The Impacts of Social and Political Upheaval on Older Adults’ Sexuality: A Call to Action

Abstract:

Sexuality educator and author Jane Fleishman discusses the need to focus on sexual pleasure instead of sexual dysfunction for older adults. She exhorts her readers to notice the impact of current political and social upheaval, the pandemic, the recent Dobbs decision, and the concomitant racial violence, climate change, political crises, technological divides, as well as the healthcare system’s inconsistencies, which have laid bare disparities, particularly for vulnerable older adults. She encourages scholars, researchers, students, and policy makers to embrace the intersections, develop new tools, and focus on marginalized populations.

Key Words:

circles of sexuality, sexual ageism, intersectionality, policy development, assessment tools, marginalized populations

The late Black Civil Rights leader turned U.S. Senator John Lewis told his followers to “get in good trouble, necessary trouble,” as he crossed the Edmund Pettus Bridge in Selma, Alabama, on March 1, 2020, commemorating the tragic events of 1965’s Bloody Sunday, when he and other Civil Rights protesters were beaten and hospitalized (Brookings, 2020). In my own way, getting my doctorate at age 62, becoming a sexuality educator centering the lives of older adults, and challenging the ageism of sexuality was a place where I imagined I, too, could get in good trouble.

I do something that people rarely expect. I talk about the pleasures of sex as we age. I talk to people in their 60s, 70s, 80s, and even 90s, who attend my trainings. At the end of my classes, very often someone will come over to me and whisper, “Sex is all over for me, I can’t get it up,” or “My doctor told me that when I reached menopause, I’d have to give up sex,” or “Who would be interested in me at my age?” Dr. Maggie Syme and her colleagues addressed this type of thinking after interviewing older adults about their own perceptions (Syme et al, 2019).

When they parrot these mythologies about sex as older adults, I’m thrilled. Not thrilled that they’ve been given erroneous, outdated, and ageist information. Not thrilled that they’re feeling hopeless. On the contrary, these are people who have just attended one of my classes where I have been quite frank about the possibilities of sexual pleasure as we age. I’m thrilled because I get to be the one to look them in the eye and invite them to discover pleasure, find new adventures, and create joy. What a job I have created for myself.

How does one become a sexuality professional at a later age? As an educator and organizer, I’ve never shied away from sensitive topics. In the 1970s, I organized clerical workers into our first union. During the HIV/AIDS crisis of the 1980s, I taught healthcare workers an empathic way of handling people with HIV/AIDS. During the early days of what we used to call the Lesbian and Gay Rights movement of the 1990s, I taught workers and union members how to protect and enhance their sexual and gender minority members’ lives.

In the early 2000s, I taught nursing home administrators how to improve the working lives of their most vulnerable workers. In each of these periods, my needs assessments included lengthy conversations with those on the frontlines. My best teachers have always been the people most affected by the issue on which I sought to shine a light. It came naturally to me to start my new career talking with older adults, reading all the research I could locate, and meeting leaders in my field to discuss the intimate, often delicate, always fascinating moments they were facing in their work. I now work primarily in assisted living and senior centers, where I teach staff and residents. My earlier work created the foundation for how I conduct my work today.

When I retired from a hospital at age 55, I went back to school for a doctorate in Human Sexuality. There I learned that old people were an under-researched and underserved demographic upon which I could focus. In 2016, I became certified through the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) as a sexuality educator. Like many older adults who attend my courses, the closest thing I had to sex education in school was someone telling me to keep my knees together. Some would call that part of my sexual journey (Heasley & Crane, 2002).

In a 2018 TEDx talk, I posed a question: is it OK for grandma to have sex? In 2020, I challenged not only ageist but heteronormative notions about sex with oral histories of LGBTQ elders (Fleishman, 2020). Since then, I’ve spoken to thousands, written blogs, published articles, and dropped more than 100 podcast episodes, all to bring conversations about sex and aging into the public sphere.

