Research in Gerontological Nursing

Research Brief 

Exploring Factors Associated With Sexual Activity in Community-Dwelling Older Adults

Kim A. Killinger, MSN, RN, ACNS-BC; Judith A. Boura, MS; Ananias C. Diokno, MD

Abstract

Sexuality is an important, yet often overlooked, aspect of successful aging. The current article explores potential relationships between sexual activity in older adults and marital status, health, mobility, urinary incontinence, and caffeine and alcohol use, as well as sexual desire and erectile function in women and men, respectively. A survey was mailed to community-dwelling older adults 60 and older. Of 242 respondents (79% ages 60 to 74, 53% male), 159 (65.7%) were sexually active. A higher proportion of sexually active adults were married (p = 0.0005), had better health (p = 0.0003), and drank alcohol (p = 0.007). A lower proportion of sexually active adults had urinary incontinence (p = 0.006). Similar proportions of men and women were sexually active (62.8% and 68.2%, respectively; p = 0.38). Sexually active women had better sexual desire scores (p < 0.0001) and more drank alcohol (p = 0.0013). Sexually active men had better mobility (p = 0.012) and erectile function (p < 0.0001). Fewer sexually active men had incontinence (p < 0.0001). Only alcohol use and no urinary incontinence were predictors unique to women and men, respectively. Health care providers must be aware of factors that may impact sexual health in older adults.

[Res Gerontol Nurs. 2014; 7(6):256–263.]

Ms. Killinger is Director, Urology Research, Ms. Boura is Biostatistician, and Dr. Diokno is Urologist, Department of Urology, Beaumont Health System, Royal Oak; Ms. Boura is also Assistant Professor, and Dr. Diokno is also Professor, Oakland University William Beaumont School of Medicine, Rochester, Michigan.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kim A. Killinger, MSN, RN, ACNS-BC, Director, Urology Research, Department of Urology, William Beaumont Hospital, 3535 W. Thirteen Mile Road, Suite 438, Royal Oak, MI 48073; e-mail: KKillinger@beaumont.edu.

Received: March 25, 2014
Accepted: August 12, 2014
Posted Online: November 10, 2014

Abstract

Sexuality is an important, yet often overlooked, aspect of successful aging. The current article explores potential relationships between sexual activity in older adults and marital status, health, mobility, urinary incontinence, and caffeine and alcohol use, as well as sexual desire and erectile function in women and men, respectively. A survey was mailed to community-dwelling older adults 60 and older. Of 242 respondents (79% ages 60 to 74, 53% male), 159 (65.7%) were sexually active. A higher proportion of sexually active adults were married (p = 0.0005), had better health (p = 0.0003), and drank alcohol (p = 0.007). A lower proportion of sexually active adults had urinary incontinence (p = 0.006). Similar proportions of men and women were sexually active (62.8% and 68.2%, respectively; p = 0.38). Sexually active women had better sexual desire scores (p < 0.0001) and more drank alcohol (p = 0.0013). Sexually active men had better mobility (p = 0.012) and erectile function (p < 0.0001). Fewer sexually active men had incontinence (p < 0.0001). Only alcohol use and no urinary incontinence were predictors unique to women and men, respectively. Health care providers must be aware of factors that may impact sexual health in older adults.

[Res Gerontol Nurs. 2014; 7(6):256–263.]

Ms. Killinger is Director, Urology Research, Ms. Boura is Biostatistician, and Dr. Diokno is Urologist, Department of Urology, Beaumont Health System, Royal Oak; Ms. Boura is also Assistant Professor, and Dr. Diokno is also Professor, Oakland University William Beaumont School of Medicine, Rochester, Michigan.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Kim A. Killinger, MSN, RN, ACNS-BC, Director, Urology Research, Department of Urology, William Beaumont Hospital, 3535 W. Thirteen Mile Road, Suite 438, Royal Oak, MI 48073; e-mail: KKillinger@beaumont.edu.

