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Sex education and sexual interest don’t end at a certain age. Melanie Ramey is here not only to debunk myths about sexuality, sexual involvement, and connection later in life but to shed light on sexual information for all ages. This podcast will answer the questions that were never properly answered in health class and address the sex information we need but are too reluctant to discuss. Join Melanie for frank discussions about bodies, sexual health, desire, and age, with honesty and humor.
Narrator: [00:00:03] Here's a fact that should not be surprising, but probably is. 25% of those aged 75 to 85 are still sexually active. Given that reality, there are implications for privacy, individual rights and sensitivity to the issue among adult children, caregivers and assisted living facilities. Welcome to the Sexually Speaking podcast with sex educator and therapist Melanie Ramey.
Melanie Ramey: [00:00:32] Hello again. In this podcast we are continuing our discussion of sexuality throughout life from the time we're born until we get old, regardless of how old that will be. And this is a podcast for everyone, regardless of your age. Even if you're younger and you keep on breathing, you will get old. This reminds me of the subject of untold research that seeks to determine how and why some people live to be very old. And you see this all the time. You should eat certain things, you shouldn't eat certain things, you should drink certain things, you shouldn't drink certain things, and on and on kinds of ideas as to how it is that you can live to be old. Well, I have the solution and that is keep on breathing. That is the only sure way to live to be old. But this brings us to our topic then today that we're still breathing. As long as we are alive, we are also sexual beings. And so an interesting study in the New England Journal of Medicine revealed that 73% of Americans 57 to 64 years old, report being sexually active, 53% of Americans 64 to 75 years old report being sexually active, 26% of Americans 75 to 85 years old report being sexually active. People who are in excellent or very good health are two times more likely to be sexually active as those in fair or poor health. Women, for example, reported less sexual activity because they lacked sexual partners more often than men.
Melanie Ramey: [00:02:29] So where do older adults have sex? Well, in their private homes, in assisted living facilities, or in nursing homes. Obviously, older adults who continue to live in their own homes have more freedom to pursue whatever kind of relationships they choose. Wherever one lives, there are physical conditions that might interfere with sexual functioning. These, of course, can include health issues. They can include certain diseases like vascular disease, heart disease, diabetes, arthritis, cancer, stress incontinence, Parkinson's, depression and dementia. But I'm putting on the Facebook page a reference to a book by Doctor Robert Butler and Myrna Lewis. And they deal with all the different kinds of the medical conditions and how they impact one's sexuality. And so you might want to take a look at that. There are also medications that can interfere with sexual functioning. And these can include the antihypertensive drugs, the lipid lowering agents, diuretics, opioids, antihistamines, stimulants and antidepressants, to name a few. And alcohol and tobacco can also have an effect. So if you begin noticing a change in your sexual functioning and desire and have added a new medication or changed the dosage of one you have been taking, this should be the first place to check and see if that might be what is causing a change. Usually, when taking a prescription medication, you receive some printed information about the possible side effects. Unfortunately, the print is usually so small it's very difficult to read. If you use a computer or iPad or something like that, Google the medicine and it will come up and you can actually read it to understand what the side effects may be.
Melanie Ramey: [00:04:50] In reality, the word home is often broadened to include wherever an older adult lives, and this can include residing in an assisted living facility or a nursing home. In either of the special issues that are regarding sexuality can be a problem in these facilities. Assisted livings generally afford privacy and the space is occupied by only one person. Nursing homes are another matter, as they may have more than one unrelated person in a room. I have heard of assisted living facilities that require residents to keep the doors open to their living space. That is not legal. Residents have a right to privacy wherever they live. People are people wherever they live. And one of the issues is that in relation to other residents, to an unmarried couple who may have developed a relationship since coming to live there. And as you know, people like to gossip sometimes and they like to talk about other people, whether they're in an assisted living facility or in the community. It's very often these gossipy things are an expression of jealousy or the expression of a judgmental personality. But it's logical to realize that people living closely together, eating together, engaging in other activities offered by the residents, get more acquainted with other people and notice what other people are doing.
