MANHATTAN, Kan. -- A Kansas State University specialist in adult development and aging says that discussions about safe sex aren’t limited to young adults.
Erin Yelland has studied the topic of sexual intimacy in America’s long-term care facilities. Speaking recently on the K-State Research and Extension podcast “Dig Deep,” Yelland said there was a time when the purpose of sex was predominantly viewed as procreation. Now, it’s much more.
“It’s part of our personal wellness, our ‘relationship wellness,’ and research consistently shows how important intimate and sexual relationships are, well into older adulthood,” she said.
She notes that as some adults of the Baby Boom generation begin their migration into long-term care facilities, they will bring with them the morals and mores of the Sexual Revolution they led 60 years ago.
“This is the generation that first had access to the birth control pill from a young age,” Yelland said. “They've often been more permissive and more open-minded in their attitudes than many other generations before them."
Yelland points to data indicating that among all adults ages 45 and older, rates of sexually transmitted diseases and sexually transmitted infections have slowly been rising for the past decade. In 2016, the American Association of Retired Persons reported rising exposure rates among older populations, especially in retirement communities and skilled-nursing facilities (commonly known as nursing homes).
One of Yelland’s key areas of expertise is sexual wellness among older adults, including policy development within long-term care. She said that as a whole, the elder-care industry is still lagging behind its clientele.“Many facilities simply don’t have any policy in place to guide staff, residents and family members in navigating the muddied waters of sexual expression among residents,” she said. “Because there’s no policy and little to no training on the topic, staff and administrators are often left to bumble through these socially uncomfortable situations with little to no direction. Many staff members may have never learned what normal sexual development looks like for older adults, and it’s a challenge to navigate something that you don’t even recognize.”
Yelland said the lack of consistent policy introduces confusion; in response, health care staff may rely on their own personal values and ideas about what a sexual or intimate relationship should be like. This is where age comes into play. Yelland said that adults in their 70s often define “physical intimacy” differently than adults in their 20s or 30s.
“Many older adults may not have the physical capacity to engage in traditional intercourse anymore,” she said. “They may not have the physical stamina, or there may be other health issues that prevent them from engaging in more physically strenuous behaviors.”
“This doesn’t mean that people aren’t having traditional intercourse, though. But, we do know that as people get older, the way that they express their sexual desires will change. We might see more cuddling, hand-holding, hugging, smooching and these types of things. So it’s not always the more traditional sexual behaviors that we’re addressing.”
The #MeToo movement that came to prominence in 2017 pulled the issue of consent into the brightest spotlight it’s ever had. Yelland said consent needs to be continuously scrutinized in long-term care facilities as well because loss of cognitive capacity (such as a dementia or Alzheimer’s diagnosis) is becoming more common.
“When talking about sexual expression in long-term care, consent is a huge priority, particularly if there’s a question on cognitive capacity,” Yelland said. “How do we consistently ensure that all people are protected in such a complex, ever-changing environment?
However, she adds, “we still want to protect those freedoms and one’s basic human right to sexual expression, with policies in place to protect everyone involved – policies that balance protection, privacy and freedom.”
Bodies may change. Living conditions may change. But people are still people, Yelland said, with the same basic needs they had 50 or 60 years earlier in their lives.“They are still sexual beings, and regardless of what kind of behavior they want to engage in – hand holding, cuddling, intercourse – we need to realize that these are adults with a sexual history and sexual interests,” she said. “We need to figure out the balance of protecting residents and staff from unwanted behavior and advances, while ensuring that residents can express what they desire in meaningful ways.“This also includes protecting our health care staff: doctors, nurses, home care providers, and administrators.”
Listen to the full interview with Erin Yelland on the K-State Research and Extension podcast, “Dig Deep.”
What is a sexual advance directive?
Statistically, 50% of adults age 85 and older will struggle with some form of dementia – Alzheimer’s disease is overwhelmingly the most common.
As the legal community continues to furnish clients with wills, durable powers of attorney, and advance directives, a new document has the potential to appear: the sexual advance directive. This idea first gained widespread attention in 2016, through a research paper authored by Alexander Boni-Saenz, an associate professor with the Chicago-Kent School of Law.
During the summer of 2019, Yelland led a group of students in researching the emerging concept of a sexual advance directive – a document that reads and functions much like its medical parent, but which addresses quality of life rather than its termination. Some of their findings were presented at a conference in January.“We basically described what a sexual advance directive could be; that you are allowing someone to put their sexual wishes in writing, so that long-term care administrators, family members, friends and other decision-makers could understand your preferences,” Yelland said.
“More than half of our adult respondents – about 65% – thought this was a great idea, and that such a document should be an option, and that the document should be active if they were to develop some form of dementia in the future.”
There are still plenty of details to be worked out. The language of such a document needs to be clarified and standardized. The sexual advance directive needs to be accepted by the legal community as a whole, and recognized as a binding contract. And perhaps last of all, the sexual advance directive will eventually have to be upheld in a court of law, and possibly within a criminal trial.
Yelland is taking her research a step further, delving into the more specific details of the document. “What specific activities and behaviors should a sexual advance directive address? Who should the ultimate decision-making authority be? We’re doing research to further our understanding of what this could potentially look like, more from the family science and gerontology side. And then in the legal world, they’re having similar conversations.”
“The concept of the sexual advance directive is very much in its infancy, but I don’t think it’s going to take very long for this ‘infant thought’ to grow up,” Yelland said.