals. The following explores the nature and the impact of these factors on the work of health and social care workers and emphasises the importance of addressing them to promote effective and person-centred care for older adults.
Although views on ageing have been discussed in relation to their impact on older peoples’ self-perceptions and behaviour in Module 1.3, it is worthwhile to keep reminding ourselves that each person holds certain ideas about older people, old age and ageing in general. These ideas or views start to develop during childhood and continue to be shaped throughout a person’s lifetime and are considered to be a product of the embodiment of stereotypes, as well as experiences with older people (Klusmann et al., 2020; Levy, 2009). Whilst views on ageing describe beliefs or attitudes that are generalised across a group of people or lifespan, it is important to acknowledge their complex nature. It is possible that an individual regards older people as having more life experience than younger people but also to have more limitations in their physical fitness. This example shows that views on ageing can be both positive as well as negative and that they can relate to different aspects of life – two concepts known as multi-directionality and multi-dimensionality (Klusman, 2020). Furthermore, views on ageing also include ideas of how older people should behave (norms) (Kessler et al., 2023).The importance of reflecting on one’s own views on ageing and their potential impact on one’s professional practice gains importance when we take a closer look at ageism.
Research has shown that prevalent stereotypes about ageing include beliefs that older adults are frail, dependent, forgetful, and resistant to change (Cuddy et al., 2018). In its most extensive form such negative views on ageing can lead to ageism, which refers to prejudice, stereotyping or discrimination solely based on a person’s age. It involves negative attitudes, beliefs, and behaviours that devalue and marginalised older adults. Ageist attitudes are deeply ingrained in society and can also negatively influence the perceptions and behaviours of health and social care professionals towards older patients. Consequently, is necessary to take a look at the risks of ageism in health and social care and too consider the factors that can lead to potentially negative or deficit-oriented views on ageing in these settings.
Ageism in Health and Social Care
Ageism can have significant implications for the work of health and social care professionals. It can lead to the under-assessment and under-treatment of health conditions in older adults, as symptoms may be dismissed as a normal part of ageing. Ageist attitudes can also result in a lack of communication and shared decision-making, limiting older adults’ autonomy and participation in their care (Palmore, 1990).
That age-based assumptions and biases in healthcare settings can impact the quality of care provided, also applies to the topic of sexuality and ageing as ageism can hinder open discussion about sexuality with older adults. Research indicates that topics such as sexual health are more likely to be addressed with younger people than with older clients or patients. One study found that medical practitioners were reluctant to address sexual health with older patients as they did not regard it as a “legitimate topic” (Gott et al., 2004). This shows that health and social care professionals may hold ageist beliefs that older adults are asexual or incapable of sexual activity, leading to the neglect or overlooking of their sexual health needs (Haboubi & Lincoln, 2003).
The nature of the health and social care professions is such that their services are most frequently used by older persons experiencing some form of health problem or issue with functioning in their daily activities. This inevitably means that the older people with whom health and social care professionals come into contact have more support needs than people in the same age group who do not need professional support. In addition to physical limitations and pain, people in care situations may also be emotionally stressed and anxious. Such an accentuated exposure to a particularly vulnerable subgroup of older people can impact the perceptions and views of health and social care professionals in a negative way by reinforcing prevalent stereotypes. Furthermore, health and social care professionals might have a stronger tendency to focus on deficits in their clients or patients as it is their profession’s mission to identify and address problems in order to deliver quality care to older individuals.
Health and social care workers need to recognise and address ageism to ensure equitable and person-centred care for older individuals.
Overcoming Ageism and Promoting Positive Views on Ageing
To combat ageism and promote positive views on ageing, health and social care professionals can engage in various strategies. Education and training programmes should emphasise the importance of challenging stereotypes and biases. Encouraging intergenerational interactions and promoting positive, yet realistic portrayals of older adults in media can help reshape societal views on ageing. Additionally, adopting person-centred approaches to care that respect individual preferences, goals, and aspirations can counter ageism and improve the well-being of older adults.
Conclusion
Views on ageing and ageism can significantly impact the work of health and social care professionals. Negative perceptions of old age or older persons can lead to age-based discrimination, unequal access to healthcare, and inadequate treatment options for older adults. To provide high-quality care, it is crucial for health and social care professionals to challenge their own and others’ stereotypes, address ageism, and promote positive views on ageing. By adopting person-centred approaches to care and advocating for equitable treatment, health and social care professionals can contribute to improving the well-being and quality of life for older individuals.
