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It’s time to end the taboo of sex and intimacy in care homes

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Imagine living in an aged care home. Now imagine your needs for touch and intimacy being overlooked. More than 500,000 individuals aged 65+ (double the population of Cardiff) live in care homes in Britain. Many could be missing out on needs and rights concerning intimacy and sexual activity because they appear to be “designed out” of policy and practice. The situation can be doubly complicated for lesbian, gay, bisexual or trans individuals who can feel obliged to go “back into the closet” and hide their identity when they enter care.

Little is known about intimacy and sexuality in this sub-sector of care. Residents are often assumed to be prudish and “past it”. Yet neglecting such needs can affect self-esteem and mental health.

A study by a research team for Older People’s Understandings of Sexuality (OPUS), based in Northwest England, involved residents, non-resident female spouses of residents with a dementia and 16 care staff. The study found individuals’ accounts more diverse and complicated than stereotypes of older people as asexual. Some study participants denied their sexuality. Others expressed nostalgia for something they considered as belonging in the past. Yet others still expressed an openness to sex and intimacy given the right conditions.

Insights

The most common story among study participants reflected the idea that older residents have moved past a life that features or is deserving of sex and intimacy. One male resident, aged 79, declared: “Nobody talks about it”. However, an 80-year-old female resident considered that some women residents might wish to continue sexual activity with the right person.

For spouses, cuddling and affection figured as basic human needs and could eclipse needs for sex. One spouse spoke about the importance of touch and holding hands to remind her partner that he was still loved and valued. Such gestures were vital in sustaining a relationship with a partner who had changed because of a dementia.

Care staff underlined the need for training to help them to assist residents meet their sexual and intimacy needs. Staff highlighted grey areas of consent within long-term relationships where one or both partners showed declining capacity. They also spoke about how expressions of sexuality posed ethical and legal dilemmas. For example, individuals affected by a dementia can project feelings towards another or receive such attention inappropriately. The challenge was to balance safeguarding welfare with individual needs and desires.

Some problems were literally built into care home environments and delivery of care. Most care homes consist of single rooms and provide few opportunities for people to sit together. A “no locked door” policy in one home caused one spouse to describe the situation as, “like living in a goldfish bowl”.

But not all accounts were problematic. Care staff wished to support the expression of sex, sexuality and intimacy needs but felt constrained by the need to safeguard. One manager described how their home managed this issue by placing curtains behind the frosted glass window in one room. This enabled a couple to enjoy each other’s company with privacy. Such simple changes suggest a more measured approach to safeguarding (not driven by anxiety over residents’ sexuality), which could ensure the privacy needed for intimacy.

Conclusions

Our study revealed a lack of awareness by staff of the need to meet sexuality and intimacy needs. Service providers need guidance on such needs and should provide it to staff. The information is out there and they can get the advice they need from the Care Quality Commission, Independent Longevity Centre, Local Government Association and the Royal College of Nursing.

Policies and practices should recognise resident diversity and avoid treating everyone the same. This approach risks reinforcing inequality and doesn’t meet the range of needs of very different residents. The views of black, working-class and LGBT individuals are commonly absent from research on ageing sexuality and service provision. One care worker spoke of how her home’s sexuality policy (a rare occurrence anyway) was effectively a “heterosexuality policy”. It may be harder for an older, working-class, black, female or trans-identified individual to express their sexuality needs compared to an older white, middle-class, heterosexual male.

Care homes need to provide awareness-raising events for staff and service users on this topic. These events should address stereotyping and ways of achieving a balance between enabling choices, desires, rights and safeguarding. There is also a need for nationally recognised training resources on these issues.

Older people should not be denied basic human rights. This policy vacuum could be so easily addressed over time and with appropriate training. What we need now is a bigger conversation about sex and intimacy in later life and what we can do to help bring about some simple changes in the care home system.

Complete Article HERE!

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My Son Might Be Gay. What Should I Say to Him?

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There’s a reason he hasn’t come out to you yet.

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Making your way through this cruel, confounding, ever-changing world is difficult. Something make you anxious this week, or any week? Lay it on me at askdaveholmes@gmail.com. I’m here to help you minimize the damage you will necessarily inflict on the world just by being alive.

