Should we encourage the elderly to have more sex in nursing homes?

Previously published Slate articles made new.
Sept. 10 2008 6:58 AM

Naughty Nursing Homes

Is it time to let the elderly have more sex?

Sexual desire may wane with age, but it doesn't disappear. For Slate's 2007 "Sex issue," Daniel Engber reported on sexual expression in nursing homes—a thorny issue for doctors worried about whether their senile patients are capable of informed consent. His original article is reprinted below.

When 15 elderly residents at a rundown and understaffed nursing home in Tampa, Fla., died over a three-year span that recently ended, their families filed suit in state court. According to Charles Duhigg's damning report in last Sunday's New York Times, these claims of negligence don't have much of a chance. Throughout the industry, financial backers have begun to hide their profits behind elaborate corporate façades, making litigation against nursing homes almost impossible. Not surprisingly, the quality of care is already in decline.

Daniel Engber Daniel Engber

Daniel Engber (@danengber) is a columnist for Slate. Send him an email at danengber@yahoo.com.

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But there is one way in which these venal, cost-cutting schemes might actually improve conditions in the nursing home. As lawsuits become harder to win, families will have less of a say in how their relatives are treated—and that could give administrators the freedom to reverse overcautious policies on intimate contact between residents. If that happens, elderly patients could reap the rewards of more sex.

Old people have plenty of intercourse when they're not in an institutional setting. A survey published last month in the New England Journal of Medicine found that a quarter of those between the ages of 75 and 85 were having sex, and many were doing it at least once every couple of weeks. A third of these sexually active respondents said they had either given or received oral sex in the past year.

There's no reason to think that nursing-home residents would be any less frisky, if left to their own devices. After all, we're talking about a mixed-sex population living in close quarters with almost endless amounts of free time. Already, staffers routinely field patient requests for personal lubricants, pornographic magazines, larger-size beds, and prescriptions for Viagra. And that's with the 1.6 million elderly residents who came of age before the sexual revolution. Within a few decades, nursing homes will be replete with the desires and expectations of almost 7 million liberated baby boomers.

For now, though, never mind what they want: We seem content to let our elders lie in celibate repose as they wait for Oscar, the death-sniffing cat. In most nursing homes, residents are relegated to narrow mattresses with very little privacy. Nurses enter rooms without knocking, and express disgust at masturbation or coupling, and in some cases, residents are even deprived of conjugal visits from their long-term partners. (This 2004 case study [PDF] from Clinical Geriatrics describes a 77-year-old resident who is instructed by his doctor to "take cold showers" when he complains of sexual issues.) Overseas, elderly patients seem to enjoy a bit more open-mindedness; at one home in Denmark, you can even call out for hookers and X-rated movies. But most nursing-home residents in the United States suffer under a regime of tyrannical chastity.

Why are nursing-home administrators so queasy about sexual expression? They're afraid of getting sued. An estimated 50 percent of elderly residents suffer from some degree of Alzheimer's disease or dementia, which, depending on its severity, can make them confused, forgetful, or unaware of their own behavior. Even in the best cases, many of these patients may not be able to provide clear consent to a sexual advance.

At the same time, certain kinds of cognitive impairment can actually enhance a patient's sex drive. Almost a quarter of dementia sufferers lose interest in sex, but about 14 percent experience a heightened libido—and up to 8 percent become unable to control their sexual behavior. This can manifest as incessant masturbation and repetitive sexual advances. (A patient with memory loss might forget that he's just had sex with his wife or girlfriend, or mistake a stranger for an intimate partner.) Certain psychoactive drugs—especially those prescribed for Parkinson's disease—can also serve as nursing-home love potions.