Received: March 25, 2014
Accepted: August 12, 2014
Posted Online: November 10, 2014

Human sexuality has been associated with health benefits and longevity and is increasingly being recognized as an important aspect of quality of life throughout the lifespan. Promoting successful aging is particularly important in light of the recent growth in the aging population, as Baby Boomers mature and life expectancies increase. Although prevalence estimates vary, Lindau et al. (2007) reported that the majority of adults older than 57 were sexually active, and 26% of adults ages 75 to 85 were sexually active. Continued study of sexuality in older adults also has important public health implications, as the Centers for Disease Control and Prevention surveillance reports suggest that the overall proportions of older adults with HIV is increasing ( Linley, Prejean, An, Chen, & Hall, 2012).

Background

Sexuality in older adults involves a complex interplay between physical capacity, motivation, attitudes, opportunity for partnership, and sexual conduct ( Lindau, Laumann, Levinson, & Waite, 2003). For some, sexuality may become less important with aging, but this may not be true for the majority. Investigating sexual health can be challenging because of the sensitive nature of questions; preconceived expectations; and varying definitions of what individuals, cultures, and generations consider sexual activity.

Although relatively few studies explore sexual expression in community- dwelling, healthy older adults, many studies have examined the impact of illness on sexuality. Conditions such as diabetes (Lindau et al., 2010) and joint issues have been negatively correlated with sexual activity (Bach, Mortimer, VandeWeerd, & Corvin, 2013). Urological conditions, such as overactive bladder (Coyne et al., 2011) and urinary incontinence (Hawkins et al., 2011), are prevalent in older adult patients and can also impair sexual health. Cardiovascular and pulmonary conditions, as well as cancers, that more commonly affect older adults, can also contribute to sexual concerns (Steinke, 2013). However, the loss of a partner (Bach et al., 2013) and health problems may be more to blame for declining sexual activity than disinterest.

In a landmark study of 1,956 older adults living in Washtenaw County, Michigan (i.e., Medical, Epidemiological, and Social Aspects of Aging [MESA]), Diokno, Brown, and Herzog (1990) also found potential links between mobility problems and urinary incontinence and the lack of sexual activity. In addition, investigators found an association between coffee intake and sexual activity. Sexual activity was reported by 62% of 185 married women who drank coffee, and only 37.5% of the 40 women who did not drink coffee (p = 0.008). In men, non-intake of coffee was related to increased erectile difficulty (p = 0.024) (Diokno et al., 1990). Despite real or perceived challenges, the majority of older women and men believe that sexuality has beneficial effects and is a lifelong need (Penhollow, Young, & Denny, 2009).

Although the development and widespread marketing of medications to treat male erectile dysfunction (ED) has increased the focus on sexuality in older adults, sexual concerns are still inconsistently addressed, especially in older women. The extent to which urology specialists and other health care practitioners are able to evaluate for sexual concerns may be limited by time constraints, discomfort discussing sexual issues (Price, 2009), and a general perception that sexuality may not be as important for older adults. In one study of sexuality in adults ages 40 to 80, only 11.5% of men and 15% of women had been asked by a doctor about possible sexual difficulties during routine visits within the past 3 years ( Laumann, Glasser, Neves, Moreira, & Global Study of Sexual Attitudes and Behaviours Investigators’ Group, 2009). Health care practitioners may find it difficult to talk about sexuality with older adults partly because of a lack of knowledge (Gott, Hinchliff, & Galena, 2004). Others have noted that nurses working with institutionalized older adults also have limited knowledge of sexuality in older adults (Mahieu, Van Elssen, & Gastmans, 2011). However, one Dutch study’s findings suggested that although continence nurses were aware of the strong association between urological complaints and sexual problems, few routinely assessed sexual function (Bekker, Van Driel, Pelger, Lycklama à Nijeholt, & Elzevier, 2010). Therefore, a need exists for more information, and health care providers in particular need a more complete understanding of sexuality in older adults to provide holistic, comprehensive, and high-quality care.

The purpose of the current study was to (a) explore factors that may impact sexuality and sexual expression in a population-based sample of older heterosexual adults and (b) re-evaluate the findings of the Diokno et al. (1990) study. Therefore, the authors of the current article designed another study of older adults in Washtenaw County, Michigan, to explore the effect of factors such as marital status, health, mobility, urinary incontinence, caffeine and alcohol use, sexual desire, and erectile function on sexual activity in older adults.

