First comprehensive survey charts sexual behavior among Americans ages 57 to 85By John Easton
Medical Center Communications
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’s National Social Life, Health and Aging Project, presented in the August 23 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 percent of women), vaginal dryness (39 percent of women) or erectile dysfunction (37 percent 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 Lindau, Assistant Professor of Obstetrics & Gynecology and lead author of the study.
With the first baby boomers turning 60, older adults make up the fastest growing segment of the U.S. 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, the George Herbert Mead Distinguished Service Professor in Sociology and the College and co-director of the 1992 National Health and Social Life Survey, which surveyed people aged 18 to 59.
“Social relationships are known to contribute to health and well-being in older men and women,” said Richard Suzman, 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 percent) and even fewer women (22 percent) 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 percent) 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, the Lucy Flower Professor in Urban Sociology and the College and Director of the Center for Aging at the National Opinion Research Center. 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.”
Funded by the National Institutes of Health, the project 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 either over-estimate 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 the National Social Life, Health and Aging Project 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 papilloma virus, a sexually transmitted disease.
The researchers 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, participants were very forthcoming. 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 reported being sexually active had 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 one quarter of women acknowledged masturbating whether or not they had a sexual partner.
“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 commonly reported reason for sexual inactivity among individuals with a spousal or other intimate relationship for men (55 percent) and women (64 percent) 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 policy-makers 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.”
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 also is supported by NORC, whose staff was responsible for the data collection.
Additional authors of the study include Philip Schumm, Senior Biostatistician in Health Studies, Colm O’Muircheartaigh, Professor in the Irving B. Harris Graduate School of Public Policy Studies, and Wendy Levinson of the University of Toronto.