Sex in aged care: Maintaining the wellbeing of older people
By: Catherine Barrett
I remember the first time I really noticed that sexuality was important to older people. I was working as a nurse unit manager in a residential aged care unit when a nurse reported that John, one of the male residents, was masturbating while she assisted him to shower. She felt she “shouldn’t have to put up with that”. I agreed with her, but added that the resident had the right to masturbate. We had to find a way to balance John’s right to sexual expression and the nurse’s right to a safe workplace.
In conversations with staff it became apparent that John had only started masturbating in the shower since he began wearing a new continence pad we were trialling. The product looked a bit like a big nappy, and worked a lot like a chastity belt. Because he was cognitively impaired, he couldn’t open the pad to reach his genitals and masturbate, and so staff working the night shift volunteered to take off the pad at 6am so he could spend time naked and masturbate. Once we did this, John stopped masturbating in the shower.
The conversations about John’s sexual rights created a shift in the unit. Staff saw how talking about residents’ sexuality was important. Team meetings became a vehicle for talking about other sexual issues and, in each case, we identified practical strategies to address the residents’ sexual rights.
We became confident and comfortable addressing sexuality and were regularly asked to provide education to colleagues in other units. We tried strategies – like removing John’s continence pad – and when they worked, we knew we were on track. When they didn’t, we tried something else. Over time we built an empirical knowledge base.
Looking back I realise how little we knew. We were ageist – we didn’t think older people were sexual, and so their sexual expression was challenging for us. We didn’t know how to respond. We didn’t understand that older people had sexual rights, let alone what they were. There were no policies in place to guide us, and we weren’t aware of anyone educating in the area.
Around that time I met Delys Sargeant. Delys was the director of the Social Biology Resources Centre, which was set up to address issues of sexuality and relationships in health. The centre’s focus was predominantly on sex education in schools but Delys was willing to deliver education on older people’s sexuality. Her ideas were considered radical at the time – older people had sexual rights and sexuality was beneficial to health and wellbeing.
Delys became a role model for me. I admired the openness with which she discussed sexuality and her preparedness to challenge the status quo. I left my aged-care job to become a researcher and educator to share with others how recognition of sexuality can make a difference to the lives of older people.
Delys is now in her 80s and has received an Australia Medal for her work in sexuality education. I asked her what she thinks has changed in terms of recognising older people’s sexuality: “There’s a lot more information about sexuality available now. When I was growing up I didn’t know how babies were made. I thought you conceived through kissing. For a lot of older people, there wasn’t sexual information around when they were little. Some are still learning about their bodies. We are learning through television and internet. Some of us also have grand children who are quite adult and we are learning through them. We never stop learning.”
I love the concept of older people as lifelong sexual learners. I wonder what young people would say if they realised their grandparents are learning about sexuality from them. I asked Delys was sexuality means to older people and she shifted immediately to pleasure: “Pleasure matters to older people. It’s really important to hold onto that when you are getting older and things are difficult. When you are sick or your body isn’t doing what you want it to, pleasure matters. Sexual pleasure is an important part of pleasure. Pleasure is about engaging the senses through music, touch and smell. It’s about putting on a lovely dress, having your hair done, having your nails done or your feet massaged. Some of these have sexual meanings and others don’t, or they develop sexual meaning later in life. There are different ways of being pleasured or self-pleasuring. And we give different meanings to those pleasures.”
Delys thinks that education on sexual pleasure needs to focus particularly on older women. A straight talker, Delys said a lot of her friends are “shy talking about themselves in a sexual way.” She thinks some older women are coming to terms with living alone after a lifetime of having a sexual partner and “want to know if it is okay to have sexual desires when they don’t have a partner”. She added that some didn’t have positive sexual experiences when they were married and that this needs to be addressed:
“Many older women don’t know their options for sexual pleasure, particularly older women with memory problems or dementia. A lot still don’t know what goes on with their bodies. I’d like them to know how to use a vibrator – because they’re safe, they’re available and they work. They need education.”
I agree with Delys; there may be many older women who don’t understand their bodies and their sexuality. I remember as a nurse catheterising an older woman and having to explain to her that her vagina and urethra were not the same. When I asked Delys what changes she would like to see, she suggested: “In aged care you get asked a lot of information about your health, but sexual health is rarely discussed. Sexual health needs to be understood as broader than sex – it’s about pleasure. Service providers aren’t initiating conversations with older people about that. They’re not trained in that area and they need to be.”
Delys said service providers need to be educated so they understand that “sexuality is important to everybody. It’s differently important to older people. It means your body is working. You feel good about yourself”.
As a sexuality researcher and educator, I meet lots of inspiring older people like Delys and I get to hear stories about their sexual lives. Some of the most amazing people I have ever met are older LGBTI people. They have lived extraordinary lives and have powerful stories.
Some of these individuals have become more visible since the development of a National LGBTI Ageing and Aged Care Strategy. I discussed this with Noel Tovey, an indigenous gay man in his eighties who launched the national strategy back in 2013. I asked Noel what he thought sexuality means to older people and what has changed. He said:
“Sexuality is very important to older people, I think. Some older people have been in the closet for years and have just recently come out. A lot more people will come out because it’s easier to be gay now. There will be more older people who will be willing to admit they are gay and that they’ve been in a gay relationship for a number of years. I know a man, he and his partner have been together for more than 50 years and he still refers to his partner as his roommate. For older people, sexuality is their life. What could be more positive than somebody who has lived with the same person for more than 50 years?”
Noel said that the importance of sexuality in the lives of older people might be missed by younger folk who think sexuality is lost with age. And that they need to understand that “older people don’t lose their sexual drive, it changes but you don’t lose it”.
In order to address this Noel said service providers “really need to understand homosexuality. Otherwise if they can’t treat an older gay person honestly, how do they expect to provide care for the older person?”
In 2015, Noel was made a Member of the Order of Australia (AM) for significant service to the performing arts and Indigenous performers, and as an advocate for the LGBTI communities.
Recognition of older LGBTI people by service providers can transform their quality of life. In 2008 I worked on a project that documented the experiences of older LGBTI people accessing aged care services. One of the most heart-warming stories in the project report was told by Nancy, a 79-year-old trans woman living in residential aged care. Nancy had experienced transphobic discrimination all her life and had been rejected by her family. An extraordinary aspect of Nancy’s story was how service providers empowered her to live the life she wanted to live.
Nancy was very particular about her appearance and when she lost capacity to maintain her appearance herself, staff stepped in to support her. When Nancy was vilified by other residents, staff protected her.
When Nancy was not allowed to see her dying husband, staff advocated for her and when she was not allowed information about his burial, staff spent a year searching for his grave so she could visit.
Nancy’s story highlights the power of aged-care service providers to make a difference to the lives of older people. Now, 25 years on from my experiences as a nurse unit manager, we have made significant gains in terms of recognising older people’s sexuality. I expect that the next 25 years will see a sexual revolution in the way that older people are perceived. Older people will increasingly assert their sexual rights and those of us that are not yet old will breathe a sigh of relief knowing we will be able to continue exploring our sexual selves and the changes that come with age.
Dr Catherine Barrett coordinates a sexual health and ageing program at the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne.
This article was first published in Archer Magazine #4. Subscribe to Archer here.