H(OT) 5: Aging And Intimacy

Jennifer Ruoff, OTD, OTR/L, BCG, CDP: Hi, I’m Jennifer Ruoff. I am our director of OT clinical services. I’m here with Rachel Read, our director of EHR clinical services, at FOX Rehabilitation bringing you the H(OT) 5 on aging and intimacy. It’s something that often people feel uncomfortable talking about. So we thought we would bring it to light and share information that we’ve had through our experience of being occupational therapists, what we have gathered, and share it with you.

So in preparing for kind of video we looked in at a couple of stats. And I thought it was interesting: STDs in the years of 2014 and 2015 rose for the entire population by 11 percent. But for people over the age of 60, it rose to 23 percent of STDs. So that tells you people are having sexual relations, and we need to feel comfortable talking about it as healthcare professionals because it’s becoming an issue.

People over the age of 65 also have the lowest condom use in all of the population. So I think being able as healthcare professionals to educate people on safety and being aware of that just because you’re older does not mean that you know things can’t happen.

Rachel Read, OTD, OTR/L, BCG, CAPS: And I think oftentimes there’s this misconception like, “Oh well, they’re older. They kind of know or should assume that you know that different… You know contraceptives that you can use.”

And I think that it’s a misconception because when I was reading and preparing for this often with the population that we’re working with they didn’t have this education in school or they didn’t have that information like you know at their fingertips that they’re aware of you know: barrier contraceptives versus oral contraceptives and what they’re going to protect and what they’re not.

You know we often have to just make sure we are doing our due diligence educating them of what we know without assuming that maybe they already know these things.

Jenn: Because even, too, with the stat about the low contraceptive use that people over the age of 65 actually comprise of the largest increase in-office treatments for STDs. So again, it’s happening, and it’s our job to kind of talk about it.

So the stigma around sex and intimacy: We never can assume as healthcare professionals that just because people are old they’re not having sex. We’re here at FOX Rehabilitation to fight the view on ageism and that could be one of the highest stigmas to related to aging — that people are old; they’re not having sex. Or if they are having sex, they know what to do or they know how to protect themselves. It’s our job to talk about it.

I was also reading that in a typical office visit with a physician, there’s just not enough time, especially for people with chronic conditions, to talk about all of these topics: falls, nutrition, how you’re completing your daily routine and activities. That as occupational therapists, we have the core training in our degree to be able to talk about this, asking if people are sexually active and if they are recommending appropriate screening and education that goes along with it.

Rachel: I think that’s a great recommendation. I also think that not just limited to OTs but other healthcare professionals as well, whether you’re a physical therapist or a nurse, I think it’s something that we should be asking. And again it’s that uncomfortable question. It’s like oftentimes I treat a lot of incontinence, and I do a lot of education on incontinence, and it’s a very sensitive topic as well. It’s like, “Well, I don’t want to ask them if they were incontinent.” Well, you know you really should. And you really need to ask if they’re sexually active as well.

Jenn: Get comfortable with being uncomfortable. So body image, do you want to talk a little bit about this?

Rachel: So yeah definitely. So as we age, you know, body image is just something that we all kind of combat: the changes. And just as we are getting older, going from your 20s, 30s, to your 40s, and so on. A lot of things happen and your body goes through a lot of different changes.

Jenn: I’ve got wrinkles here that are like…

Rachel: I have like a gray hair, and I have to get my hair dyed all the time. So you know and those are things that like I’m super self-conscious about. As we age, just men and women, you can become very self-conscious about these things.

Jenn: And you can think about how you feel too externally even though you say it’s all about the confidence you have in yourself. But how you feel in how people perceive you. You know, I feel more attractive when I’m dressed and I get to do my makeup and I’m not in sweats.

Rachel: My eyebrows are done.

Jenn: I’m not in a baseball hat. So giving older adults the opportunity to also feel the same way that we feel.

Rachel: And I think as OTs with our knowledge about addressing our activities of daily living, whether it’s grooming, bathing, toileting, getting dressed, encountering those situations and seeing how it can impact a positive body image. Oftentimes I’ve seen many, you know, older adults, women who when I look at their pictures they always had makeup on. They always have this beautiful lipstick on. And then you go into their house and they don’t have that. And that’s such a piece of how they were, like that probably made them feel a million times different in your perception of the way you look at yourself.

