What are the experiences of sexual intimacy in people aged 75-85 in the UK in the context of partnership relationships
Background
This study arises from working with patients for many years and having had clinical conversations about all aspects of their life. I have frequently observed expressions of intimacy in older couples. The context of my clinical work is in long term conditions, allowing me to work with patients and their families in their own homes. Over time patients have started to talk to me about their sexual activity and asked questions about health implications. I became aware of how little research was available to inform clinical dialogue and that awareness encouraged me to undertake the study.
Methodology
The methodology for the study is Intuitive Inquiry, Anderson (2011) explains that intuitive inquiry incorporates intuitive and compassionate ways of knowing in a method which involves 5 “cycles”. This method is highly suited to researchers who wish to understand their topic fully, who become immersed in the subject Braud and Anderson (1998). Intuitive inquiry provides a systematic approach that incorporates both objective and subjective knowledge through an interpretive process. This ensures the researcher’s point of view and the evaluations of the accounts of others are in constant dialogue. The five cycles of intuitive inquiry are set out below;
- Cycle1 involves clarifying the research topic,
- Cycle 2 looks at the literature and describes the “lenses” or major constructs the researcher has defined.
- Cycle 3 is concerned with data collection and the creation of data summaries
- Cycle 4 integrates the data with literature to develop an understanding of the subject then produce the final “lenses”.
- Cycle 5 Synthesises the stages of the study to produce a final interpretation
Literature
A rigorous literature review was carried out identifying papers from 1995-onwards, drawing on papers from European / North American/Canadian/Australian populations. Articles concerning people under 75, single pathologies and sexual activity, masturbation, sexual abuse, care homes and prostitution were excluded.
The literature is set out in three main sections the physiological changes related to sexual ageing, the barriers to sexual intimacy and the enablers. Physiological changes detailed include the effects of hormone reduction, urinary incontinence, prostatism and increased prevalence of cancers related to sexual organs. The barriers to sexual intimacy include, partner availability, media portrayals, psychological factors, relationship factors, access to advice from health care professionals, religion, medication. The enablers to sexual intimacy include culture, information and medication.
Definition
A new definition of sexual intimacy synthesised was from the literature review,
In the context of partnership relationships, particularly those of long standing, sexual intimacy for older people may be seen a reciprocal or mutual action or sense of presence which results in a shared experience or frisson. This moment or moments in time evoke a sexual excitement, contentment or pleasure which have both physical and emotional elements that are life affirming.
Data Collection
Older people were recruited using a variety of techniques; purposive sampling, (where the participants are chosen because of their specific knowledge), convenience sampling, (for example in shopping centres) and snowball sampling (where older people themselves have been encouraged to suggest to their friends or families that they may wish to contact me). The participants were approached using many and varied routes including clubs, post offices, advertisements and word of mouth. Potential participants were provided with flyers or post cards telling them about the study and offering them the chance to contact me via letter, telephone, or email. The in depth interviews ranged from 30-90minutes which were tape recorded and transcribed verbatim.
Sample
In total 11 participants aged between 75-85 completed in depth interviews and over 40 written responses from individuals in the same age group have been received on postcards and emails.
Data Analysis
The data in the form of transcribe interviews and written documents from the study were analysed in four ways; a broad thematic analysis of all data looking at the observable acts of intimacy and the continuums of thoughts and feelings revealed by the participants, a phenomenologically inspired analysis of the in-depth interviews . Additionally a reflective analysis of the unique difference the participant’s age brought to the study was undertaken. This involved looking at the rhythm and meter in the delivery of the information by the participants and the influence of being in the later stages of theirs lives had on sexual intimacy.
In intuitive inquiry data analysis must accommodate the data as it is presented.
In line with general qualitative research four key areas were considered;
- The theoretical positioning of the researcher
- The congruence between methodology and methods
- The strategies to establish rigor
- The analytic lens through which the data are examined.
Findings
The data examined through Thematic Analysis revealed a series of observable acts of intimacy which included kissing cuddling, appreciating music, being naked, sexual intercourse, sharing a bed and using sexual adjuncts. Additionally a range of themes were established through general qualitative analysis and represented continuums of the participants thoughts and feelings. These were collapsed into meta themes and comprised;
- Effects of ageing
- The nature of relationships
- The family context
- Seeking assistance
- The sexual life story
Interviews were then analysed using a phenomenologically inspired method. The lived experience in the texts revealed the essential meaning which held all the aspects together and within which the other parts were situated.
The essence emerged as “Being Together” and held within it the parts of the whole that include:
- Maintaining intimacy in changing circumstances
- Setting current intimacy across a life course
- Concern about what people think
- The possibility of sexual intimacy
The reflective findings on the difference that age brings discerned a rhythm and meter in the conversations and a difference in the delivery style of the information. Age also brought closeness to death which was discussed by the participants in the context of a sexual chronology.
Conclusion
The data reveals a complex story of older people enjoying a wide range of sexual activities but frequently feeling this not something that should be discussed or considered socially acceptable. There is a close relationship between ageing and sexual expectation for older people themselves and those who are charged with providing healthcare. Older people are often polarised as a sexual being maintaining a youthful interpretation of sexual activity or an asexual invisible member of society.
The need for clinicians to actively discuss sexual health care needs as part of their assessment was made apparent and the place of older people as sexual beings requires both individual and societal acceptance. The role of nursing in the progression of these changes is clear. Nurses are well placed to initiate conversations with individuals to address their sexual health needs and to emphasis the wider benefits of consensual sexual intimacy in improving quality of life for older people.
Dissemination
I have produced wide range of publications, poster presentations and conference speeches relating to the study which was generously supported by The Band Trust research scholarship and the Florence Nightingale Foundation.