So, what’s your problem?

Dave,

I have a 17-year-old son, and I am fairly sure he is gay. He is not out, although I don’t know if he might be to any close friends. What’s hardest for me as his dad is that I know that this time of life can be confusing and frustrating to any kid, and I only know the experience of a straight guy. I can’t imagine how much harder or more complicated it must be for him. I would love to be able to be more supportive of him, but I certainly am not going to confront him.
Since your column a couple of weeks ago was advice for coming out to your family, my related question is: What advice do you have for the family of someone who hasn’t yet come out?
Many thanks,

Mark

Mark, you are one hell of a father, so first and foremost: thank you. You’re attuned to your kid’s developing identity, you’re not trying to change him, and you’re considering how your words and behavior will affect him down the road. I’m not a parent, but I know these are all difficult and necessary things. You are actively improving your son’s quality of life just by thinking about them. Well done.

Here’s a story to illustrate what you should definitely not do. Years ago, when I was not much older than your son, I was at home on a Sunday night flipping through the TV channels with my mother. Not much was on: a Murder She Wrote we’d already seen; a Parker Lewis Can’t Lose she wouldn’t have understood; probably an actual opera in Italian on A&E or Bravo, because that’s actually what those networks used to give you. I paused on our local PBS affiliate, where a huge choir was singing, and after a few seconds I realized it was the Gay Men’s Chorus of some city or another doing a fundraising concert.

I stopped there, just to see what would happen. At this time in my life, I was 99 percent certain I was gay, though nowhere near ready to spring it on my parents. We had no gay people in our lives back then, no way to gauge my family’s level of tolerance. And here it was: the most passive, least courageous way I could drag the topic into the family room, kicking and singing.

We had no gay people in our lives back then, no way to gauge my family’s level of tolerance.

We watched as they delivered a rendition of what I remember as “Somewhere Over the Rainbow,” because either they or my memory are unforgivably basic. But it was gorgeous. Stirring and brave and subversive, coming as it did in a time before marriage equality was on the map, a time when you only saw gay people on the news. I got chills.

Then they finished, and my mom turned to me and said, “I really pity them.”

I switched it to Parker Lewis and left the room.

Now, I am comfortable telling you this story now because it was ages ago, she has come a long way since then, and also there’s a zero percent chance she’s ever going to read this because it’s on the computer. But it stands as evidence that sometimes saying nothing is the stronger choice

Good on you for not point-blank asking your son whether he’s gay. You are probably going to be the last person he tells. That doesn’t mean that he doesn’t trust you or that you didn’t make it an easy enough process for him. It means one simple, inescapable thing: Once you have told your dad you’re gay, there is no going back. You have given your final answer, and you are locking it in. And what if it all just lifts one day, and you wake up straight, and then you get married and have to spend your whole wedding day wondering whether your dad is thinking about what you told him that one time?

Right now, if your instinct is correct, your son is sorting through all of his competing urges and trying to determine which are his and which belong to society. Right now, everything is possible. You are probably correct that the confusion and frustration he’s experiencing is different than what you and all teenagers have gone through. But as to whether it’s harder, it’s all relative. This is the only adolescence he’s ever going to have. And as you know from personal experience, it’s not like straight teenagers are dying for their parents’ involvement in their relationships and identity development. Right now, he has to be secretive, not because he’s gay, but because he’s 17. And if his personal experience is indeed tougher than his peers’, then he will end up tougher than his peers.

I’d love to say that you should do a big, showy “Hey, I sure do like those gay people” at the dinner table. I want to tell you to find out when Brokeback Mountain is on HBO and then accidentally turn it on right at the beginning when he’s in the room. I wish it were as simple and CBS-sitcommy as invite the gay guy from work to family bowling night. But it isn’t. Don’t do any of these things. At this age, kids are not only wildly self-conscious, they are also you-conscious. They know what you’re trying to do and what you’re asking without asking. Any well-meaning attempt to raise The Topic is only going to make him more nervous.

At this age, kids are not only wildly self-conscious, they are also you-conscious.

