Baby boomers’ attitudes to maintaining sexual and intimate relationships in long‐term care

Abstract

Objectives:
Australian aged care policy is wholly focused on individual “consumers” and consequently neglects the needs of dyadic partners. This paper highlights partnered baby boomers’ attitudes to maintaining sexual and intimate relationships in residential care.

Methods:
In 2016, cross‐sectional data were collected using an online survey of partnered baby boomers recruited using social media. Qualitative data were analysed using word frequency, keywords‐in‐context and thematic analysis. Descriptive statistics were generated from quantitative data.

Results:
There were 168 participants (85% female), aged 51‐71 years. Many reported that remaining together and continuing physical and sexual contact were important in aged care contexts—necessitating private couple's suites, shared beds, access to condoms, lubricants and sexual health professionals.

Conclusions:
Considerable cultural change will be required to raise residential aged care to the standard expected by some partnered baby boomers. Shifting to a more couple‐centred approach may benefit partnered residents’ health and well‐being.

Full text

Australas J Ageing. 2020;39(Suppl. 1):49–58.
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49
wileyonlinelibrary.com/journal/ajag
1
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INTRODUCTION
Australian aged care policy lacks a framework for dyadic
partners by framing care recipients as individuals (termed
“consumers”).1 Partnered consumers’ expectations prior to
entering care is a neglected research area.2,3 This paper high-
lights the concerns of partnered baby boomers4 contemplat-
ing potential futures in residential care.
Research reveals that couples’ primary relationships typ-
ically become more important with age.5 Partner intimacy
and emotional support remain important, even when living
separately.6-8 Due to the ongoing companionship and mutual
care they receive,1,5 happily partnered cohabiters reportedly
experience better health and well-being than non-cohabit-
ers9,10 or unhappily partnered couples.9 The practice of sleep-
ing together has independent, added health benefits.11
Ongoing sexual activity is a normal component of many older
adults’ intimate relationships. Extant literature suggests that sex-
ual expression is integral to one's identity12 and remains import-
ant throughout life.13 Furthermore, sexual attitudes and identity
change only minimally during adulthood.14 Nonetheless, sexual-
ity research has predominantly focused on individuals, resulting
in a paucity of data on the role partnerships play.14,15
Organisational cultures in Australian residential aged
care facilities (RACFs) generally preclude discussing, as-
sessing or responding to residents’ sexual health needs.16,17
Received: 28 April 2019
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Revised: 22 August 2019
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Accepted: 4 September 2019
DOI: 10.1111/ajag.12732
RESEARCH
Baby boomers’ attitudes to maintaining sexual and intimate
relationships in long-term care
AlisonRahn1,2
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TiffanyJones3,4
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CaryBennett2
|
AmyLykins5
1School of Social Sciences, Sociology
Department, Western Sydney University,
Penrith, NSW, Australia
2School of Humanities, Arts and Social
Sciences, Sociology Department, University
of New England, Armidale, NSW, Australia
3Faculty of Human Sciences, Department of
Educational Studies, Macquarie University,
Sydney, NSW, Australia
4College of Science, Health and
Engineering, School of Psychology and
Public Health, Australian Research Centre
in Sex Health and Society, La Trobe
University, Bundoora, Vic., Australia
5Faculty of Medicine and Health, School
of Psychology, University of New England,
Armidale, NSW, Australia
Correspondence
Alison Rahn, School of Social Sciences,
Western Sydney University, Locked Bag
1797, Penrith, NSW 2751, Australia.
Email: a.rahn@westernsydney.edu.au
Abstract
Objectives: Australian aged care policy is wholly focused on individual “consum-
ers” and consequently neglects the needs of dyadic partners. This paper highlights
partnered baby boomers’ attitudes to maintaining sexual and intimate relationships
in residential care.
Methods: In 2016, cross-sectional data were collected using an online survey of
partnered baby boomers recruited using social media. Qualitative data were analysed
using word frequency, keywords-in-context and thematic analysis. Descriptive sta-
tistics were generated from quantitative data.
Results: There were 168 participants (85% female), aged 51-71 years. Many reported
that remaining together and continuing physical and sexual contact were important
in aged care contexts—necessitating private couple's suites, shared beds, access to
condoms, lubricants and sexual health professionals.
Conclusions: Considerable cultural change will be required to raise residential aged
care to the standard expected by some partnered baby boomers. Shifting to a more
couple-centred approach may benefit partnered residents’ health and well-being.
KEYWORDS
homes for the aged, long-term care, privacy, sexual health, sexual partners
Editorial material and organization © 2020 AJA Inc. Copyright of individual abstracts remains with the authors.

