Return to The Best Times Homepage

Book Review

Sexuality and Long-Term Care: Understanding and Supporting the Needs of Older Adults, by Gayle Appel Doll (Health Professions Press, 2012)

Sexuality & Long-Term Care

A book about sexuality for older adults?
In the preface, we learn that when the author told others what her topic was, "many wondered if it ... could fill a whole book, because surely most people when they get old could not care less about sexuality."

Doll, a professor of gerontology and director of the Center on Aging at Kansas State University, reveals her reasons for writing on this admittedly controversial topic:

"... we are on the cusp of a cultural revolution regarding older-adult sexuality. We are told that 60 is the new 40 ... More and more older people will recognize that they can enjoy a sexual life long beyond the time at which society has told them they should no longer be interested. ... We need to be ready."

Doll addresses this book to a broad audience of professionals who serve the needs and, yes, desires of older adults, from nursing home administrators and social workers to personal care attendants. But she also speaks to family members and to older adults who already sense a sea change in what our next decades will look like. She bravely beats the twin drums of education and awareness of cultural diversity on a subject both delicate and complex.

What is sexuality for older adults? According to Doll, many long-term care institutions treat their elderly residents like giggling teens sneaking furtive embraces away from the watchful eyes of parents. What we need to realize, she asserts, is that we are sexual beings from birth until death. Rather than thinking of sexuality in narrowly defined ways, we need to expand our definitions—and transform our attitudes.

"While many older people are pursuing full and loving lives without engaging in sexual intercourse," she writes, "most all of us need to be able to experience intimate relationships across the lifespan that are enhanced by a broad range of sexual expression."

Older people, she says, "define and express their sexuality in more diffuse and varied ways than younger persons."

You may be surprised to learn, for instance, that Doll characterizes a weekly visit to the hair salon as an expression of sexuality. The desire to look and feel attractive, she says, is one of the hallmarks of healthy sexuality in an older adult, along with "touching, hugging, sending roses, providing comfort and warmth, dressing up, expressing joy, exploring spirituality"; "flirtation and affection, passing compliments, proximity and physical contact"; and the physical expressions we're all familiar with.

So what's the problem? In many elder-care settings, untrained personnel view any form of touching, fondling, or affection as a threat to the orderly efficiency that seems to be their primary concern. In home-caregiving situations, family members may react to the sexual needs of an elder parent with anger, disgust, or indifference. The problems multiply when dementia enters the picture.

In scenario after scenario, Doll gives readers a taste of the complex dilemmas of sexuality in a culture where religious and ethical mores, health-care ethics, and increased longevity demand new answers. What is a nursing home's response when a resident asks for help in procuring pornographic materials so he can take care of his sexual needs? What happens when a nursing attendant knocks on a resident's door, walks in without an invitation, and discovers two people sharing the bed?

How do staff assess whether a sexual behavior is appropriate or inappropriate? How do staff members' own beliefs, values, and ageist stereotypes enter the picture? How do we address the needs of older lesbians, gays, bisexuals, and transsexuals? (Doll points out that "in American culture, people are presumed to be heterosexual until proven otherwise.")

While it is not light reading, Doll's book is an invaluable resource for professional caregivers and family members of older adults who are currently in caregiving settings, and for anyone who contemplates how our lifelong needs for intimacy will be met as we live out our elder years.