Method

After obtaining institutional review board approval, the authors of the current article purchased a mailing list of 2,500 households in Washtenaw County, Michigan, from a marketing list vendor; each household had a head of household who was a least 60 years old. The authors developed two gender-specific surveys that were based on the MESA study (, available in the online version of this article). Demographics, medical and surgical history, health and mobility, coffee and tea intake, sexual activity, alcohol use, and urinary incontinence were assessed in men and women; in addition, sexual desire was assessed in women, and erectile function was assessed in men. One survey for men and one survey for women were sent to each head of household and his or her partner. Questions about sexual orientation were not included in the survey; however, the authors anticipated that almost all respondents would be heterosexual, as only 1% to 2.3% of adults self-identify as gay or lesbian (Carpenter, 2013). Sampling only heterosexual couples would allow the authors to re-examine the previously found link between caffeine and sexual activity in married couples (Diokno et al., 1990). Using this method, sampling 2,500 households would yield up to 5,000 survey respondents. If only one partner completed a survey, he or she was still included in the study. A cover letter, a study information sheet, the two surveys without any subject identifiers, and two postagepaid return envelopes were mailed to each household. No other attempts were made to recruit study participants or contact survey respondents.

Definitions

In the MESA study (Diokno et al., 1990), participants were considered sexually active if they responded yes to the question: “Are you sexually active?” However, for the current study, participants were asked, “Are you sexually active? Sexual activity can include touching and caressing, masturbation, and sexual intercourse.” Those who reported sexual activity (based on the study definition) at least once per month were considered sexually active. Participants were also asked how much coffee and tea they typically consumed in a 24-hour period, what type of coffee and/or tea (i.e., caffeinated or decaffeinated) they consumed, and how long they had been drinking coffee and/or tea. Other sources of caffeine, such as soda and/or energy drinks, were not assessed. MESA participants were considered coffee drinkers if they drank at least one cup of any type of coffee per day without specifying whether the coffee contained caffeine. Participants in the current study were categorized as coffee drinkers if they drank at least one cup of caffeinated coffee per day for at least 1 year. Although other tea types (i.e., green tea) were assessed, to be consistent with the MESA study, participants in both studies were labeled as tea drinkers if they consumed at least one cup of black tea per day for at least 1 year. Any reported wine, beer, or liquor consumption was considered alcohol use.

Measures

The survey for men also contained the validated Sexual Health Inventory for Men (SHIM; Rosen, Cappelleri, Smith, Lipsky, & Peña, 1999). The SHIM is a widely used scale with high sensitivity and specificity for screening/diagnosis of erectile dysfunction (ED). The SHIM is scored by adding the numbers associated with each response. ED can be classified into five severity grades based on SHIM scores: no ED (22 to 25), mild (17 to 21), mild to moderate (12 to 16), moderate (8 to 11), and severe ED (1 to 7).

The survey for women contained the sexual desire domain of the Abbreviated Sexual Function Questionnaire (ASFQ©; Williams, Abraham, & Symonds, 2010); however, the sexual arousal, orgasm, and pain domains were not included. Including all ASFQ domains would be important for a comprehensive study of female sexual dysfunction, but because existing data suggest that desire is significantly associated with frequency of sexual activity in later life (Kontula & Haavio-Mannila, 2009), only the desire domain was included. The desire domain contains four questions about frequency of pleasurable thoughts about sex, desire for sensual touching, desire for taking part in sexual activity, and frequency of initiating sexual activity over the past 4 weeks. Each question has five levels of responses: not at all, rarely, sometimes, often, and very often. ASFQ scores were calculated using standardized scoring criteria. Both the ASFQ and scoring manual are available with permission (access http://www.pfizerpatientreportedoutcomes.com/therapeuticareas/sexual-health/female-sexual-dysfunction).