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RAHN et Al.
Beyond issues of sexual orientation and gender identity,18
there is a lack of research into partnered consumers’ rela-
tionship needs more broadly. In gerontological literature,
non-institutionalised partners of care recipients are gener-
ally referred to as “spousal caregivers”.19 Such terms are
arguably ageist, constructing partners as individual enti-
ties, denying the intimate nature of their dyadic relation-
ships and the benefits of cohabitation (a safeguard against
loneliness; a secure, predictable environment; and a social
contract of mutual support).8,19,20 Becoming separated from
a partner can be a distressing experience for both parties.21
The entry of Australia's large baby boomer cohort (born
1946-1965)4 into residential care will likely require changes in
service provision. As adolescents/young adults in the 1960s and
1970s, boomers experienced a climate of rapid and profound so-
cial change. Less shaped by traditions and religious beliefs than
previous generations, sexual permissiveness increased.14,17,22
Some have speculated that boomers will continue to self-iden-
tify as sexual beings14 and voice their views on the topic of
sexuality.23 Having pioneered social changes throughout their
lives, old age may represent their “last frontier”.24
Research reflecting the voices of older adults them-
selves is particularly lacking. To adequately prepare for an
ageing baby boomer cohort, data are needed to evidentially
inform health and aged care policy. To address gaps in the
literature, the research question explored in this article is
as follows: what are partnered baby boomers’ attitudes
to residential aged care? This paper reports on four topic
areas—the perceived importance (or not) of: (a) intimate
relationships, (b) living/sleeping together, (c) remaining
sexual and (d) privacy in residential care.
2
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METHODS
This article reports on a survey that explored partnered baby
boomers’ attitudes to maintaining sexual relationships in
RACFs, being the final stage of a broader, three-part mixed-
methods study.1
2.1
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Design
A web-based survey tool (Qualtrics©) was used to col-
lect quantitative and qualitative cross-sectional data.
Qualitative questions were open-ended and framed phe-
nomenologically to elicit participants’ lived experiences.
Besides demographic data, the survey explored six topic
areas identified from earlier phases of the larger study.1
Ethics approval was granted by the University of New
England's Human Research Ethics Committee (approval
HE15-171).
2.2
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Recruitment
Participants were recruited using volunteer sampling over
a 2-month period in 2016. The survey was promoted via
paid Facebook advertisements and electronic newsletters/
social media pages/websites belonging to COTA (Council
on the Ageing), the Australian Association of Gerontology
and Queensland AIDS Council (an organisation offering
aged care sexual diversity training). Participation was
anonymous—respondents followed an electronic link in the
advertisement to the Qualtrics© website, where they gave
implied consent before commencing. English-speaking
participants living in Australia, born between 1946 and
1965, who self-identified as partnered, were included in
the study.
2.3
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Data analysis
Results were analysed by the first author and checked by
the three co-authors—differences in interpretation were re-
solved collectively through discussion. To limit researcher
bias and increase rigour, qualitative data presented in this
paper were analysed using three methods. Initially, tex-
tual data were analysed for word frequency.25 Frequently
used words (and their variants) were noted, along with the
context in which they appeared (known as keywords-in-
context).25 The language choices identified helped provide
signposts to then undertake thematic analysis 26 (using
QSR NVivo 11 software), to identify the range of ideas
and attitudes evident in the text. Descriptive statistics were
generated from the quantitative data using Microsoft®
Excel software.
Policy Impact
This paper highlights partnered baby boomers’ at-
titudes to maintaining sexual relationships in resi-
dential care. Australian aged care policy focuses on
consumers as individual entities and lacks a frame-
work for dyadic partners. Shifting to a more couple-
centred approach may benefit partnered older adults’
health and well-being.
Practice Impact
Providing comprehensive sexuality training for aged
care employees, offering partnered residents’ choices
about their living arrangements (including choices
about bed sizes) and developing systems to maximise
couple privacy, may provide significant health benefits
to partnered residents and increase their quality of life.

