It starts with sex and goes downhill from there.
By Paula Spencer Scott, Caring.com senior editor
Worried about getting old? Who isn't -- except perhaps those who are already unmistakably there. Survey after survey shows the elderly are more content with life, less depressed, and less fearful of death than the young.
"I'm a lot more sanguine and comfortable about aging at 76 than I was at 56," says George Vaillant, professor of psychiatry at Harvard Medical School who codirects its Study of Adult Development.
Worried about getting old? Who isn't -- except perhaps those who are already unmistakably there. Survey after survey shows the elderly are more content with life, less depressed, and less fearful of death than the young.
"I'm a lot more sanguine and comfortable about aging at 76 than I was at 56," says George Vaillant, professor of psychiatry at Harvard Medical School who codirects its Study of Adult Development.
In the meantime, though? Guys in midlife harbor plenty of fears when they peer ahead. (Women have their own, slightly different set of aging fears).
Among men's top fears about getting older:
Men's Aging Fear #1: Impotence
"No question that men worry more than women about performing," says Ken Robbins, a University of Wisconsin professor of psychiatry who's also board certified in internal medicine. "When libido starts to diminish or things don't work as well as they did before, it's very common for men to worry that they'll embarrass or humiliate themselves."
Perhaps performance anxiety isn't surprising, given a 2008 British study that showed men think about sex 13 times a day, compared to 5 times a day for women.
The prospect of impotence was scarier than cancer or death to readers of a men's magazine in a 2001 poll. Perhaps there's a good medical reason for this: Otherwise healthy men who have erectile problems have been shown to have abnormal coronary tissue, higher incidence of high blood pressure, high blood fat, and other markers of heart disease.
Fear fighter: Have your cholesterol checked. Three-fourths of men with erectile dysfunction (ED) have abnormal cholesterol. "Two-thirds of men who've had heart attacks had ED that predated angina by at least three years," says urologist John Mulhall, director of the Sexual Medicine Program and the Sexual Medicine Research Laboratory at Weill Medical College of Cornell University in New York City.
Men's Aging Fear #2: Weakness
It's said that knowledge is power -- but for men, so is physical power itself. "Men value strength and vigor more -- and when it starts to slide, they take it much harder than women do," Robbins says. "Losing physical strength adds to their overall sense of loss: 'If I can't lift things, what kind of man am I?'"
Feeling weaker was named one of the most dreaded parts of aging for nearly 9 in 10 people surveyed earlier this year by the American Geriatrics Society Foundation for Health in Aging along with Abbott Labs.
Fear fighter: Start (or keep up) resistance training and a healthy diet. Only 25 percent of the 1,000 adults in the AGSF study made strength training part of their everyday routine, even though this basic can protect muscle health.
Men's Aging Fear #3: Retirement/irrelevance
The prospect of retiring fires enormous anxiety because it, too, begs the question, "If I'm not my career, what am I?"
"Men fear retirement because it's how they define themselves and how they fill their time," says geriatrician Laurie Jacobs, director of the Jack and Pearl Resnick Gerontology Center at the Albert Einstein College of Medicine in New York City. In the U.S., reaching retirement age tends to coincide with having your opinion solicited less and becoming more "invisible," she adds. Net result: a huge ego blow.
Women have an easier time giving up work, psychiatrist Ken Robbins adds, because they more quickly fill its gap with friends and children.
Fear fighter: Avoid being sidelined by staying involved, even if it means finding new ways to do so. Try to follow new technologies, stay interested in younger people, reinvent yourself by discovering a new meaning and purpose to your life post-retirement. Or keep working. Above all, stretch yourself to keep social networks strong.Jacobs foresees the coming wave of baby-boom retirees reshaping retirement and how aging itself is perceived "because they've changed every other life stage as they've gone through it."From his first souped-up junker to his badge-of-success sports car (or midlife-crisis convertible), what a man drives reflects his very identity. In American culture, cars also represent freedom, independence, and the endless possibilities of the open road.
Women have an easier time giving up work, psychiatrist Ken Robbins adds, because they more quickly fill its gap with friends and children.