Statistical Analyses

The authors of the current article conducted a power analysis to test whether coffee impacted sexual activity and estimated that 124 female survey respondents and 144 male survey respondents would be needed to achieve 80% power at a 0.05 significance level. This calculation was based on the previous study by Diokno et al. (1990). Using response rates to prior studies (Ibrahim, Diokno, Killinger, Carrico, & Peters, 2007) as a guide, the authors estimated that sampling 2,500 households would provide up to 823 survey respondents (divided equally by gender), as well as sufficient power for the current study. Survey responses were examined with Fisher’s exact, Pearson’s chi square (expected frequency >5), or Mantel-Haenszel tests, as well as backwards elimination multivariable logistic regression analyses. A p value of <0.05 was considered statistically significant.

Results

A total of 242 participants (113 women and 129 men) returned the survey. Of these 242 individuals, most were ages 60 to 74 (79%), married (90%), White (90%), college educated (84%), retired (64%), and in good to excellent health (87%). Overall, 159 (65.7%) were sexually active, and 110 of 151 (72.9%) sexually active participants engaged in intercourse. The majority of sexually active adults (104 of 158, 65.4%) reported performing sexual activity at least once per week. Most participants reported some caffeinated coffee or tea intake; 55% drank coffee only, 5% drank tea only, and 6% drank both coffee and tea. However, 35% reported no coffee or tea intake. Sample characteristics stratified by age group are depicted in the Figure.

Sample characteristics by age group.

Figure.

Sample characteristics by age group.

The authors grouped survey respondents based on whether they stated they were sexually active and examined factors that may be associated with being sexually active. Compared with adults who were not sexually active, a higher proportion of sexually active older adults were married (p = 0.0005), did not have urinary leakage (p = 0.006), had better mobility (p = 0.0014) and health (p = 0.0003), and reported alcohol use (p = 0.007) (Table 1). Those who were sexually active also reported higher levels of satisfaction with their sex life (p < 0.0001). Engaging in sexual activity and having intercourse declined with increasing age (p < 0.0001) (Figure).

Comparison of Not Sexually Active and Sexually Active Study Participants

Table 1:

Comparison of Not Sexually Active and Sexually Active Study Participants

Comparison of Not
Sexually Active and Sexually Active Subjects

Table 1 (Continued):

Comparison of Not Sexually Active and Sexually Active Subjects

When examined by gender, similar proportions of women and men were sexually active (Table 1). Of those who were sexually active, most women (74.6%) and men (71.4%) stated that they engaged in intercourse. When sexually active women were compared with inactive women, and sexually active men were compared with inactive men, marital status and general health remained significantly different between groups (Table 1). Sexually active women were more likely to be taking hormones (p = 0.049), report alcohol use (p = 0.0013), and have better ASFQ desire scores (p < 0.0001) compared with women who were not sexually active. Sexually active men reported better erectile function (p < 0.0001) than sexually inactive men and were less likely to report erectile difficulty (p < 0.0001); however, a higher proportion used erectile aids (p = 0.012). Although urinary incontinence was reported by similar proportions of women and men overall, only a higher proportion of sexually inactive men versus active men had urinary incontinence (p < 0.0001), as well as difficulties with mobility (p = 0.012). When coffee and non-coffee drinkers were evaluated, no statistically significant differences were found (Table 2). Tea and non-tea drinkers, as well as those reporting any caffeine (i.e., tea and/or coffee) use, were also similar when compared with participants who denied caffeine use.

Comparison of Non-Coffee and Coffee Drinkers

Table 2:

Comparison of Non-Coffee and Coffee Drinkers

Multivariate logistic regression analyses evaluated the effect of several variables on sexual activity, including coffee intake, tea intake, age, marital status, urinary incontinence, health status, diabetes, alcohol use, and mobility. In women, the ASFQ desire score was added to the multivariate models; in men, erectile difficulty, the use of erection assistance, ED based on SHIM scores, and history of prostate cancer treatment were added to the multivariate models. Only significant variables, and coffee/tea use regardless of significance, were included in the final backwards elimination model. In women, being sexually active increased as the ASFQ score increased (p < 0.0001), and alcohol was also positively associated (p = 0.0388) with sexual activity. In men, urinary incontinence and ED based on SHIM scores were negative predictors of sexual activity (p = 0.0031 and p < 0.0001, respectively). Other variables that were tested had no effect on sexual activity (Table 3).