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RAHN et Al.
3
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RESULTS
3.1
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Survey responses
Of the 367 surveys received, 199 were excluded from analy-
ses (153 supplied demographic data only and 46 did not meet
inclusion criteria), leaving 168 valid responses. The response
rate for the 23 quantitative questions varied between 83.9%
and 100%. The range for the 13 qualitative questions was
70.8%-100%.
3.2
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Participants
Participants’ geographic and socio-demographic information
is presented in Table 1. Female participants predominated
(n=125, 85%) and 55% of participants (n= 113) lived in
non-metropolitan areas. Regarding their direct experience of
RACFs, 51% (n=76) had friends or relatives living in RACFs
(now in or the past), most commonly their own or their part-
ner's parents; 29% (n=48) had current or past work-related
experience with RACFs; 15% (n=23) had no direct expe-
rience with RACFs; and a further 17.9% (n=30) provided
insufficient information to ascertain their level of experience.
3.3
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Participants’ main concerns
Participants’ experiences of RACFs to date had encouraged
them to reflect on what constitutes quality of life. For many,
good quality of life was considered the highest priority:
I see no quality of life laying in a bed, not know-
ing anyone, not being able to do anything, just
for the sake of breathing.
(female respondent number 134 - FR134)
Respondents preferred to envisage a future where they
had agency, that is the capacity to maintain their autonomy
and make their own choices about the rhythms of their daily
life:
I fear being in this regimented environment as I
spent my childhood in boarding school…I don't
want to go back into that kind of environment
where you have little control over what you do
with your time.
(FR29)
Such agency extended to decisions about: (a) maintain-
ing one's intimate relationship; (b) preferred living/sleep-
ing arrangements; (c) continuing to freely express one's
sexuality; and (d) privacy needs in care. Unsurprisingly,
many respondents preferred to maintain their autonomy
by delaying or avoiding being institutionalised, if at all
possible:
I want to…avoid these regimented places for as
long as possible. We prefer to live in our own
place decorated as we choose, eat and drink
what we choose and prepare…[and] live to our
own timetable.
(FR121)
I have volunteered in aged care facilities. I do
not like them and would not want to live in one.
Euthanasia is more appealing.
(MR84)
3.3.1
|
Maintaining one's intimate
relationship
When asked about the importance of maintaining their in-
timate relationship in residential care, most participants
(n=92, 60%) described it as “vital” (Table 2). Respondents
stressed the importance of continuing to “be yourself” and
being able to closely replicate daily life with a partner as it
was prior to entering care, if desired:
We should be given the opportunity to live as
normal lives as possible. Just because we are in
a care facility doesn't mean we should stop any
activity we enjoy as a couple.
(FR38)
Above all, participants typically wanted to be treated with
respect, both as individuals and dyadic units:
It's important for me to feel that my partner and
I are treated with respect, as individuals who
have lived full lives, raised children and had ca-
reers. I find the infantilisation of old people in
care abhorrent.
(MR2)
People in aged care are adults of varying sex-
ual orientation. It is vital that they be allowed to
continue to conduct their intimate lives as they
choose in respectful, healthy privacy.
(FR52)