Melanie Ramey: [00:06:37] It's very important to understand that these kinds of things come up, and sometimes residents complain about other residents to the staff, and you have all sorts of altercations that get involved. But I would also like to mention that it's not uncommon when you live with new people, get acquainted with new people, that people do develop special relationships. And I recall the experience that Justice Sandra Day O'Connor had in that regard. As you remember, she was the first woman appointed to the Supreme Court of the United States. She served 25 years, and she retired from the court in 2006. The main reason for her retirement was that her husband was developing dementia, and she wanted to return with him to Arizona, their original home. So upon their return to Arizona, he went to live in an assisted living facility. A few weeks later, when she went to visit her husband, he greeted her holding a woman's hand and introduced the woman as his friend. The staff was concerned, as were some of the other residents, as to what she should do, because clearly she was his wife. Her response to their concerns was that she was glad that he had made a special friend there, as it would make him more comfortable, and that it really had nothing to do with her being his wife. He very likely no longer even understood what the word wife actually meant. I have consulted on a number of difficult situations that have come up in assisted living facilities, involving patient relationships and their families.
Melanie Ramey: [00:08:35] Most of these could have been avoided if the management had used preventive educational approaches with the staff and family at the time of admission. It's not uncommon for the caregiving staff in these facilities to be young people. They also need to be trained to understand that people are sexual beings as long as they live. Some of them lack understanding about older adults and sexuality. It's very unfortunate that the training requirements for assisted living staff is very minimal on all levels.
Melanie Ramey: [00:08:58] Doctor Gail Appel Doll, director of the Center on Aging at Kansas State University, has written the best resource of which I am aware. It's entitled Sexuality in Long Term Care. And as she points out, there are three domains that intersect and play a role in how people experience and express sexuality. These are the biological, the psychosocial, and cultural. These domains are constantly changing, which also means that one's sexual changes over the life span. She, like other experts in the field of aging, make the case that it's absolutely essential that assisted living facilities and nursing homes must develop policies that set forth the various aspects of sexual expression and how the staff is to respond. Staff training is an essential component. It cannot be omitted.
Melanie Ramey: [00:10:31] One of the best models of policy development was the one done by the Jewish Home at Riverdale in the Bronx, New York. They have also developed an excellent video entitled Freedom of Sexual Expression, Dementia and Resident Rights in Long Term Care Facilities. I will put information on the Facebook page as to how you can obtain this video. I think that all facilities should be using it for staff training.
Melanie Ramey: [00:10:40] Like all older people, members of the LGBTQ community experiences the same loss as older adults, loss of career, loss of families, friends and changes in health. However, there are special issues that also affect them. They are two and a half times more likely to live alone, two times more likely to be single, and four and a half times more likely to have no children to call on when they are in need. Their social networks consist of families or friends, or families of friends, or families of choice. Older gays, by a large majority, consider friends to be a source of social support rather than family of origin. And this is probably because they sometimes have been rejected by some of their relatives, or maybe they've continued to feel a need to sort of hide their sexual orientation, and also, they don't have children. In the nursing home it's important that staff treat them professionally without bias or judgment. Many older gay people are fearful and hesitant about moving into a nursing home. In particular, it's probably due to previously experienced discriminations. It is vital that all long term care facilities do an in-depth assessment of all of their policies, intake, assessments, staff training and marketing material so that they can offer inclusive services to everyone, including the LGBTQ community.