Module 2.3
Older persons’ barriers to the expression of sexuality
Learning Outcomes
After reading this module you should be able to…
- Identify the barriers faced by older adults in expressing their sexual identity and the stigma associated with it.
- Evaluate the impact of cultural and social factors on the barriers to sexual expression in older adults.
- Examine the unique challenges faced by LGBTQ+ older adults in expressing their sexuality and the impact of discrimination and stigma.
- Understand the implications of cognitive impairment on sexual expression and the need for tailored support for older adults with cognitive decline.
- Discuss strategies to promote a safe environment for sexual discussions and ensure older people receive the care, information, education, and treatment they require.
Introduction
Barriers to expression of sexuality in older persons are related to the unique biological, psychological, and social challenges faced by older adults, as well as to cultural and social factors. These barriers include physical changes in older age, reluctance to seek and receive advice including treatment for sexual health, gender disparity in partner availability for intimacy and sexual activity, lack of information and education about sexuality, sexual identity and stigma, and cognitive impairment due to degenerative brain disorders.
Physical changes and sexual dysfunction
This topic is discussed in more detail in Module 1.2 Health related changes in Topic 1. Sexuality and Ageing.
Reluctance of older people to see and receive advice and treatment for sexual health
Barriers to seeking and receiving advice and treatment for sexual health in later life clearly exist and are both related to cultural and social factors (Ezhova et al, 2020). Both health professionals and older adults are hesitant to initiate conversations about sex and sexual health (Aboderin, 2017; Lindau et al., 2007; Pitt, 1998). A scoping review conducted by Ezhova et al. (2020) for instance, indicated that healthcare providers are hesitant to initiate conversations around sexual health or offer appropriate advice or clinical tests and that older people similarly tend to be reluctant to seek medical help on sexual matters. Indeed, an American study found only 38% of men and 22% of women aged 50+ years reported having discussions concerning sex and sexual health with their health practitioner (Lindau et al., 2007). In part this situation can be attributed to the fact that sexual experiences and sexual desire in older people are often stigmatised and healthcare professionals can feel unskilled, undertrained and unprepared to initiate discussions around sexual health in older age (Freak-Poli, 2020). This is not a new situation, as Pitt (1998, p.1452) noted decades ago ‘some older people are too shy to seek help, fearing that they should be ‘past it’ and may be regarded as ridiculous or as ‘a dirty old man’ (or woman). It is also often common that older people view practitioners as paternalistic to them, which might mean they expect healthcare professionals to initiate discussions on sex (Williams et al., 2007; Lindau et al., 2007). These barriers extend beyond interactions with health and social care professional and a systematic review conducted by Bauer et al. (2016) found various barriers to sexual expression in older residents in residential and nursing homes:
Barriers to expression of sexuality in older residents in long-term care settings
- Older people may be concerned about the impression given to other residents if they engage in sexual activity (Bauer et al., 2016).
- Residents can feel staff may not treat information confidentially regarding older people’s sexuality (Bauer et al., 2016).
- Older people thus do not perceive a need to discuss sexual health unless there is a problem to address (Slinkard & Kazer, 2011).
- Residents perceive staff to lack understanding around older people’s sexuality (Bauer et al., 2016).
- Older people avoid sexual discussions due to concerns around embarrassment or shame for both being sexually active and having a sexual ‘problem’ (Colton, 2008).
- Although sexual dysfunction is a barrier to sexual health, older people rarely raise it themselves (Colton, 2008).
- Older people rarely have discussions about sex with their health professionals and when they do, only minimal information is exchanged (Colton, 2008).
- Older people consider sexuality to be personal rather than an issue for staff or family members (Bauer et al., 2016).
- Older people think health professionals believe sex is irrelevant to older adults and that older people are largely asexual (Colton, 2008).
- Older people avoid discussions of sex and sexuality due to a lack of knowledge and consequent anxiety around potential treatment options for their sexual dysfunction or over concerns that age will mean treatment failures (Colton, 2008).
The evidence in the systematic review highlights that, in general, older people consider their sexuality and its expression to be a significant component of a good quality of life. However, some older people prefer their sexuality to remain within the personal realm and at the same time there is an evident desire for many to be able to discuss sexual dysfunction or other issue related to sexuality with care staff. In spite of this desire however, older people rarely initiate or have discussions about sex with their health or social care professionals and when they do, little information is exchanged as they are hesitant to discuss the topic openly. Negative attitudes, shame, embarrassment and a feeling that health-care staff are disinterested or have no treatment options to offer can all inhibit discussion. Thus, strategies that support promotion of a safe environment for sexual discussions are required for both health and care services and staff, and for older people (Bauer et al., 2016), so that there can be open sharing of information that can support older people to receive appropriate care, information, education, and treatment (Bauer et al., 2016).