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RAHN et Al.
3.3.2
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Preferred living/sleeping
arrangements
Participants were asked whether they wished to remain liv-
ing and/or sleeping together in residential care (Table 3).
Most (n=98, 64%) said it was “vital” for them to share a
room. Many also described it as “vital” (n=65, 43%) or at
least “somewhat important” (n=49, 32%) to share a bed,
although this appeared to be somewhat less important than
sharing a room. Few respondents thought it was “not at
all important” to share a room (n=6, 4%) or bed (n=13,
9%). These findings demonstrate that being in close prox-
imity to a partner on a daily basis, by sharing a room and/
or bed, was important to maintaining participants’ intimate
relationships.
From their descriptive answers, many believed that cou-
ples, rather than institutions, should be the ones choosing
whether (or not) partners live and/or sleep together:
The one thing we HAVE discussed and made
the family aware of, is our wish to remain
TOGETHER – literally until death us do part.
(FR13)
If they want to share a bed then they should have
that right particularly if one needs care but the
other doesn't. They should both be able to go
into care together.
(FR107)
3.3.3
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Sexual expression
A commonly held view was that sexual expression is not just
the domain of the young but continues throughout life, that is
“no matter the age, we are sexual beings” (FR46).
Just because people are older or disabled does
not mean they are asexual. Quality in all areas
of life is important.
(FR91)
TABLE 1 Socio-demographic characteristics of sample
Category N=168 %
Sex
Female 142 84.5
Male 26 15.5
Year of birth
Born 1946-55 112 67.7
Born 1956-65 56 33.3
Place of residencea
Major city 73 43.5
Inner regional 59 35.1
Outer regional 30 17.9
Remote area 1 0.6
Very remote area 1 0.6
No fixed address 2 1.2
No data provided 2 1.2
Birthplace
Australia 125 74.4
United Kingdom 24 14.3
New Zealand 5 3.0
Western Europe 4 2.4
South Africa 3 1.8
South East Asia 3 1.8
North America 2 1.2
Caribbean 1 0.6
South America 1 0.6
Aboriginal/Torres Strait Islander
No 161 95.8
Yes 7 4.2
Sexual orientation
Opposite sex attracted 158 94.0
Same sex attracted 7 4.2
Attracted to both sexes 2 1.2
Attracted to neither sex 1 0.6
Relationship status
Married 125 74.4
De facto 27 16.1
Single, in a relationship 9 5.4
Other (LATb, polyamorous) 7 4.2
Income (per annum)
<$20000 42 25.0
$21000-40000 39 23.2
$41000-60000 35 20.8
$61000-80000 14 8.3
$81000-100000 10 6.0
$101000-150000 11 6.5
(Continues)
Category N=168 %
$151000-$200000 4 2.4
More than $200000 4 2.4
No data provided 9 5.4
aBased on the Australian Statistical Geography Standard-Remoteness Area
(ASGS-RA) geographical classifications.
bLAT stands for living apart together, a relationship structure where committed
partners choose not to cohabit.
TABLE 1 (Continued)