Fear fighter: Avoid being sidelined by staying involved, even if it means finding new ways to do so. Try to follow new technologies, stay interested in younger people, reinvent yourself by discovering a new meaning and purpose to your life post-retirement. Or keep working. Above all, stretch yourself to keep social networks strong.Jacobs foresees the coming wave of baby-boom retirees reshaping retirement and how aging itself is perceived "because they've changed every other life stage as they've gone through it."From his first souped-up junker to his badge-of-success sports car (or midlife-crisis convertible), what a man drives reflects his very identity. In American culture, cars also represent freedom, independence, and the endless possibilities of the open road.
Men's Aging Fear #4: Losing wheels (and independence)
The prospect of having to give all that up -- which many men first think about when they see their own fathers turning in the keys for safety's sake -- is scary indeed.
Driving is also emblematic of another fear: Becoming dependent on others to meet basic needs. "It's no coincidence that the men with the highest social status in assisted-living communities are the ones who have driver's licenses," Robbins notes.
Fear fighter: Consider the facts. Many older adults continue to be able to drive safely into their 70s and 80s. A refresher course can help. But know that this is one area where the greater good -- the safety of others --should trump private fears, when the time comes.
Fear fighter: Consider the facts. Many older adults continue to be able to drive safely into their 70s and 80s. A refresher course can help. But know that this is one area where the greater good -- the safety of others --should trump private fears, when the time comes.
Men's Aging Fear #5: Losing your mind (or your wife losing hers)Perhaps recent headlines are scaring more men into the fear of Alzheimer's: Men are more likely than women to have mild cognitive impairment (MCI) -- sometimes called "pre-Alzheimer's" -- and get it earlier, according to a Mayo Clinic study in the September 2010 journal Neurology. Nearly one in five men ages 70 to 85 have the condition, which falls between normal forgetfulness and early dementia.
More women, on the other hand, actually develop Alzheimer's disease. But that, too, is a scary prospect for their mates, thrust with little preparation into a caregiver role. "Most men haven't done too much caregiving," Robbins says. And nothing dashes the fantasy of a footloose-and-fancy-free retirement like tending full-time to a partner who doesn't even know you.
Dementia was the number-one health concern of 12,000 Americans (both genders together) in 2010 Bupa Health Pulse, a survey conducted by the British healthcare company Bupa.
Fear fighter: Know that only about 15 percent of cases of mild cognitive impairment evolve into dementia each year. (If you're married, you may be protected; MCI is highest in men who were never wed.) No surefire ways to prevent Alzheimer's have been found, but a heart-healthy lifestyle may lower the risk.
As for facing a journey of dementia care, one silver lining is that more and more men are caregivers today. And unlike a generation ago, many great resources now exist to support inexperienced caregivers.
Dementia was the number-one health concern of 12,000 Americans (both genders together) in 2010 Bupa Health Pulse, a survey conducted by the British healthcare company Bupa.
Fear fighter: Know that only about 15 percent of cases of mild cognitive impairment evolve into dementia each year. (If you're married, you may be protected; MCI is highest in men who were never wed.) No surefire ways to prevent Alzheimer's have been found, but a heart-healthy lifestyle may lower the risk.
As for facing a journey of dementia care, one silver lining is that more and more men are caregivers today. And unlike a generation ago, many great resources now exist to support inexperienced caregivers.
Paula Spencer Scott, Caring.com senior editor
Paula Spencer Scott, senior editor, works on Caring's Health and Caregiver Wellness channels, including writing the Steps & Stages Alzheimer's resource,FYI Daily, the Self Caring blog, and other medical and caregiving content. She's specialized in women's life-stage concerns (baby care, family care, self care, elder care) from her first job as an editor at 50 Plus Magazine through stints as a Woman's Day columnist, a Parenting Magazine contributing editor, the author of Momfidence, and the co-author of five books with doctors at Harvard, UCLA, Duke, and Arizona State. She's a 2011 Met Life Foundation Journalists in Aging fellow, awarded by the Gerontological Society of America and New American Media, and serves on the board of the University of North Carolina Science and Medical Journalism Program. A mother of four, she lives in the San Francisco Bay Area.