Multivariable Analysis of Factors’
Impact on Sexual Activity

Table 3:

Multivariable Analysis of Factors’ Impact on Sexual Activity

Discussion

The current study represents factors associated with sexual activity in healthy, community- dwelling older adults, as most (87%) respondents were in good to excellent health. Although the ability to compare findings across studies is limited by varying definitions of sexual activity (Addis et al., 2006; Diokno et al., 1990; Lindau et al., 2007), the proportions of sexually active men and women were similar overall. MESA investigators reported that 66.6% of men and 31.7% of women 60 and older (73.8% and 55.8% of married men and women, respectively) were sexually active (Diokno et al., 1990). Similarly, 68.2% of men were sexually active in the current study; however, a higher proportion of women (62.8%) were sexually active. In another study that included slightly younger men and women (ages 40 to 80), 79.4% of men and 69.3% of women had engaged in sexual intercourse within the past 12 months (Laumann et al., 2009). The current study, as well as others, noted a decline in sexual activity with age (Lindau et al., 2007).

The results of the current study are in accordance with previous findings that sexually active older adults reported better overall health (Lindau & Gavrilova, 2010) and mobility and are more likely to be married (Bach et al., 2013). However, in contrast to other studies (Barber et al., 2002), urinary incontinence did not seem to affect sexual activity in women. The explanation for this finding is unclear, but it may be due to the small sample and few incontinent participants overall. However, in men, incontinence was a significant negative predictor of sexual activity, which is not surprising because urinary incontinence is also associated with ED (Coyne et al., 2011; Diokno et al., 1990). Because of the associations between overactive bladder, urinary incontinence, aging, and sexual difficulties (Coyne et al., 2011), urology specialists should be particularly aware of the need to assess for sexual problems.

The authors of the current article hypothesized that caffeine may be responsible for the previously reported association between coffee use and sexual activity (Diokno et al., 1990); however, coffee and/or tea consumption in the current study did not seem to have any effect. Other forms of caffeine, as well as coffee brand, type, amount, and caffeine concentration, were not considered in either study but may have contributed to the discrepancy in findings. Sexually active women (but not men) were more likely to report alcohol use. Other studies have also noted a link between moderate alcohol use and sexual activity in women (Addis et al., 2006). Although human sexuality is multifactorial and complex, alcohol consumption may lower inhibitions and increase desire in women more than men.

Overall satisfaction with one’s sexual life may not necessarily be related to being sexually active, as some study participants who were not sexually active still reported satisfaction. This finding suggests that the importance of maintaining one’s sexual life is individualized and probably dependent on attitudes (Waite, Laumann, Das, & Schumm, 2009 ), as well as partner availability (Bach et al., 2013). Lindau and Gavrilova (2010) reported that married men and women have more frequent partnered sexual activity than formerly married or single individuals, especially at older ages; they noted that social and cultural norms may limit intimate sexual activity to individuals in committed relationships. Although it is beyond the scope of the current article to examine factors associated with sexual satisfaction, higher levels of satisfaction were reported in sexually active adults, indicating that sexual expression continues to be important as one ages.

Limitations

Strengths of the current study include incorporating the SHIM and ASFQ into the survey and allowing participants to self-define sexual activity independent of whether they were engaging in sexual intercourse. This expanded definition acknowledges other forms of sexual expression, such as touching, hugging, and kissing (Ginsberg, Pomerantz, & Kramer-Feeley, 2005 ), which may be used frequently, especially when individuals are adapting to physical or other impairments.

Limitations include a lower-than- expected response rate and a lack of statistical power, which limited the authors’ ability to identify associations between sexual activity and coffee/caffeine use. The authors had used an anonymous survey to protect participants’ privacy; however, some nonrespondents called the study telephone number provided to participants for questions, but the number was used to object to the sensitive nature of study questions.

