The link between cognitive function and sexuality in older adults

Experts agree that we know very little about sexuality among people living at home with AD or other cognitive problems. Older adults who have cognitive problems that impact the way they think and make decisions may ask physicians to help managing sexual problems. And caregivers may ask physicians about sexuality in the older adults for whom they provide care.

One frequently asked question is: Do older adults always have the capacity to consent to sexual activity?

Researchers have previously shown that the majority of people aged 57 to 85 have a spouse or other intimate partner and, among those with a partner, most are sexually active. Having an active sexual life is linked to better physical and mental health, higher quality of life, and lower rates of loneliness.

To learn more about the connection between sexuality and cognitive status, researchers designed a new study. They analyzed data from the National Social Life, Health, and Aging Project to learn more about the relationship between sexual behavior, function, and cognition (people's ability to think and make decisions). Their study was published in the Journal of the American Geriatrics Society.

Based on their study, the researchers reported that:

- 83 percent of men and 57 percent of women had an intimate partner. The more impaired participants' abilities to think and make decisions were, the less likely they were to have an intimate partner.

- Women with lower cognitive scores were less likely than men with lower cognitive scores to have intimate partners.

- Nearly half of all men with dementia were sexually active, as were 18 percent of women.

- Among people with an intimate partner, the majority of men (59 percent) and women (51 percent) with dementia were sexually active. More than 40 percent of partnered men and women ages 80 to 91 living with dementia were sexually active.

- More than 1 in 10 people living with a partner reported feeling threatened or frightened by a partner. This finding was similar among women and men and across different levels of cognitive problems. Experts and guidelines call on physicians to screen for elder abuse (the mistreatment of older people, which can take many forms, including physical, emotional, and sexual abuse, financial exploitation, and neglect), including sexual abuse, but definitions of abuse and standards of consent for sex vary widely.

The researchers estimate that, among people living at home who are aged 62 and older, at least 1.8 million men and 1.4 million women with suspected or diagnosed dementia are sexually active. This number will more than double by 2050. However, rarely do these people (especially women) receive a physician's counseling about sexual changes that may occur with dementia or other medical conditions.

The researchers suggested that these findings can inform improved counseling, treatment, and person-centered decision-making by physicians and other healthcare providers caring for people with dementia or Alzheimer's disease.

Sexual activity is an important aspect of human function throughout your lifetime, said the researchers. They added that respectful care for older adults, including people with cognitive impairments, requires an understanding of sexual norms and problems -- and effective strategies to manage sexual concerns with dignity.