Gender disparity in partner availability
Lack of opportunity for sexual experiences is a major barrier to sexual fulfilment for older adults. Several studies highlight this as the greatest barrier to being sexually active and demonstrate that it is not older age or lack of interest in sex, but more often rather the lack of a partner availability, with women particularly disadvantaged (Freak‐Poli, 2020; Rosen & Bachmann, 2008). For example, one Dutch study showed that partnered older adults were 15 times more likely to engage in sexual activity and 51 times more likely to engage in physical tenderness than un-partnered older adults (Freak-Poli et al., 2017). The fact that older partnered adults were engaging in sexual behaviour strongly suggests that given the opportunity, un-partnered older adults would also be likely to engage in sexual behaviour. Many people experience changes in marital status over their life course, and there is an increasing number of older adults who are not married nor cohabiting with their partner. Hence, partner status rather than marital status should be considered when studying sexual activity and physical tenderness.
Loss of a partner through death or incapacity of a spouse is a common scenario in the lives of older adults. While both un-partnered older men and women are less likely to engage in sexual behaviour than partnered older adults, older women greatly outnumber older men and thus are most likely to be un-partnered. On average, women live longer than men, and men often tend to pair with younger women, resulting in many women facing their husbands’ ageing before their own. This frequently means women spend approximately a decade more in widowhood without a partner when compared to men (Freak-Poli et al., 2017; Karraker et al., 2011).
Cultural factors can further disadvantage adult women in society. Although both women and men are included in the stereotype of the ‘asexual’ older person, older women tend to be subject to more restrictive sexual standards that largely only allow them to be sexual within committed relationships, which can restrict women’s sexuality to a greater extent than men’s (Lai & Hynie, 2011). These standards are grounded in stereotyped beliefs about the nature of gender, age, and sexuality, which are frequently reinforced by negative evaluations of those who behave in ways that violate social norms. It has been identified that women often feel subjected to a twin bind of both sexual and ageist constructions of ageing that define a woman as “sexually unattractive at an earlier age than a man” (Treas & Van Hilst, 1976, p. 135 in Lai & Hynie, 2011).
Cultural factors and lack of information
Older adults lack accurate information about sexuality. Sex education was not standard in curricula for many older people during the formative or even college years of their lives. Thus, current older generations frequently missed out on the sexual health education provided in schools today. Sexual values were also shaped by circumstances (e.g., economics, enculturation), and influenced by societal myths (e.g., that menopause signifies a downturn of sexual desire and loss of sense of femininity, that sexual activity must be initiated by the male, that there is only one correct position for intercourse). Thus, limited knowledge about sex and attitudes about sexuality among older adults are inextricably linked (Kazer, 2003). Consequently, older adults may hesitate or even evade discussion of sexual matters with their health care providers or may be under erroneous assumptions about sexual function in later life. One manifestation of this lack of knowledge or willingness to discuss sexual matters is the rising rates of HIV/ AIDS diagnoses in older adults (Goodroad, 2003; Streckenrider, 2023). Moreover, among older adults, due to lack of information regarding where to seek HIV testing, a diagnosis of HIV/ AIDS tends to be made later, the disease’s course is faster, and prognosis is poorer. Improving HIV/ AIDS education for older adults can therefore be an effective strategy for reducing infections (Falvo & Norman, 2004).
Western culture places great value on youth, physical attractiveness, and vigour. The pervasive message – conveyed in countless subtle and not-so-subtle ways—is that aging and sexual desirability are mutually exclusive. Older adults are therefore likely to share these perceptions and are certainly victimised by the negative stereotypes that these attitudes represent. This can play out in a number or ways, including lowered expectations for sexual fulfilment and avoidance of intimate relationships due to feelings of unworthiness or shame (Rheaume & Mitty, 2008). In general, there is a significant lack of educational resources, knowledge and research on sexuality for older people. Older age groups, independent of their sexual orientation, represent a hidden population and are commonly absent from sexual health campaigns and government policies (Ezhova et al., 2020).