The one thing you can do, which I suspect you’re already doing, is to make him feel like a secure and separate person. To chisel away at the shame our culture hangs on all of us. To make him strong in his opinions and choices, even when they wouldn’t be yours. Discuss the news of the day with him, and when he makes a point that differs from yours, thank him for giving you a fresh perspective. Do what you can to make him feel like he can stand on his two feet, even when he’s standing apart from you. It’s a skill he’ll need, no matter which side of the fence he eventually lands on.

No matter what you do, know one important thing: He’s 17, and he’s probably going to react by rolling his eyes and going to his room. That’s what I did when my own father subtly tried to engage with me long ago. Teens can’t help it. It is their job. But trust me: Your son is listening, and he won’t forget it. (And Dad, wherever you are: I see now what you were doing playing so much Wham! in your car, and I appreciate it.)

But again, by simply being the kind of person who asks a question like this, you are doing more than most fathers. This kid is lucky to have you. We all are

Complete Article HERE!

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Why men and women lie about sex, and how this complicates STD control

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When it comes to reporting the number of sex partners or how often they have sexual intercourse, men and women both lie. While men tend to overreport it, women have a tendency to underreport it. Although the story is not that simple and clear-cut, I have discovered some interesting reasons why this is the case – and why it matters to doing research on sexual health.

Lying is an inherent aspect of reporting sexual behaviors. For instance, more females report being a virgin (i.e., had not had sexual intercourse) despite having had genital contact with a partner, compared to males.

I have studied sexual avoidance and also frequency of sex in patient populations. In this regard I have always been interested in gender differences in what they do and what they report. This is in line with my other research on gender and sex differences.

The low validity and usefulness of self-reported sexual behavior data is very bad news for public health officials. Sexual behavior data should be both accurate and reliable, as they are paramount for effective reproductive health interventions to prevent HIV and STD. When men and women misreport their sexual behaviors, it undermines program designers’ and health care providers’ ability to plan appropriately.

Pregnant virgins, and STDs among the abstinent

A very clear example is the proportion of self-reported virginal status among pregnant women. In a study of multi-ethnic National Longitudinal Study of Adolescent Health, also known as Add Health, a nationally representative study of American youth, 45 women of 7,870 women reported at least one virgin pregnancy.

Another example is the incidence of sexually transmitted diseases (STDs) which are not expected among young adults reporting sexual abstinence. Yet more than 10 percent of young adults who had a confirmed positive STD reported abstaining from any sexual intercourse in the last year before STD testing.

If we ask youth who have had sexual experience, only 22 percent of them report the same date of first sex the second time we ask about it. On average, people revise their (reported) age at first sex to older ages the second time. Boys have higher inconsistency reporting their first sex compared to females. Males are more likely than females to give inconsistent sexual information globally.

Why don’t people tell the truth about sex?

Why do people lie about their sexual behavior? There are many reasons. One is that people underreport stigmatized activities, such as having multiple sexual partners among women. They overreport the normative ones, such as higher frequency of sex for men. In both cases, people think their actual behavior would be considered socially unacceptable. This is also called social desirability or social approval bias.

Social desirability bias causes problems in health research. It reduces reliability and validity of self-reported sexual behavior data. Simply said, social desirability helps us look good.

As gender norms create different expectations about socially acceptable behavior of men and women, males and females face pressures in reporting certain (socially accepted) behaviors.

In particular, self-reports on premarital sexual experience is of poor quality. Also self-reports of infidelity are less valid.

Although most studies suggest these differences are due to the systematic tendency of men and women to exaggerate and hide their number of partners, there are studies that suggest much of this difference is driven by a handful of men and women who grossly inflate and underreport their sexual encounters.

Even married couples lie

Men and women also lie when we ask them who is making sexual decisions regarding who has more power when it comes to sexual decision-making.

We do not expect disagreement when we ask the same question from husbands and wives in the same couples. But, interestingly, there is a systematic disagreement. More interestingly, in most cases when spouses disagree, husbands are more likely to say “yes” and wives “no.” The findings are interpreted in terms of gendered strategies in the interview process.

Not all of the gender differences in reported sexual behaviors are due to men’s and women’s selective under- and over- reporting of sexual acts. And, some of the sexual behaviors do vary by gender. For instance, men have more sex than women, and men less commonly use condoms. Men have more casual partners, regardless of the validity of their report.