Melanie Ramey: [00:12:59] I also want to comment on a topic that I'm getting ready to discuss, and that's if people become involved with Alzheimer's or have dementia as they age. It's absolutely critical that people have a power of attorney for health care regardless of one's age. And this is because any kind of health crisis can arrive at any time. However, this becomes even more critical as one ages if one should develop some form of dementia. Someone must be able to make health care decisions for a person if that person may not be able to continue to do so. If the power of attorney is not made when one is mentally able to do it, it can become an issue of having to seek guardianship of a person in order to obtain care for them. Guardianship is a legal procedure that can also be time consuming and expensive and difficult to arrange, especially in a crisis situation. The presence of dementia has a unique issue with regard to sexuality, and that is of the capacity to consent to a sexual relationship. It is common that sexual expression is not fostered but restrained in nursing homes. The personal values of the nursing home staff may supersede the rights of patients. Sexual expression is often labeled sexually inappropriate behavior. By law, nursing homes must accommodate the privacy needs of consenting adults.
Melanie Ramey: [00:14:50] But this whole issue of consent and when one is able to consent is very important to understand. And I want to talk with you about a most interesting and unfortunate case in that regard. And this was a case in the state of Iowa that was settled in 2015. And this was the case of Mr. Henry Rayhons. Mr. Rayhons was a 78 year old farmer. And he was a former member of the state legislature. His wife was a resident of a nursing home nearby in Iowa. And she was suffering from Alzheimer's. Mr. Rayhons was accused of sexually abusing his wife. The nursing home staff told him his wife was not able to consent to having sex. Mr. Rayhons visited his wife every day. One day, the older woman, who was also in the same room as his wife, said that she heard noises that sounded like sex when he was visiting. Mr. Rayhons denied it and said he only kissed his wife and held her hands. He said she liked to touch him and be held. However, this other resident reported to the staff that she was sure she heard sounds that sounded like sex. The staff unfortunately reported him to the state regulators in Iowa, and the district attorney in that county decided to prosecute him. He reported in a very emotional testimony that he and his wife loved each other very much, and that he loved her until the day she died. There was no evidence that he had sexually abused his wife.
Melanie Ramey: [00:16:49] The other woman in the room was admittedly hard of hearing and, quote, thought she had heard sounds that sounded like sex. There were no witnesses, and an examination of his wife found no evidence that she had had sexual intercourse. As you can imagine, this was a very difficult for Mr. Rayhons. And the jury found Mr. Rayhons not guilty of sexual harassment. And at the conclusion of the trial, the director of the Iowa Coalition Against Sexual Assault said that one of the very sad things that this case makes clear is that facilities, health care providers, families and patients need to have clear guidelines to protect vulnerable people and to be sure that sexual predators are punished, if appropriate. And I would have to have empathy for everyone involved in this situation, as it has been extremely unfortunate. So this is of course, back to our point of few minutes ago, that it's really critical that staff and facilities have good policies in place, and that the staff are trained in how to interact with residents in terms of their sexual needs and desires. This is a developing issue that will continue to be in our thoughts as more and more people go to live in these facilities. But I would also strongly, strongly urge that if you are investigating a place for one of your family members or friends or so forth, that you ask to see the policies that they have about sexuality and the residence, because these will be very revealing.
Melanie Ramey: [00:18:58] For example, if they don't have any, that is not the place you want to leave somebody. And if they do have them, take time to read them and be sure that you understand them, because some issue may come up regarding your person after they have gone to live in a facility. Another issue that's just sort of peripheral here is that some of the facilities have not actually sort of changed their understanding of people and their families. I know recently someone told me about assisted living facility where they live, and that they had formerly been taking all the residents shopping once a week to get personal items, and they made an announcement they were no longer going to do that and that people should have their family bring in stuff. Well, a lot of people don't have families, and as more of us get to be older, people outlive their families. And so, you know, these facilities need to actually be more open to understanding that a lot of people there are single people, a lot of people there are LGBTQ people. They have different kinds of family situations and cannot be dependent upon a, quote, family to help take care of them. But the policies that the facilities have about residents and their privacy and so forth are very important. And be sure and take time to understand them before you sign somebody up. And so until next time, stay well.
Narrator: [00:20:38] You've been listening to Sexually Speaking with sex educator and therapist Melanie Ramey. Join Melanie again for more fascinating topics about sexuality. Please visit Sexually Speaking with Melanie Ramey on Facebook, Instagram, and LinkedIn.