In her inspiring way, Gayle Doll has brought together key thinking about sexuality and aging, and her research and writing (2012) has informed much of mine. As an interdisciplinary researcher, she has reached out and included in this issue of Generations Journal many of the thought leaders in the areas of sexuality and aging to contribute. There is so much good work going on. Now, as a member of an underrepresented population (an older cis lesbian) and as a sexuality educator in my late 60s, my sexual journey and my professional journey continue as I educate others through my work.

Effects of Dizzying Pace on Older Adults

The dizzying pace of social and political change impacts older adults and their sexuality in many ways. How many of these crises are not new for older clients? And how many of them are feeling a kind of PTSD or other wearying anxieties? What can you do about it? And when the onslaught of change is occurring at a dizzying pace, the impacts on older adults can resound throughout their entire beings.

The impact on older adults’ sexuality requires a dialectical approach to the losses and the possibilities for pleasure (Jones, 2022). Impacts of the COVID-19 pandemic have barely begun to be measured yet we have seen some stark contradictions: almost 80% of all deaths from COVID occurred in people ages 50 and older (Christie et al., 2021), and those who survived COVID faced serious isolation. The underlying fears of death and separation were paramount and many of these older adults were thinking back to the polio epidemic or the HIV/AIDS crisis. Particularly for those in LGBTQ communities, COVID brought home the added burden of the ravages of death and fears about sexual contact. For people of color and other marginalized populations, the COVID crisis hit hardest of all, underscoring the chasms between those who had access to quality medical care and those who did not (Fredriksen-Goldsen, 2008).

The U.S. Supreme Court’s recent decision reversing Roe v. Wade (Dobbs, 2021) has left many women and others reliving the dread of septic abortions and the loss of sexual freedoms at many levels, or worried about their offspring. Concomitant racial violence, climate change, political crises, technological divides, and the healthcare system’s inconsistencies laid bare disparities, particularly for vulnerable older adults.

The pandemic also ushered in good news for those who were fortunate enough to live in areas with high-speed internet: better online communication, deliveries, services, and better ways to support one another online. More people have been reached through the advent of online sexuality education programs, sexuality products, and pornography, and much of that has become specifically designed for older adults and the healthcare professionals who work with them. Such impacts need more study. Self-imposed ageism is a factor in online communications with older adults (Kottl et al., 2022).

Teaching About Sexual Ageism

When I first began teaching courses on sex and aging, the audiences were sexuality professionals who had vast knowledge of sexuality issues but knew little about older adults’ sexuality. Then I started teaching healthcare professionals working with older populations and realized they had vast knowledge about aging, but knew little about sexuality. It was as if I were picking up a copy of Erikson’s theory of human development (Erikson, 1980) or Kinsey’s first book on human sexuality (Kinsey, Pomeroy, & Martin, 1948) to find key chapters missing from each. Both fields were changing quickly, but neither was embracing the well-being of older adults’ sexuality. Sexuality educators were not addressing the issues of aging. Healthcare professionals working with older adults were not addressing the issues of sexuality.

I try fiercely to encourage scholars, researchers, students, and policy makers in each of these fields to embrace the intersection—that place where sexual ageism occurs (Gewirtz-Meydan & Ayalon, 2022)—the invisibility that imperils us all to ignore something fundamental to all stages of life, including the last stages. Dailey developed the Circles of Sexuality model more than 40 years ago, first published in a text on older adult sexuality (Dailey, 1981). Little did we know that his model, which describes the intersection of sensuality, intimacy, identity, sexual health, reproduction, and sexual exploitation, would be adapted for all parts of the lifespan even though older adults—the very group upon which he first focused his model—were often overlooked. Since that time, his model has been revised and republished for many audiences through writings by those working on sexual justice and ageism (Advocates for Youth, 2007; Green, 2014; Dailey, 2017). We need to continue our work educating healthcare professionals and implore them to consider that aging is not necessarily the salient factor in sexual dysfunction (DeLamater, 2012).

We need to teach older adults directly about the potential for sexual pleasure as they/we age, right up until death (Chando et al., 2021).