Secretive females, swaggering males

Studies have found that on average, women report fewer nonmarital sexual partners than men, as well as more stable longer relationships. This is in line with the idea that in general men “swagger” (i.e., exaggerate their sexual activity), while women are “secretive” (i.e., underreport sex).

Structural factors such as social norms shape men’s and women’s perceptions of appropriate sexual behaviors. Society expects men to have more sexual partners, and women to have fewer sexual partners.

According to the sexual double standard, the same sexual behavior is judged differently depending on the gender of the (sexual) actor (Milhausen and Herold 2001). Interestingly, men are more likely to endorse a double standard than women.

In the presence of sexual double standards, males are praised for their sexual contacts, whereas females are derogated and stigmatized for the same behaviors, “He’s a Stud, She’s a Slut.”

Research suggests that lifetime sexual partnerships affect peer status of genders differently. A greater number of sexual partners is positively correlated with boys’ peer acceptance, but negatively correlated with girls’ peer acceptance.

Self-serving bias is common

As humans, self-serving bias is a part of how we think and how we act. A common type of cognitive bias, self-serving bias can be defined as an individual’s tendency to attribute positive events and attributes to their own actions but negative events and attributes to others and external factors. We report on sexual behaviors which are normative and accepted to protect ourselves, and avoid stress and conflict. That will reduce our distinction from our surroundings, and will help us feel safe.

As a result, in our society, men are rewarded for having a high number of sexual partners, whereas women are penalized for the same behavior.

The only long-term solution is the ongoing decline in “double standard” about sexual morality. Until then, researchers should continue questioning the accuracy of their data. Computerized interviews may be only a partial solution. Increasing privacy and confidentiality is another partial solution.

Complete Article HERE!

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What do men really think about sex? This is why we need better education

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We asked men how they learned about sex, and found that puerility and pornography have always trumped the facts. Mandatory sex education is most welcome

‘Alan, now aged 79, was evacuated to the countryside at the age of five – and spotted a bull mounting a cow. “It was a significant part of my sex education,” he said.’

It was announced this month that sex and relationship education is to become mandatory in schools for children aged four to 15. About time too. It’s never been easy for children who have wanted to learn credible information about sex.

We’ve recently been interviewing men for a project to find out what they really think, feel and do about sex, and found the early information they received was, in many cases, baffling. “Women don’t like it,” Bill was told as a teenager in the 1960s, “but you can do it all the same … [and] you only do it on Sundays when the children are out.”

Back in the 1940s, communicative adults were hard to come by, and children had to solve the mystery by themselves. Alan, aged 79, was evacuated from London to the countryside, aged five. There he spotted a large bull mounting a cow. “It was very significant,” he said. “I have never forgotten it.”

At primary school Bill, now 75, believed boys stood behind girls to do “it” (he was basing this on his observation of dogs). He was hugely embarrassed when told to stand behind a girl in a school folk-dance performance. “I thought that was very dirty.”

It was a rare grown-up who suggested that sex might be something pleasant, or something to look forward to; rather, a child’s sex education was more likely to elicit feelings of fear, danger and shame – and would often involve a lonely search for the facts. By the late 1950s, parental guidance was still fairly non-existent. At 14, Michael remembered finding a “dirty book” belonging to his father: “The Kama Sutra was an excellent source of information, but often mind-boggling too … the contortions! The big penises! And the pleasure shown on women’s faces. I couldn’t believe it could be like that!”

‘The Kama Sutra was an excellent source of information – but mind-boggling, too!’

While Michael was studying the Kama Sutra, the only sex still being taught in the classroom involved plants and rabbits, and was often expressed in Latin. Several more decades were to pass before human genitalia and procreation were bravely described in English. Not until the early 1990s did the national curriculum specify that sex education must be taught. But just the mechanics. Nothing about relationships. And making the subject even more shambolic was the decision that each school could have its own individual policy, and each teacher was stuck with their own capabilities, experiences, terrors and confusions in conveying this information.

The easy way out was to explain that sex happened “when people loved each other and wanted babies”. Pleasure, variety and consent were rarely mentioned. But some teachers bravely tried to further enlighten the children. In 1994, in his last year of junior school, Dean, who was then aged 10, went to a sex education lesson in which his teacher tried her very best to take an innovative, practical and robust approach.