Future studies would benefit from a more diverse population sampling to improve generalizability of results, the inclusion of validated quality of life and geriatric sexuality questionnaires, and examinations of sexual health in lesbian, gay, bisexual, and transgender older adults.

Nursing Implications

The current study’s results support previous findings that urinary incontinence, poor health, and poor mobility are factors that negatively impact sexual health. Nurses working with community-dwelling older adults or older adults residing in nursing homes should be aware of these associations to provide comprehensive care. Older adults have been found to lack accurate and current information about sexuality (Rheaume & Mitty, 2008), and nurses are well suited to bridge this knowledge gap. Because health care providers are often hesitant to discuss sexual health in older adults, significantly impacting the health of this population (Price, 2009), nurses and other providers should receive formal training regarding geriatric sexual health needs so they have the adequate knowledge and skills to support older adults. Armed with the proper information and attitudes, nurses can promote sexual health through education and counseling, particularly after major health events or in the setting of chronic illness (Steinke, 2013).

Conclusions

Maintaining sexual health will likely increase in importance as more individuals live longer and in better health. However, much must still be learned about the impact of behaviors, habits, and illness on sexuality among older adults. Ongoing study raises awareness that sexuality is important to the human experience, regardless of age, and can improve nurses’ and other health care providers’ ability to communicate and help older adults address unmet needs.