Future of Policy Development

In senior living, whether it is an assisted living community or nursing home or other communal living situation, stories abound of an aide who walks in on older adults engaging in some form of sexual activity. In these instances, the aide often has to make a nanosecond decision (based on little or no training) while the older residents are startled. “What do we do now?” is often the question I am asked after-the-fact. And my response is about decentering the individual aide and inviting the organization to take a more active role.

The individual should not be left on their own to make a decision about such a regular part of life. Why, I ask, does a decision need to be made? What are the parameters? Who is involved? We must move away from individual decision-making dilemmas to community-wide proactive policies as we begin to wake up to the realities of pleasure while aging.

Such policies should be part of the overall wellness umbrella and cover sexual wellness in staff training, education for families, and education for residents on issues such as consent, sexual health, relationships, and intimacy. Changing a facility’s layout to make room for privacy and communication would also be covered by such a sexual wellness policy (Fleishman, 2019). It has been almost three decades since the first sexual wellness policy was developed at the Hebrew Home in New York City (see Reingold, 2022, this issue; Dessel & Ramirez, 1995). This topic deserves more attention by administrators and clinical directors of senior living communities. While there are policies for older adults on every imaginable topic of life in a senior living community (including how much soup you can take back to your apartment), why are there so few policies about sexual wellness? If we can talk about older adults taking home doggy bags, why can’t we talk about older adults doing it doggy style?

I’ve scoured the country for other policies and have found that, much like salutogenic (or wellness-based) research on older adults’ sexuality, I can count the number of sexual wellness policies that are being administered on one hand. We need to move beyond interactional approaches on the individual level and shift our focus to the organizational level, particularly for independent living, assisted living, and skilled-nursing facilities. Yet therein lies the problem. To develop sound policy, administrative and clinical leaders must feel comfortable discussing these hot topics, training their staff, informing new residents, and educating families. And such a focus on sexuality at the organizational level may lead to changes in building layout, the intake process, the referral process, and types of family engagement. A sexual wellness policy would be wise to consider the Circles of Sexuality model (Dailey, 1981).

Take for instance the lack of sexual wellness policies at an assisted living community in which a resident asks his son and son-in-law not to hold hands when they visit him because he’s concerned about other resident and staff homonegativity. A sexual wellness policy that covers sexual orientation would allow his family to be themselves when they visit.

Another example concerns two unmarried residents who want to visit each other’s apartments to have sex. They are concerned that staff could walk in on them and “report” them to their children. A sexual wellness policy would have clear language on family involvement in their elders’ sexual lives.

When a Black man and a white woman decide to embark on a sexual relationship and are seen holding hands in the family room of a senior living community, a sexual wellness policy that treats racial and ethnic discrimination as a violation could save this couple’s relationship from public outcry.

When a family member beseeches the nursing staff to keep their widowed mother away from another widow with whom she has begun a sexual relationship, a sexual wellness policy could address the family’s concerns while holding their mother’s sexuality in a respectful balance. Policies speak clearly to the mission of an organization. Is it not time for administrative and clinical leaders to broaden their policies to include sexuality in their wellness lens?

Need for Better Assessment Tools

As Doll (2012) and Huitema and Syme (2022, this issue) note, there are no adequate tools yet to assess an older adults’ cognitive state as it relates to sexual interactions. Often I receive calls from administrative leaders in senior living communities who are concerned about the possibility of abuse, trauma, or family disruption when an older adult with some form of dementia is engaging in sexual activities. At times, their concerns are valid, yet they are often tinged with paternalism, given how we often view those with dementia. We must balance safety with respect. The need for assessment tools may have implications for policy, education, and therapeutic interventions.

In addition, assessment tools may shift in the next few years. Huitema (2022) has developed a framework for an assessment tool and has reflected on the idea of cognitive capacity in her research. Instead of using the legal or medical term, she has opted for a new term that conveys a respectful and non-pejorative way of looking at older adults, particularly those with cognitive impairments. Huitema uses “sexual consent potential” as a way of focusing on the individual’s strengths, possibilities, and agency. In the future, I hope to see Huitema and Syme and other colleagues develop a tool we can use to convey that same respect.