Jenn: Or being able to take a shower every day. Like think about, I mean, I know when I have kids you don’t shower as often as you would like. Your hair gets greasy just feels like…

Rachel: Your husband walks in, and you’re like, “no thanks.”.

Jenn: You just feel not yourself to where sometimes older adults just stop doing rather than thinking,”How can I do this easier?”

Like when you’re working with clients and they look in the mirror and they’re like, “Oh, I don’t even recognize this person or I don’t know who this is.” Talk to them about it. Address it. Don’t just blow over it and think about ways you can get them back to feeling better about the way that they look.

So with that, hopefully your ability to use these tools increase their body image, increase their perception, talking about safe sex and hygiene. It’s so important that we talked about a little bit earlier the use of condoms. And you know oftentimes I remember when I was in college, it was something that was always educated you know whether it be at the university level or within our classes.

But I think having the opportunity, especially within senior living…

Rachel: For sure.

Jenn: Of talking about it and addressing it with clients. Maybe it’s an inservice that you provide if you are servicing a senior living or a nursing home or even in a hospital setting: talking about safe sex, what to do, what are the options, what are the resources available. And then, educating on hygiene. You know, the link to incontinence and utilize can a lot of the times to when untreated STDs that someone is unaware. It’s important that we talk about it. And then if someone is having sex, giving them opportunities and resources to do it a way that’s safe for them and in a way that allows them to participate in the activity.

Rachel: And be mindful of, you were talking about like college. The senior livings are like a dorm setting. You know, you’re all living in a group setting and things and people and there’s a lot going on. And so you know just being comfortable with having the conversation with people and then also the safety of it. I mean the reality is there are a lot less men in the senior living communities per woman ratio. And so you know if you hear or see something going on, it’s having a conversation with that man or that female to make sure everyone’s practicing safe sex. And sex doesn’t necessarily have to mean physical intercourse. It could be other sexual acts or intimacy.

Jenn: Cuddling and sitting with each other, putting your hand around someone, holding hands. Being able to hold hands with someone…

Rachel: We all seek that physical contact, sometimes more than others and that people more than others.

Jenn: Yeah, I’m not a hugger.

So education for the spouse as well: I’ve seen this more in memory care that when one spouse moves into the memory care the other spouse is living at home. Maybe that spouse starts to gain more intimate relationships with other people. Again, it doesn’t have to be physical. But they’re just seeking that attention. And oftentimes the spouse that is living in the community will say, “How could she do that to me,” or, “I don’t understand,” “We’ve been married for 60 years.” Providing education related to that specific condition whether it be memory impairment or dementia and being able to give the spouse resources for intimacy and support and emotional support I think is huge and something that we often don’t think about. We think about how uncomfortable it is to talk to the client about sex but then don’t ever really think about it from the other angle.

And then in line with that: the loss of a partner. I see this so much going out into the community and providing house-calls. It can play a detrimental role in someone’s ability to perceive themselves as being a member of society the way that they’ve known. So whether they’ve been married to the same spouse for again 60 years and lived in the same house for 60 years. Now that person is not in their life — so how can I provide them tools and resources to become intimate again or even think about becoming intimate again and being able to.

Rachel: And again that level of intimacy: It doesn’t have to go to the extreme I guess you could say.

Jenn: With the generation that we’re dealing with, they’ve only had one partner and only one person I deal with it a lot when I’m doing ADLs and showering. They’ll say, “My husband’s the only person that’s ever seen me naked,” or “No one has ever seen me get undressed,” and being able to approach that with them and getting them more comfortable with the intimacy and how you deal with it.

Rachel: Along with that too, I feel like oftentimes educating the children as well. Oh you know they get very upset that you know mom is now interacting with some other male. And it could just be, again you’re reiterating the same thing, they’re just seeking companionship. They’re seeking someone to have a conversation with to be a go to.

We are just in general it’s like in our DNA: We want companionship. We want somebody to be with. And sometimes it’s just that one person or sometimes it’s a group of people. But I think oftentimes having that conversation with family members, and as difficult as it can be with the children to have that conversation, you should you should motivate mom to go out a little and seek these opportunities.

Our last topic that we wanted to discuss was just combating the different disorders that an older adult can face. So they oftentimes will have chronic conditions or various comorbidities that can impact them. One of the biggest being pain. So chronic pain, whether it’s due to just some kind of other disorder or arthritis, can really be a major hindrance to really all of their social engagement activities, their activities of daily living. And so one of the things that we want to talk about in managing that pain is just how to manage that in preparation for any sexual activity that they’re going to be completing I guess you would say.