“Miss Woods asked the class if they knew of any ‘barrier methods’. I didn’t really know what they were, but someone said ‘condoms’. Miss Woods said, ‘Yes, anything else?’ Then a boy called Dave said, ‘You can get them with feathers on the end, Miss.’ Miss Woods looked cross, and said, ‘No you can’t’ – but Dave went on and on, saying, ‘Yes you can, they’re called French ticklers, I read in my Mum’s book. It had pictures in,’ and then Miss butted in, and said ‘Nonsense’, so Dave had to shut up.”

Here was Miss Wood’s chance to grasp the nettle. But even then, in the late 20th century, she could not. Although bolder than many teachers, she was still not able to respond to any surprises that might crop up.

Even if teachers now manage to describe sex as pleasant, it sometimes seems to frighten and shock, rather than enthuse the children. Informed, six years ago, by a comparatively enlightened teacher, that people had sex “because it felt lovely”, eight-year-old George was horrified. “Miss made a terrible mistake,” he told his Grandma, with great authority and concern. “She said it felt nice! She’s got it really wrong!”

Age specificity hadn’t really been thought through. Slightly older, more intrepid boys, sensing that they still weren’t quite getting at the truth, or any satisfactory explanations – either from each other, or from adults – now gained access to a greater selection of more flamboyant, salacious, almost cartoonish information: porn.

“I think as boys we’d seen a few porno films here and there,” said Jason. “The first stuff I saw was on a video. I was 13, and the tape started doing the rounds – we thought that was the way you did it.”

As the years have passed, and porn has become more widely available online, younger and younger children have been seeing such imagery. In 2001, Jack, then aged 10, learned about sex from pornography. “Everyone was looking at it,” he said. “That’s how I found out I was gay. I didn’t want to look at the girls.”

Despite the overwhelming flood of pornography – and the continuing lack of guidance – there do appear to be a few glimmers of hope. The importance of relationships and feelings is now creeping into sex education at last, and it is a relief to find the idea of consent has surfaced. Many of the young men interviewed in the BBC3 documentary Sex on Trial were sympathetic when shown footage of a young woman whose consent had not been clearly given. In fact, they were more sympathetic than the young women. That’s reason to be hopeful, at least where young men are concerned.

Unfortunately, most sex education is still passed between children themselves, taught by the “naughty” peers who seem to have found out more than anyone else. Or are pretending that they have. Boasting has always been, and still seems to be for many boys, the beginning of proving that you are a proper man. Frequency, volume, conquest and size still matter to them. How are young men to understand women if they have never been taught to understand themselves, and the people teaching them have been taught even less?

Hopefully the new national curriculum mandatory sex education plans will bring about change for the better. It might help if lessons could be conducted in small groups, with the sexes separated. It would need to be age-appropriate, of course – with less emphasis on the mechanical details, and more on the importance of relationships, with appropriately trained teachers, prepared for anything the children might say, know or have experienced. They also need to be unshockable.

Complete Article HERE!

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When a Partner Dies, Grieving the Loss of Sex

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After Alice Radosh’s husband of 40 years died in 2013, she received, in addition to the usual condolences, countless offers of help with matters like finances, her car and household repairs. But no one, not even close friends or grief counselors, dared to discuss a nagging need that plagues many older women and men who outlive their sexual partners.

Dr. Radosh, 75 and a neuropsychologist by training, calls it “sexual bereavement,” which she defines as grief associated with losing sexual intimacy with a long-term partner. The result, she and her co-author Linda Simkin wrote in a recently published report, is “disenfranchised grief, a grief that is not openly acknowledged, socially sanctioned and publicly shared.”

“It’s a grief that no one talks about,” Dr. Radosh, a resident of Lake Hill, N.Y., said in an interview. “But if you can’t get past it, it can have negative effects on your physical and emotional health, and you won’t be prepared for the next relationship,” should an opportunity for one come along.

Yes, dear readers of all ages and the children of aging parents, many people in their golden years still have sexual urges and desires for intimacy that go unfulfilled when a partner becomes seriously ill or dies.

“Studies have shown that people are still having and enjoying sex in their 60s, 70s and 80s,” Dr. Radosh said. “They consider their sexual relationship to be an extremely important part of their lives. But when one partner dies, it’s over.”