As Demographics Shift, Focus on Marginalized Populations

The provision of equitable sexual healthcare and education requires that providers recognize and acknowledge disparities built into systems created within our heteronormative, white supremacist, and ableist culture. These disparities demand attention and intentional effort and vigilance on the part of sexuality professionals. As a White cis lesbian woman, I acknowledge that I may have knowledge gaps—and I invite you to reflect on your own experiences as you read this.

Elders are made up of many identities and have concomitant health disparities. Older adults in marginalized communities may face additional challenges. How does this affect their sexuality? Imagine the late Bayard Rustin and his lover, Walter Nagle. Bayard was the chief architect of Dr. Martin Luther King’s 1963 March on Washington and a well-respected civil rights leader. He was Black and he was gay, yet he never felt comfortable coming out as a gay man given his fear that that it would drive a wedge in the movement. As soon as Bayard met Walter, they were attracted to each other immediately. Marriage was unimaginable. And because he couldn’t legally marry Walter, in 1982 Bayard adopted Walter as his son. They were together until Bayard’s death in 1987.

Or imagine Mandy Carter, a Black lesbian I got to know researching my book on LGBTQ elders (Fleishman, 2020). Mandy grew up in a time and a place where it was hard to come out, so as soon as she knew she was a lesbian, in 1967, she took off for San Francisco for the Summer of Love. Mandy worked at Maud’s, a lesbian bar in the Haight Ashbury district, got involved in anti-war organizing, and found her community and purpose in life. She is an activist still, almost 60 years later (Carter et al., 2021).

Each of these leaders and other members of marginalized older adult populations faces enormous challenges—racism, ableism, heterosexism, classism, xenophobia, homophobia, biphobia and transphobia, in addition to ageism (Bornstein, 1994). And yet, empirically, older adults in marginalized populations show a high level of resilience (Fleishman et al, 2020). Anecdotally, I’ve seen high levels of collective resilience on the part of members of marginalized populations as well. Given the wide range and forms of oppression older adults face, Fielding (2021) calls on us to dismantle erotic privilege, the types of privilege afforded to only certain bodies that are white, cis het, able-bodied, thin, tall, and ages 18–35. While there is scant research on older adults in marginalized populations, one study that focuses on their sexual satisfaction rather than on their dysfunctions (Fleishman et al, 2020) indicates that the connections between internalized homophobia, resilience, and relationship satisfaction is correlated with sexual satisfaction.

Psychosocial concerns of older adults in marginalized communities include: 1) social isolation due to sexual, gender, or BIPOC identity; 2) invisibility, such as an intellectual disability, or an inability to freely express gender or sexuality; 3) the impact of HIV/AIDS, including lack of access to quality medical care, especially among older trans clients; and 4) lack of support from one’s biological family, which is so crucial to caring for older adults. It is critical to highlight the importance of the HIV/AIDS pandemic and its impact 40 years later.

That pandemic had an enormous impact, especially on older gay men (Odets, 2019). Walt Odets, a San Francisco therapist who has worked with gay men since that period, describes three generations of gay men who have been affected by the HIV/AIDS crisis: the older cohort who lost lovers, brothers, sisters, and friends; the middle group, which benefited from safer sex education that started in their elders’ communities; and the younger group, which was furthest from the crisis, who may resist safer sex practices.

HIV/AIDS also had an impact not only on gay men, but on lesbians, bisexuals, transgender, queer, and heterosexual people who lived through that period, struggled, and lost comrades. HIV/AIDS had a disproportionate impact on BIPOC people, and through my work, I have witnessed a form of PTSD among LGBTQ elders who are now facing a second pandemic, COVID-19, in their lifetimes.

Illuminate the Intersection

When working with older clients, consider these and other intersections: the challenges they may face with LGBTQ identity and heteronormativity, with systemic racism, with kink, leather, and poly identities, and with various kinds of visible and invisible disabilities, including HIV/AIDS. We might apply this expansiveness to age as well. Gallop (2019) describes queer temporality (or the notion that we may not remain the same) as we age. Our bodies are no longer the same and we are in the position as we age to discover new ways to imagine the beauty and ultimately the sexual expansiveness in an older body.

