Stigmatised: sex and seniors.Stigmatised: sex and seniors. Photo: Mark Bowden

I spoke to a man recently who had a dilemma and needed some advice. His 73-year-old mother-in-law, who has early dementia, had been living in a nursing home for about six months. He and his wife were contacted by the staff who told them that she had started a relationship with another resident. They were seen kissing and holding hands, often spending time in each other’s room.

My client felt that as long as the relationship was consensual, it should not be a problem; he had noticed she seemed happier lately and couldn’t understand why the nursing home felt it necessary to inform them. But his wife was outraged – she had never seen her parents show any affection at all, and the thought that her mother might be having sex with a “stranger” was abhorrent to her.

In today’s society many people believe old people are not sexual any more and often managers of aged-care facilities think so too. Nursing home residents should be able to enjoy a healthy sex life, which is important to their psychological and physical wellbeing. It shouldn’t be a taboo. We are not just talking about intercourse – kissing, cuddling, holding hands or lying in bed together can be great sexual intimacy.

Aged-care facilities have a duty of care to make sure there is no abuse, but just because someone has dementia doesn’t mean they can’t consent. Carers have to remember that their residents are adults, not children, and having dementia doesn’t always stop them from making decisions. They may decide what TV show they want to see, what to eat, what to wear or even to refuse their medication. Therefore no one has the right to deny them the fundamental right of sexual expression.

Service providers need better education to understand that the most important challenge is to determine the capacity of an older person to consent to sexual activity, and to be able to put aside their beliefs and values. They also have to realise that they can’t discriminate against older lesbian and gay people, who often feel they have to get back into the closet.

More practical matters need to be addressed, too, since privacy can be a problem, with staff often “just walking in” without knocking at the door. And what about providing single king-size beds?

Over the past few years, several surveys have been conducted to find out more about the sex lives of older Australians, and the good news is that sexual activity is enjoyed into advanced age. Ageing doesn’t end sex, it changes it. Sometimes a couple may end up not having penis-vagina intercourse any more, but there are many other satisfying ways to be sexual.

Dr Lesley Yee of the Australian Centre for Sexual Health believes there are a number of ageist stereotypes in our community that make it difficult for both doctors and patients to discuss sexuality openly as patients become older. Many physicians may see sexual dysfunction in the elderly as a biological part of the ageing process and therefore not a medical issue. Discussing sex remains difficult or embarrassing for many GPs and in turn patients also find it difficult to raise sexual issues with their doctors.

Ageing changes sex; women start to experience menopausal changes such as vaginal dryness. The vaginal lining thins and sometimes intercourse becomes uncomfortable. Libido and sexual self-esteem may decrease, and for both men and women it often takes longer to have an orgasm. Men may experience erection problems and arousal can take more time. As a result many older people are not prepared for the sexual changes and they withdraw. But it doesn’t have to be that way as there are so many other ways to be sexual.

Keep your sex life alive by making time for it. Try different approaches that allow you to get excited and enjoy each other. Use hands, mouth, and sex toys to make love and enjoy an orgasm. Try to have sex in the morning when you are not tired and men’s testosterone levels are higher. Having sex releases several hormones in the body, which increases intimacy and bonding and works against loneliness and depression. When you are on your own, solo sex is a great option.

The United States seems to be less ageist than Australia. My favourite sex educator Betty Dodson is still working at age 84 and produces YouTube videos with business partner Carlin Ross. New York sex therapist Ruth Westheimer, better known as Dr Ruth, has her own YouTube channel and is 85 years old. American writer Joan Price is an advocate for ageless sexuality; check her out on YouTube where she discusses her books about ageless sex.