Sexual identity and stigma
Older LBGT+ people are both notably absent in sexual health campaigns and are also a disadvantaged group, which can compound the unique risks and adverse health outcomes they face (Tremayne & Norton, 2017; Fredriksen-Goldsen et al., 2015). For example, the Aging and Health Report indicated that among older LGBT+ adults the rate of victimisation due to LGBT+ identification increases with age, and the rate of internalised stigma for those 80 and older is higher than for those 50-64 and 65-79 years old (Fredriksen-Goldsen et al., 2011). Although legal protections from discrimination and societal acceptance of members of LGBT+ communities have been increasing, many older LGBT+ individuals, especially those who came out when much younger, have experienced one or more forms of personal victimisation directly attributable to their gender identity and/or sexual orientation. The legacy of these experiences includes internalised homophobia and negative impacts on sexual expression and sexual quality of life. For example, 82% of older LGBT+ individuals who participated in the initial phase of the Caring and Aging Study reported experiencing at least one lifetime episode of victimisation because of actual or perceived sexual and/or gender identity discrimination, and 64% reported experiencing at least three or more episodes, and many LGBT+ individuals suffered enduring negative impacts on the quality of their sexual lives (Fredriksen-Goldsen et al., 2011). Furthermore, research has documented incidents of conflict, abuse, and ostracism of LGBT+ older adults in residential living environments due to displays of same-sex affection or simply the recognition by other residents or staff that the individual belongs to a gender and/or sexual minority (Brotman et al., 2003; Stein et al., 2010).
In addition, the supports that older people typically depend upon to reduce loneliness, promote aging in place, and gain access to care and services are less accessible to LGBT+ adults for a variety of reasons. Although acceptance and support for those who are LGBT+ has been increasing, LGBT+ older adults continue to experience discrimination from professionals and organisations whose mission is to help with challenges associated with aging. This can only undermine efforts to age in place, which would be the best way to support autonomy and privacy for both single and coupled members of the LGBT+ community, to facilitate them to continue freely expressing usual sexual practices. To put the situation in context, fear of mistreatment or discrimination is believed to be a major contributing factor to the finding that LGBT+ older adults are
20% less likely than their heterosexual peers to access government services such as housing assistance, meal programmes, food stamps, and senior centres, all of which may be essential for remaining at home as an individual ages (Czaja et al., 2016).
Isolation, loneliness, poverty, depression, delay of care, and disability are of particular concern for LGBT+ older adults compared to heterosexual and cisgender older adults (LGBTQIA Health Education Center, 2021). LGBT+ older adults are less likely than heterosexual adults to have children to help them and may also be estranged from family members or continue to conceal their sexual orientation due to fear of rejection (De Vries, 2009). At the same time, for many older LGBT+ adults, living with a family member may either severely limit opportunities for sexual intimacy or mean that sexual intimacy is not an option. Therefore, hiding one’s sexual orientation or gender identity, living in fear of disclosure, being estranged from family and communities, and experiencing arrest, harassment, violence, and discrimination can all have short and long-term consequences on a person’s health and well-being.
Cognitive impairment
Cognitive impairment may affect frequency of and satisfaction with sexual activity. Less than 25% of married individuals with mild to moderate cognitive impairment continue to engage in sexual activity (Ballard et al., 1997). Up to 70% of caregivers of individuals with possible or probable Alzheimer’s disease report indifference to sexual activity in their partners (Derouesné et al., 1996). The prefrontal cortex is involved in various aspects of sexual functioning including executive functioning, abstract thinking, sense of self and others, and judgement. Memory and emotional factors are also integral to intact sexual behaviour (Hartmans et al., 2014). A 2014 systematic review found an overall trend toward diminished sexual behaviour with cognitive decline and impairment (Hartmans et al., 2014). Cognitive functioning influences the perception of sexuality. Nonetheless, and in spite of these findings, sexual interest remains for many cognitively impaired older adults and healthcare providers should be aware of potential barriers to healthy sexual expression.
Conclusion
Although physiologic and psychosocial factors impact sexual expression, sexuality remains integral to quality of life for many older adults. Healthcare providers should therefore consider sex and gender diversity as well as multifactorial sexuality constructs around aging to become better equipped to address components such as sexual expression, sexual dysfunction, sexual identity and stigma, cognitive impairment and capacity to consent, and at times, sexually inappropriate behaviours. Recognising and ameliorating potential barriers to healthy sexual expression can improve quality of life for older adults and their loved ones.
Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Education and Culture Executive Agency (EACEA). Neither the European Union nor EACEA can be held responsible for them.Project Number: 2021-1-FR01-KA220-ADU-000026431
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