Sexual wellbeing is likely to be an important aspect in the management of older mental health patients as increasing age1 and mental illness2 can both adversely affect sexual practice and satisfaction. With this in mind, we explored the expectations and attitudes of people over age 65 years with mental illness towards sexual healthcare with an anonymous, cross-sectional postal survey. Participants (mean age 78 years) were patients affiliated with old-age psychiatric services at St Charles Hospital, with 64% having diagnoses of either dementia or depression. A total of 139 surveys were posted, 30 were returned (22% response rate) and six people complained.
We found that most responders (18, 82%) believed doctors should enquire about sexual matters, although only the minority (2, 9%) had been involved in such discussion with their doctor. Many responders (14, 64%) felt at ease with sexual discussion, yet, few (5, 23%) regarded their doctor as comfortable with this. Furthermore, women reported less comfort, but no less interest in sexual discourse than men (P = 0.03), suggesting particular understanding should be employed when taking sexual histories from older females. Increasing age (P = 0.03) and cohabitation (P = 0.08), were found to be associated with a decreased desire to discuss sexual issues.
Aged sexuality is still a taboo. It is widely believed by doctors that sexual enquiry is inappropriate and often unnecessary among older adults,3 however, this study and American research4 indicate that this is not always the case. The implication being that physicians are not meeting the sexual healthcare needs of older mental health patients.
While we found reluctance among many older people to respond to the survey, of those who did, most older patients wished to be asked about sexual issues. However, clinicians need to do this sensitively. The lack of response, and number of complaints about the survey, highlights a crucial finding; while sexual enquiry is acceptable and welcomed in the US, it may not be so well tolerated in the UK.
In summary, many older age psychiatric patients want to talk about their sex lives with doctors but are currently not afforded the opportunity. GPs are well placed to assess issues of sexual dysfunction. Older, UK-based populations are difficult to survey regarding sex but this study indicates that further research would be valuable.
- © British Journal of General Practice, 2008.