Jenn: Yeah, activity tolerance, standing tolerance. Think about occupational therapists back when we used to do those activity analyses in school and break apart the entire activity. Think what it requires for sexual relations and how they have to prepare for it and what it means.

Rachel: So different things you could do for arthritis or chronic pain would be maybe if you have a home exercise program from your physical therapist on pain management techniques, if you have any pain medications that maybe your physician had prescribed.

Some things you could do in preparation just resting beforehand: a warm bath or warm shower to ease any joint pain that you’re experiencing. And then just different positions. I mean, it could be a conversation that you might have to have with your partner when you’re engaging in sexual activities as “Okay, what’s a comfortable position for you? What’s a comfortable position for me?” Again, that being comfortable… conformtable… being comfortable with being uncomfortable. I’m uncomfortable because I couldn’t get that out.

Jenn: Also think about how to modify the environment. Like maybe even changing the location of their bed or having a chair or thinking about are they someone that even sleeps in their bed. Maybe even slept in their bed for years and they’re sleeping in the recliner. You’ve got to figure it out. It’s our job.

Rachel: So another diagnosis, and we touched on it a little bit, was with dementia. So times when an older age person has dementia, they often lose that frontal-lobe ability to have awareness and has like no kind of idea of what’s appropriate and what’s not appropriate. And I know I’ve worked on memory care units. Jenn has as well, where you’ve kind of seen some inappropriate behavior and it’s just the changes in the brain that are causing that. They just aren’t able to have that self-awareness of, “What I’m doing is inappropriate right now.” And we always talk about with clients with dementia is you don’t want to take away that stimulus. You want to kind of satisfy that stimulus and find a way to satisfy that stimulus. So if it is because they’re just they’re having some sexual thoughts or some sexual activity that they want to engage in, you have to kind of figure a way to do that. And sometimes it’s just they seek that physical contact. They just need some sensory… It can be something as simple as a touch. Nobody has maybe engaged in a hug with them or just touching them in a non…

Jenn: I know what you mean, like not intimate way. They just are seeking that… there are some people, and I really think and memory care it’s our jobs to be prescribing sensory diets, to really determine what do they what are they seeking. Do they like light touch? Do they like deep pressure? Is it something that would be more beneficial… you know, are they a fidgeter? Do they fidget? What are they doing and why are they doing it?

Rachel: Yeah, what’s the root cause of that?

So one of the other conditions or conditions could be diabetes and heart disease. A lot of physical changes can occur with both of those diagnoses. Oftentimes with men they may have erectile dysfunction, maintaining or getting an erection. With women they’re much more likely to be prone to a yeast infection. And so that could impact the whole sexual activity that they were hoping to participate in.

Jenn: And if it’s cardiac-related, maybe they’re fearful of that type of arousal or intimacy would cause another heart attack or shortness of breath.

So to summarize for you all the H(OT) 5 topics that we discussed in the video today. First the stigma around older adults and intimacy. Talk about it. Ask questions. Engage. It’s our job as healthcare professionals especially as occupational therapists to be talking about sex and feeling comfortable with it.

Rachel: And the stats are supporting, like we said earlier, the stats are supporting that they’re engaging in sexual activity. STDs are on the rise in this age group and we need to get ahead of it and we need to have a conversation about it.

Jenn: Yeah, absolutely. Body Image and perception: So the way someone feels about themselves, the way they appear to themselves, but then also the way that they internalize that other people look at them, you know, allowing people the opportunity to feel attractive again and want to get back to the way that they used to appear.

Rachel: Yeah, the way they used to dress. We talked about like a closet full of clothes that they never really wore. So you know what makes them feel attractive and what makes them feel comfortable as well.

Jenn: Education on safe sex and hygiene: It’s so important. Again address it. Talk about it and provide resources and tools for people to be aware of the knowledge that is out there.

The loss of a partner whether it be the physical loss of a partner or being able to address that, but also the emotional loss of a partner first for a spouse that’s dealing with a loved one who has a memory impairment —being able to address that and how to deal with that.

And then the last thing: Be aware of the side effects of different conditions and what that can cause and how that can lead into intimacy issues maybe.

So that wraps up our H(OT) 5. We’ll see you next time.