Gallop did an outstanding job of addressing this in her book on sexuality, disability, and aging, in which she looked at the queer temporalities of the phallus (in the psychoanalytic sense). She talks about the Freudian notion of aging as a kind of castration or end of sexuality. And as a feminist who frequently looks disdainfully at Freud, this is a useful reminder that aging is often seen as de-sexualized and when a disability is developed, that impression is compounded further (Gallop, 2019). Coming out positively as a person with a disability (at any age), understanding, and expressing yourself to other people are all part of moving forward. Crip theorists (McRuer, 2006, Shakespeare, 2006) suggest that claiming your sexuality as a disabled person is a large part of that coming out and moving forward process.

Queer theorists like Butler (1990) convey that gender and identity are best expressed through performance, rather than through any sort of binary or category. Much like John Lewis’ notion of “good trouble,” these theorists call for “gender trouble” to stir up the categories of gender through performance. Describing the expansiveness of sexuality with a disability, Shakespeare (2000) explained, “If you are a sexually active disabled person, it is remarkable how dull and unimaginative non-disabled people’s sex lives can appear.” When we focus on older adults, we need to illuminate the intersections.

A Call to Action

As a healthcare professional or educator, what are you able to do to address the disparities built into systems created within white supremacist, heteronormative, cisgender, ableist, and ageist culture? This is a call to action! What will be your contribution? How will you help make a difference? The older adults in our care deserve to have their whole selves imagined, including their sexual selves. It is time for us to take action to make transformation occur (Wadley, 2021).

Let me end with a powerful story. One day while I was teaching a class, one of the students, an aide who is probably in his 20s, assumed that the couple in his building who sleep in twin beds with a nightstand between them wasn’t having sex. When he asked me about them, I told him that you just never know. Perhaps, I said, she’s afraid of his sharp toenails and prefers to sleep alone. Perhaps he doesn’t like the way she hogs the covers and prefers to sleep without a fight. Perhaps they both decided to have sex in the mornings after a good night’s sleep alone and enjoy jumping into one bed before their meds wear off.

I understand that it can be hard to imagine love and intimacy, sex and connection for older people across the lifespan. Yet if we can’t imagine this life for our elders, if we can’t talk about the possibility of sex and romance between older adults, then we’re denying them (and ourselves) lives of dignity at a time when they need every positive reason to live. Amid the dizzying pace of social, political, and economic change older adults are facing, the time is now to begin to address these disparities and allow for the discovery of pleasure and joy, and possibly some really good trouble.

Acknowledgements

I am forever indebted to those who came before me. Dr. Laura Singer Magdoff, my first mentor in this field; Peggy Brick, who co-wrote the first curriculum for older adults’ sexuality (Brick et al., 2009); Gina Ogden (Ogden, 2018), whose life ended too soon and who brought me into AASECT; Melanie Davis, who introduced me to the world of sexuality and aging (Davis, 2019); Patti Britton, who believed in my work even before I did; Beverly Whipple, whose brilliant compilation of the benefits of sexual expression continues to expand peoples’ minds (Whipple et al, 2007); and to John DeLamater, whose meta-analysis of older adults’ sexuality (DeLamater, 2012) transformed my notions of the causes of sexual dysfunction in older adults; and to Stephen Duclos, my favorite co-presenter, who has offered so many insights to my work, I am deeply grateful. Rosara Torrisi, Sabitha Pillai-Friedman, and Jayleen Galarza are my co-hosts on our podcast, www.ourbetterhalf.net, which takes apart the latest in sexuality and aging. May their youth carry our work forward. And to Stephen Duclos, my favorite co-presenter, who has offered so many insights to my work, I am deeply grateful.

Jane Fleishman, PhD, MEd, MS, CSE, is a sexuality educator who focuses on senior living communities, teaches older adults and professionals, conducts research on older adults and sexuality, co-chairs national conferences, co-hosts an award-winning podcast, and blogs with Sex Rebelle, Hot Octopuss and AgeRight.

Photo credit: Nuva Frames/Shutterstock

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