In the late 2000s, she lost both her parents, in their 80s, to cancer; her father also had dementia and stroke. "In short order during that phase," she says, "I experienced just about everything that's on this site, from dealing with their illnesses to selling the family home and moving Dad, plus advance directives, end-of-life planning, hospice, death -- and stress."
Paula Spencer Scott can be reached at paulaspencerscott@caring.com.
Sex and Aging
By Chris Woolston, M.S., and Paige Bierma, M.A.
Nothing is more irritating to author Connie Goldman than the stereotypes out there about older people and sex -- especially the one about seniors not having sex. "People see an older couple that has just gotten married or who are holding hands, and they say, 'Oh, how cute,' " says Goldman, a former public radio producer. "It's belittling."
At age 76, Goldman spends a great deal of her time trying to counter those stereotypes. "There is this idea that all old people are alike, but my experience in interviewing hundreds of seniors is that each relationship is unique and different," says Goldman, whose recent book, Late-Life Love: Romance and New Relationships in Later Years, features interviews with 22 couples about their relationships.
"I can tell you that sexual attraction and sensual feelings do not go away with age. It may not be that very hot passionate feeling that you had when you were 19, but it certainly isn't gone," Goldman says. "We find a way to express our sensual feelings, not to mention our affection."
Surveys back her up. A 2004 poll conducted by the AARP found that sexual desire runs deep among people in their 50s, 60s, 70s, and beyond. Many older people are able to put those feelings into action as well: About one out of three people over 70 who have regular partners said they have intercourse at least once a week.
Of the 1,600 people surveyed, just 4 percent agreed that "sex is only for younger people."
At any age, sex can help strengthen intimate relationships while easing stress and boosting overall health. For seniors, sex can also restore feelings of vitality, says Erica Goodstone, PhD, a certified sex therapist and licensed mental health counselor in Boca Raton, Florida, who works with many older couples and singles. "It's part of being truly alive."
Unfortunately, many older people miss out on sex and all of its benefits, even if they crave this type of physical intimacy. They may have physical problems that make sex difficult or painful, or they may have simply lost their interest and desire. But these obstacles aren't as serious as they used to be. Thanks to new treatments -- and a new appreciation for the importance of sex in later years -- older people often choose to make sex an enduring part of their lives.
Obstacles of age
Of course, sex for today's 70- and 80-year-olds is likely not the same as before. As reported by the Medical Clinics of North America (MCNA), the inevitable bodily changes of aging can affect the sexual lives of all seniors. Older men and women tend to need extra time -- and extra touching -- to become aroused. Both men and women may also need extra time to reach orgasm, and the orgasms themselves may not be as intense as they used to be.
Hormones are partly to blame. Secretion of testosterone, a hormone that helps fuel sex drive in both men and women, gradually declines with age. Postmenopausal women also lose estrogen, a biological change that can affect women's sexuality.
"My sex drive is different," observes Connie Goldman, who has been with her current partner, age 79, for about six years. "I was surprised at the changes, but I've learned to embrace them along with the other changes that come with the years."
One's definition of "sex" may also broaden over time, Goldman says. "Because of some physical limitations, I wouldn't say that my partner and I have the same kind of intercourse that we were able to have at one time," she notes, "but it makes no difference because we're able to satisfy each other in other ways."
So even as hormones drop, desire can remain strong. "The brain is the largest sex organ," says therapist Goodstone. At any age, expectations for good sex can be a self-fulfilling prophecy, she says. And as reported by the MCNA, some postmenopausal women actually have more interest in sex than ever before, because they don't have to worry about becoming pregnant.
Other physical changes can be far more noticeable -- and troubling -- than a drop in hormones. Men may have extra trouble achieving or maintaining erections. "Erectile dysfunction," as the TV ads put it, isn't really an inevitable part of aging, but it's so common that men often accept it as a fact of life. Men are especially likely to develop ED if they have diabetes, atherosclerosis, or high blood pressure. Many medications can also lead to ED, including beta blockers and antidepressants.