References

  • Addis, I.B., Van Den Eeden, S.K., Wassel-Fyr, C.L., Vittinghoff, E., Brown, J.S. & Thom, D.H.Reproductive Risk Factors for Incontinence Study at Kaiser Study Group. (2006). Sexual activity and function in middle-aged and older women. Obstetrics and Gynecology, 107, 755–764.
  • Bach, L.E., Mortimer, J.A., VandeWeerd, C. & Corvin, J. (2013). The association of physical and mental health with sexual activity in older adults in a retirement community. Journal of Sexual Medicine, 10, 2671–2678. doi:10.1111/jsm.12308 [CrossRef]
  • Barber, M.D., Visco, A.G., Wyman, J.A., Fantl, J.A. & Bump, R.Continence Program for Women Research Group. (2002). Sexual function in women with urinary incontinence and pelvic organ prolapse. Obstetrics and Gynecology, 99, 281–289.
  • Bekker, M.D., Van Driel, M.F., Pelger, R.C., Lycklama à Nijeholt, G.A. & Elzevier, H.W. (2011). How do continence nurses address sexual function and a history of sexual abuse in daily practice? Results of a pilot study. Journal of Sexual Medicine, 8, 367–375. doi:10.1111/j.1743-6109.2010.02044.x [CrossRef]
  • Carpenter, C.S. (2013). The prevalence of gay men and lesbians. In Baumle, A.K. (Ed.), International handbook on the demography of sexuality (pp. 217–228). New York, NY: Springer.
  • Coyne, K.S., Sexton, C.C., Thompson, C., Kopp, Z.S., Milsom, I. & Kaplan, S.A. (2011). The impact of OAB on sexual health in men and women: Results from EpiLUTS. Journal of Sexual Medicine, 8, 1603–1615. doi:10.1111/j.1743-6109.2011.02250.x [CrossRef]
  • Diokno, A.C., Brown, M.B. & Herzog, A.R. (1990). Sexual function in the elderly. Archives of Internal Medicine, 150, 197–200.
  • Ginsberg, T.B., Pomerantz, S.C. & Kramer-Feeley, V. (2005). Sexuality in older adults: Behaviors and preferences. Age and Ageing, 34, 475–480. doi:10.1093/ageing/afi143 [CrossRef]
  • Gott, M., Hinchliff, S. & Galena, E. (2004). General practitioner attitudes to discussing sexual health issues with older people. Social Science & Medicine, 58, 2093–2103.
  • Hawkins, K., Pernarelli, J., Ozminkowski, R.J., Bai, M., Gaston, S.J., Hommer, C. & Yeh, C.S. (2011). The prevalence of urinary incontinence and its burden on the quality of life among older adults with medicare supplement insurance. Quality of Life Research, 20, 723–732. doi:10.1007/s11136-010-9808-0 [CrossRef]
  • Ibrahim, I.A., Diokno, A.C., Killinger, K.A., Carrico, D.J. & Peters, K.M. (2007). Prevalence of self-reported interstitial cystitis (IC) and interstitial-cystitis-like symptoms among adult women in the community. International Urology and Nephrology, 39, 489–495.
  • Kontula, O. & Haavio-Mannila, E. (2009). The impact of aging on human sexual activity and sexual desire. Journal of Sex Research, 46, 46–56. doi:10.1080/00224490802624414 [CrossRef]
  • Laumann, E.O., Glasser, D.B., Neves, R.C. & Moreira, E.D. Jr.. Global Study of Sexual Attitudes and Behaviours Investigators’ Group. (2009). A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. International Journal of Impotence Research, 21, 171–178. doi:10.1038/ijir.2009.7 [CrossRef]
  • Lindau, S.T. & Gavrilova, N. (2010). Sex, health, and years of sexually active life gained due to good health: Evidence from two US population based cross sectional surveys of ageing. British Medical Journal, 340, c810.
  • Lindau, S.T., Laumann, E.O, Levinson, W. & Waite, L.J. (2003). Synthesis of scientific disciplines in pursuit of health. Perspectives in Biology and Medicine, 46(3 Suppl.), S74–S86.
  • Lindau, S.T., Schumm, L.P., Laumann, E.O., Levinson, W., O’Muircheartaigh, C.A. & Waite, L.J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357, 762–764. doi:10.1056/NEJMoa067423 [CrossRef]
  • Lindau, S.T., Tang, H., Gomero, A., Vable, A., Huang, E.S., Drum, M.L. & Chin, M.H. (2010). Sexuality among middle-aged and older adults with diagnosed and undiagnosed diabetes: A national, population-based study. Diabetes Care, 33, 2202–2210. doi:10.2337/dc10-0524 [CrossRef]
  • Linley, L., Prejean, J., An, Q., Chen, M. & Hall, H.I. (2012). Racial/ethnic disparities in HIV diagnoses among persons age 50 years and older in 37 US states, 2005–2008. American Journal of Public Health, 102, 1527–1534. doi:10.2105/AJPH.2011.300431 [CrossRef]
  • Mahieu, L., Van Elssen, K. & Gastmans, C. (2011). Nurses’ perceptions of sexuality in institutionalized elderly: A literature review. International Journal of Nursing Studies, 48, 1140–1154. doi:10.1016/j.ijnurstu.2011.05.013 [CrossRef]
  • Penhollow, T.M., Young, M. & Denny, G. (2009). Predictors of quality of life, sexual intercourse, and sexual satisfaction among active older adults. American Journal of Health Education, 40, 14–22.
  • Price, B. (2009). Exploring attitudes towards older people’s sexuality. Nursing Older People, 21(6), 32–39.
  • Rheaume, C. & Mitty, E. (2008). Sexuality and intimacy in older adults. Geriatric Nursing, 29, 342–349. doi:10.1016/j.gerinurse.2008.08.004 [CrossRef]
  • Rosen, R.C., Cappelleri, J.C., Smith, M.D., Lipsky, J. & Peña, B.M. (1999). Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. International Journal of Impotence Research, 11, 319–326.
  • Steinke, E.E. (2013). Sexuality and chronic illness. Journal of Gerontological Nursing, 39 (11), 18–27. doi:10.3928/00989134-20130916-01 [CrossRef]
  • Waite, L.J., Laumann, E.O., Das, A. & Schumm, L.P. (2009). Sexuality: Measures of partnerships, practices, attitudes, and problems in the National Social Life, Health, and Aging Study. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 64(Suppl. 1), i56–i66. doi:10.1093/geronb/gbp038 [CrossRef]
  • Williams, K., Abraham, L. & Symonds, T. (2010). PIH33 psychometric validation of an abbreviated version of the sexual function questionnaire (ASFQ). Value in Health, 13(7), A381. doi:10.1016/S1098-3015(11)72548-7 [CrossRef]
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Appendix: Comparison of Not Sexually Active and Sexually Active Study Participants

10.3928/19404921-20141006-01

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