The taboo of sex in care homes for older people
It's often been said that there's not enough discussion of the issues around older people and sex. And there's confusion about how to deal with the romantic lives of people in nursing homes, writes Adam Weymouth.
There may be a kind of all-pervading silence surrounding sex in later life, but that is not because it isn't happening.
A recent study by the University of Manchester found that 54% of men and 31% of women over the age of 70 were still sexually active.
It was the first nationally representative survey to include people over 80 in its sample, indicating both how attitudes are changing and how the sexuality of older people has been historically overlooked.
There is a growing awareness of how damaging this has been. "Human contact and sexual need are basic functions of the human being," says Dawne Garrett, older people's adviser at the Royal College of Nursing.
Sex and relationships are not viewed as a priority in care homes, according to a 2010 study by the Royal College of Nursing. "Staff are generally not comfortable with the topic, and not knowledgeable about it either, thus they are powerless to help," said the report, which found that it was rarely addressed in training, and that homes frequently failed to facilitate relationships - not respecting privacy of residents and not providing double beds.
"We have a stigma about age," says Lois Weaver, a performance artist who explores the subject of sex and ageing through her work. "We don't really treat people like elders. We treat [them] like people [who are] finished with life."
Weaver, who is professor of contemporary performance at Queen Mary, University of London, has worked extensively with residents in care homes and drop-in centres. Her show, What Tammy Needs to Know About Getting Old and Having Sex, seeks to break down the taboo of sex and ageing.
Weaver, who is in her 60s, had been told that losing interest in sex was an inevitable part of getting older, but says she was not ready to accept that. "I was getting different urges and desires," she says.
Older people and sex - what a survey found
- More than half (54%) of men and nearly a third (31%) of women over the age of 70 reported they were still sexually active
- 39% of sexually active men reported erectile difficulties; 32% of sexually active women reported problems becoming sexually aroused
- 31% of men and 20% of women reported frequent kissing or petting with their partners
Having worked in a care home in Croatia, and then with care home residents in New York, Weaver describes the attitude in British care homes as "maternalistic".
The resistance comes not from residents themselves but from those in charge, says Weaver, and speaks of her frustration at her team's repeated failures when trying to visit care homes in order to engage with older people. "They don't think their residents want to talk about sex," she says. "Of course they do."
The rare instances when she was granted an audience bore out her assumptions, and she believes that the inability to canvas the opinions and desires of the residents themselves is exacerbating the problems created by the taboo. "A lot of the women I met had all read 50 Shades of Grey," she says. "They all really wanted to talk about that. Maybe they weren't having sex, but they weren't dead. They had imaginations, they had a sense of humour, they told me dirty jokes."
Sexuality and relationships are now something that the Care Quality Commission watchdog takes into account. "One of the things we look for in our inspection work is people being treated with dignity and respect when it comes to the issue of intimacy and their sexuality in a sensitive manner," says Andrea Sutcliffe, chief inspector of adult social care.
"We also expect providers to ensure their staff develop better awareness and training in relation to relationship, sexuality and equality issues for people living in care homes."
Issues around dementia and consent can be particularly complex, but Kathryn Smith, director of operations at the Alzheimer's Society, says that is not a reason to ignore them. Dementia can present changes in behaviour which staff and families can find challenging - the sufferer may exhibit increased sexual behaviour, undergo a change in sexual orientation, or form a relationship with someone new when they still have a partner at home.
Yet disapproving of someone's actions does not constitute grounds to prevent them. "It comes down to the mental capacity of that individual," Smith says. "[Care homes] do need to remember that the individual still has the right to make that decision, provided they understand the decision that they're making.
"[Care home staff] probably feel that they're more likely to get into trouble for allowing somebody to be abused than for stopping somebody from having a relationship," she says. "But actually having your own rights and choice and control restricted could be seen as abuse as well."
DSexually transmitted infections (STIs) are on the rise amongst older people, although from a very small base. Figures published this week by Public Health England show that for every STI, except for syphilis, the over-65 age group has demonstrated the biggest percentage increase in infection since 2010.
A 2014 report in Age and Ageing found that in 2011 the over 50s made up 22% of those with HIV in Britain, up from 12% in 2002. In Brighton the incidence was as high as 35%. Such growth has been attributed to the effects of the silence surrounding sex and old age. There has been no sex education aimed at an older demographic, and over 65s are the age group still the least likely to be offered HIV tests. No-one, in short, is talking about it.
"We peddle a gold standard of sexual contact," says Garrett, "young, beautiful, usually white, usually blonde." She sees television like Last Tango in Halifax and films like The Best Exotic Marigold Hotel as encouraging, but they remain an exception, rather than the norm.
Weaver agrees. "At the root is that we don't accept [things] - we all want to stay young, be young, perform young, do young," she says. "For me, talking about sex isn't about trying to get us to do that. It's about getting us to accept where we are, and celebrate where we are.
"Sex is the key into that conversation for me, because it's fun and it gives us permission, but it's not the only thing I'm interested in. I'm just interested in how we get older, and stay vital."
The Institute of Sexology exhibition continues at the Wellcome Collection, London, until 20 September.
Subscribe to the BBC News Magazine's email newsletter to get articles sent to your inbox.