Although Valentine’s Day is often criticised as a cynical creation of florists and the greeting cards industry, it is a useful focal point for considering love and sexuality as elements of human wellbeing that often escape attention in healthcare. This neglect is most marked for later life, when popular discourse on late life romance is dominated by simple notions of asexuality or by ribald jokes.
There are many reasons why healthcare professionals need to learn more about human love and sexuality, not least of which is a fuller understanding of the nature and meaning of ageing. Sexuality is a core element of human nature, encompassing a wide range of aspects over and above those related to genital and functional, and the medical literature has rightly been criticised for taking too narrow a vision of sexuality.
This narrow vision is paralleled by a steady trend in the neurosciences of “neuroreductionism,” an over-simplistic analysis of which parts of the brain light up in functional imaging when viewing photos of a loved one.
We need to open up to the continuing significance of love and sexuality into later life, understanding that sexuality includes a broad range of attributes, including intimacy, appearance, desirability, physical contact, and new possibilities.
Numerous studies affirm sexual engagement into the extremes of life, with emerging research on the continuing importance of romantic love into late life. There is also reassuring data on the persistence of romantic love in long term relationships, unsurprisingly associated with higher levels of relationship satisfaction.
A growing literature sheds light on developing new relationships in later life, with a fascinating Australian study on online dating, which subverts two clichés—that older people are asexual and computer illiterate.
The challenge in ageing is best reflected in the extent to which we enable and support intimacy and sexuality in nursing homes. Although for many this is their new home, the interaction of institutional life (medication rounds, meals), issues of staff training, and lack of attention to design of spaces that foster intimacy can check the ability to foster relationships and express sexuality.
For example, is the resident’s room large enough for a sofa or domestic furnishings that reflect one’s style, personality, and sense of the romantic? Are sitting spaces small and domestic rather than large day rooms? Do care routines allow for privacy and intimacy? Is there access to a selection of personal clothes, make-up, and hairdressing?
Granted, there can also be complicated issues when residents with dementia enter new relationships and the need to ensure consent in a sensitive manner, but these should be manageable with due training and expertise in gerontological nursing and appropriate specialist advice.
A medical humanities approach can provide useful supports in education from many sources, ranging from literature (Love in the Time of Cholera), film (45 Years or the remarkable and explicit Cloud 9 from 2009), or opera (Janáček’s Cunning Little Vixen, a musical reflection of the septuagenarian composer’s passion for the younger Kamila Stösslová).
We as present and future older people also need to take a step back and consider whether we are comfortable with a longer view on romance and sexuality. The Abbey Theatre did us a considerable service in 2015 with a wonderful version of A Midsummer Night’s Dream set in a nursing home. We were struck by a vivid sense of the inner vitality of these older people, suffused with desire, passion, and romance.
This contemporary understanding of companionship and sexuality in later life was enhanced by casting Egeus as a son exercised about his mother’s romantic choices instead of a father at odds with his daughter.
We can also take heart from an early pioneer of ageing and sexuality, the late Alex Comfort. Best known for his groundbreaking The Joy of Sex, he was also a gerontologist of distinction, and wrote knowledgeably about the intersection of both subjects with characteristic humour.
He wrote that the things that stop you having sex with age are exactly the same as those that stop you riding a bicycle: bad health, thinking it looks silly, or having no bicycle—with the difference being that they happen later for sex than for the bicycle.
His openness and encouragement for our future mirror Thomas Kinsella’s gritty poem on love in later life, Legendary Figures, in Old Age, which ends with the line: “We cannot renew the Gift /but we can drain it to the last drop.”
Desmond O’Neill is a consultant geriatrician and co-chair of the Medical and Health Humanities Initiative of Trinity College Dublin.
Competing interests: None declared.