geriatrics
Intimacy and Older Adults
Introduction
Intimacy refers to a close feeling shared between two people, based on knowledge of and familiarity with the other person. It includes emotional, social (based on shared experiences), and physical intimacy (eg, touching, cuddling, sexual intercourse). The desire for intimacy does not decrease with age, and there is no age at which intimacy, including physical intimacy, is inappropriate. However, the disorders and emotional changes that often occur with aging can interfere with developing and maintaining an intimate relationship. Aging can also change the way intimacy is expressed. Intimacy, particularly physical intimacy, may be lost because of the following: Loss of a partner:Loss or absence of a partner is probably the most common age-related barrier to intimacy. Disorders:Various disorders that become more common with increasing age can interfere with physical intimacy. Vascular disorders and diabetes can cause erectile dysfunction; arthritis can limit movements and make them painful. The pain, discomfort, medications, and worry associated with a disorder can dampen the desire for intimacy. Moderate to severe cognitive impairment complicates issues of consent to and comfort during intercourse. For the partner, the stress and demands of caregiving may interfere with intimacy. Use of medications:Older adults are more likely to take medications (eg, antihypertensives, psychoactive medications) that can cause problems affecting intimacy (eg, erectile dysfunction, reduced libido). Age-related changes:Levels of sex hormones decrease, causing changes (eg, vaginal atrophy, reduced vaginal lubrication) that make sexual intercourse uncomfortable or difficult. Libido may decrease. Reluctance to discuss effects of aging:If older people develop problems that interfere with physical intimacy or if they feel embarrassed about changes in their body (eg, wrinkles, sagging flesh), they may not want to discuss these changes with their partner or with a health care professionals, who may be able to suggest solutions. Discrepancy in expectations of partners:One partner may want certain physical expressions of intimacy, but the other does not. Lack of privacy:Older people who live with family members or in a long-term care facility have fewer opportunities for privacy, which are necessary for physical intimacy. Shift to other forms of intimacy:Some couples grow to prefer other forms of intimacy (eg, touching, massaging, kissing, verbal expressions of affection) that express familiarity, caring, or engagement with their partner. Nonetheless, many older people continue to have a healthy sexual relationship. Intimacy, particularly physical intimacy, can help prevent depression and improve self-esteem and physical health. If older people have a new sex partner, they should practice safe sex. Acquiring sexually transmitted infections, including AIDS, is a risk, regardless of age, and physicians should discuss safe sex measures with older patients. Many older people, especially those who live alone, find satisfaction and a sense of companionship in interactions with a pet. Caring for a pet can give people a sense of purpose and connectedness. 