In a study of a representative national sample of 3,005 older American adults, Dr. Stacy Tessler Lindau and co-authors found that 73 percent of those ages 57 to 64, 53 percent of those 65 to 74 and 26 percent of those 75 to 85 were still sexually active.

Yet a report published by the United Kingdom’s Department of Health in 2013, the National Service Framework for Older People, “makes no mention of the problems related to sexual issues older people may face,” Dr. Radosh and Ms. Simkin wrote in the journal Reproductive Health Matters. “Researchers have even suggested that some health care professionals might share the prejudice that sex in older people is ‘disgusting’ or ‘simply funny’ and therefore avoid discussing sexuality with their older patients.”

Dr. Radosh and Ms. Simkin undertook “an exploratory survey of currently married women” that they hope will stimulate further study of sexual bereavement and, more important, reduce the reluctance of both lay people and health professionals to speak openly about this emotionally and physically challenging source of grief.

As one therapist who read their journal article wrote, “Two of my clients have been recently widowed and felt that they were very unusual in ‘missing sex at my age.’ I will use your article as a reference for these women.”

Another wrote: “It got me thinking of ALL the sexual bereavement there is, through being single, through divorce, through disinterest and through what I am experiencing, through prostatectomy. It is not talked about.”

Prior research has “documented that physicians/counselors are generally uncomfortable discussing sex with older women and men,” the researchers noted. “As a result, such discussions either never happen or happen awkwardly.” Even best-selling memoirs about the death of a spouse, like Joan Didion’s “The Year of Magical Thinking,” fail to discuss the loss of sexual intimacy, Dr. Radosh said.

Rather than studying widows, she and Ms. Simkin chose to question a sampling of 104 currently partnered women age 55 and older, lest their research add to the distress of bereaved women by raising a “double taboo of death and sex.”

They cited a sarcastic posting from a woman who said she was not a good widow because “a good widow does not crave sex. She certainly doesn’t talk about it…. Apparently, I stink at being a good widow.”

The majority of survey participants said they were currently sexually active, with 86 percent stating that they “enjoyed sex,” the researchers reported. Nearly three in four of the women thought they would miss sex if their partner died, and many said they would want to talk about sex with friends after the death. However, “76 percent said they would want friends to initiate that discussion with them,” rather than bringing it up themselves.

Yet, the researchers found, “even women who said they were comfortable talking about sex reported that it would not occur to them to initiate a discussion about sex if a friend’s partner died.” The older the widowed person, the less likely a friend would be willing to raise the subject of sex. While half of respondents thought they would bring it up with a widowed friend age 40 to 49, only 26 percent would think to discuss it with someone 70 to 79 and only 14 percent if the friend was 80 or older.

But even among young widows, the topic is usually not addressed, said Carole Brody Fleet of Lake Forest, Calif., the author of “Happily Even After” who was widowed at age 40. In an interview she said, “No one brought up my sexuality.” Ms. Fleet, who conducts workshops for widowed people, is forthright in bringing up sex with attendees, some of whom may think they are “terrible people” for even considering it.

She cited “one prevailing emotion: Guilt. Widows don’t discuss the loss of sexual intimacy with friends or mental health professionals because they feel like they’re cheating. They think, ‘How can I feel that?’ But you’re not cheating or casting aspersions on your love for the partner who died.

“You can honor your past, treasure it, but you do not have to live in your past. It’s not an either-or situation. You can incorporate your previous life into the life you’re moving into. People have an endless capacity to love.”

However, Ms. Fleet, who remarried nine years after her husband died, cautioned against acting precipitously when grieving the loss of sexual intimacy. “When you’re missing physical connection with another person, you can make decisions that are not always in your best interest,” she said. “Sex can cloud one’s judgment. Maybe you’re just missing that. It helps to take sex out of the equation and reassess the relationship before becoming sexually intimate.”

Dr. Radosh urges the widowed to bring up grief over the loss of sexual intimacy with a therapist or in a bereavement group. She said, “Even if done awkwardly, make it part of the conversation. Let close friends know this is something you want to talk about. There is a need to normalize this topic.”

Complete Article HERE!

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