Women face problems of their own. With age, the vagina becomes drier and loses muscle tone, which can make sex uncomfortable or even painful. Goodstone worked with one older woman who was so susceptible to pain that she didn't even want a doctor to touch her. "I assured her that doctors have ways to treat pain," she says. "[Being in] pain isn't normal."
Sexual problems may be embarrassing to discuss; however, it's important that your physician give careful consideration to your concerns. Your physician may want to check hormone levels with blood tests to be sure they are not below normal for your age.
Sexual healing
For many older men and women, a trip to the doctor could be the first step toward a more active, pleasurable sex life. For some men, doctors can prescribe drugs to treat ED, such sildenafil (Viagra). These medications have started a sexual revolution for the many men who had given up hope of ever having a sex life again. The 2004 AARP survey found that 22 percent of men had tried one of the medications -- up from 10 percent six years before. Men aren't the only ones who appreciate the pills: Women in the survey generally enjoyed sex more when their partners got treatment for ED.
Viagra and similar drugs improve erections, but they don't enhance desire (libido). Older men who lose interest in sex may want to have their testosterone levels checked. If the levels are low, testosterone gel or patches might renew the sexual spark. Some research suggests that women -- specifically women who have had a hysterectomy or had their ovaries removed -- may also benefit from low-dose testosterone patches if other causes of low libido have been ruled out. (Prescribing testosterone for women's sexual health after menopause is still controversial in the United States. The Food and Drug Administration has not approved any testosterone drugs for women's sexual health, although some doctors prescribe these products off-label.).
Women who feel pain or discomfort during sex should definitely bring up the matter with their doctor. For some women, the solution is as simple as a water-based lubricant (such as K-Y jelly). While there are some recent concerns about taking estrogen tablets, some women may find relief with estrogen vaginal cream.
Sexual passion ebbs and flows over time, and some experts believe that periods of low libido may be related to aspects of life that have become imbalanced. The imbalance could be, for example, an increase in stress, no longer feeling a close connection with a partner or spouse, or having low self-esteem. In her book Reclaiming Your Sexual Self, therapist Kathryn Hall suggests that addressing such problems can help to rekindle desire.
In the later years, good sex takes cooperation, Goodstone says: "As you get older, having a partner that you can communicate with becomes more and more important." Working together, couples can find the positions and techniques that give them both maximum satisfaction without tiring each other out or putting too much stress on sore joints.
"One of the great things about getting older is that there tends to be this freeing to say exactly how you feel, and what it is you want and need," says Goldman. "We know that there's a life cycle and that we're not here forever. We are here today, though, so we don't waste time: We talk about what we need to talk about and get on with it."
Of course, there's more to intimacy than sex. Goodstone encourages older couples to be affectionate and touch each other often. Massages, foot rubs, and holding hands can build closeness at any age. She also recommends occasionally getting a professional massage. People feel sexier when their bodies feel better, she says.
For Goldman and her partner, cuddling has become a crucial component of their intimacy repertoire. "We cuddle when we go to bed, we cuddle when we wake up, and we cuddle during the night when we bump into each other," Goldman says. "It's a form of intimacy that gives us pleasure and connection in many ways similar to intercourse. It's not the same feeling of excitement, but it is intense intimacy."
References
Interview with Connie Goldman.
Interview with Erica Goodstone, PhD.
America Association of Retired Persons. Sexuality in midlife and beyond: 2004 update of attitudes and behaviors.
Ginsberg, T.B. Aging and sexuality. The Medical Clinics of North America. 2006. 90: 1025-1036.
Nusbaum, M.R.H. et al. Addressing the physiologic and psychological sexual changes that occur with age. Geriatrics. September 2005. 60(9): 18-23.
National Institute on Aging. Sexuality later in life. Last updated April 2010
Hall, Kathryn. Reclaiming Your Sexual Self: How You Can Bring Desire Back Into Your Life. John Wiley & Sons, Inc. 2004.
Patching up low libido: Study examines testosterone in women. University of Michigan Health System. February 2, 2004.
Kingsberg S., Testosterone treatment for hypoactive sexual desire disorder in postmenopausal women. J Sex Med. 2007 Mar;4 Suppl 3:227-34.
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