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RAHN et Al.
One's sexuality was considered integral to one's identity:
It's only the young who imagine the old don't in-
dulge…yet why do we think because our bodies
age that our basic selves change?
(FR97)
Partnered sexual behaviours were regarded as normal cou-
ple behaviour, even in care settings:
If you have been in a relationship for 40+ years,
it [sexual expression] is part of the relationship.
(FR59)
Where couples are housed together, they need
to be given every opportunity for intimacy…Just
because they are old/ill doesn't mean they don't
still feel the need.
(FR124)
Table 4 reports on questions about remaining sexual in
RACFs. Having already identified as lifelong sexual be-
ings, early boomers especially believed it was important to
have their sexual choices respected by staff (n=79, 85%)
and family members (n=80, 82%) and to have access to
sexual health services in RACFs (n=72, 69%). In relation
to the provision of sexual health information, products and
TABLE 2 Responses to the question “In a RACF, how important is it to maintain your intimate partner relationship(s)?”
Answers
Born 1946-55
(N=104)
Born 1956-65
(N=50) Total (N=154) Women (N=130) Men (N=24)
Vital 54 (51.9%) 38 (76.0%) 92 (59.7%) 76 (58.5%) 16 (66.7%)
Somewhat important 31 (29.8%) 11 (22.0%) 42 (27.3%) 38 (29.2%) 4 (16.7%)
Neither important nor
unimportant
10 (9.6%) 1 (0.02%) 11 (7.1%) 9 (6.9%) 2 (8.3%)
Somewhat unimportant 1 (1.0%) 0 (0%) 1 (0.7%) 1 (0.8%) 0 (0%)
Not at all important 3 (2.8%) 0 (0%) 3 (2.0%) 2 (1.5%) 1 (4.2%)
It depends 5 (4.8%) 0 (0%) 5 (3.2%) 4 (3.1%) 1 (4.2%)
Total 104 (100%) 50 (100%) 154 (100%) 130 (100%) 24 (100%)
TABLE 3 Responses to questions about preferred living arrangements if one or both partners enter residential care settings
Question: “How important is it to sleep in the same room with your partner(s)?”
Answers
Born 1946-55
(N=103)
Born 1956-65
(N=51) Total (N=154) Women (N=130) Men (N=24)
Vital 61 (59.2%) 37 (72.5%) 98 (63.6%) 85 (65.4%) 13 (54.2%)
Somewhat important 19 (18.4%) 7 (13.7%) 26 (16.9%) 20 (15.4%) 6 (25.0%)
Neither important nor unimportant 4 (3.9%) 1 (2.0%) 5 (3.2%) 4 (3.1%) 1 (4.2%)
Somewhat unimportant 2 (1.9%) 1 (2.0%) 3 (2.0%) 2 (1.5%) 1 (4.2%)
Not at all important 6 (5.8%) 0 (0%) 6 (3.9%) 5 (3.8%) 1 (4.2%)
It depends 11 (10.7%) 5 (9.8%) 16 (10.4%) 14 (10.8%) 2 (8.3%)
Total 103 (100%) 51 (100%) 154 (100%) 130 (100%) 24 (100%)
Question: “How important is it to sleep in the same bed with your partner(s)?”
Answers
Born 1946-55
(N=104)
Born 1956-65
(N=49) Total (N=153) Women (N=129) Men (N=24)
Vital 38 (36.5%) 27 (55.1%) 65 (42.5%) 55 (42.6%) 10 (41.7%)
Somewhat important 37 (35.6%) 12 (24.5%) 49 (32.0%) 41 (31.8%) 8 (33.3%)
Neither important nor unimportant 6 (5.8%) 2 (4.1%) 8 (5.2%) 6 (4.7%) 2 (8.3%)
Somewhat unimportant 2 (1.9%) 1 (2.0%) 3 (2.0%) 3 (2.3%) 0 (0%)
Not at all important 10 (9.6%) 3 (06.1%) 13 (8.5%) 12 (9.3%) 1 (4.2%)
It depends 11 (10.6%) 4 (8.2%) 15 (10.0%) 12 (9.3%) 3 (12.5%)
Total 104 (100%) 49 (100%) 153 (100%) 129 (100%) 24 (100%)

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RAHN et Al.
services in RACFs, those answering “yes” were more likely
to be male (n=20, 83%) than female (n=131, 68%) and/or
to have work-related experience of RACFs (n=34, 71%),
diverse sexual orientations (n = 10, 100%) or non-tradi-
tional relationship structures (living-apart-together and
polyamorous relationships) (n=9, 100%). Those answer-
ing “no” were principally cohabiters in monogamous het-
erosexual relationships (n=15, 94%). Amongst the latter
group, a few were influenced by their own decreased sex-
ual needs: two respondents experienced sexual problems
in their relationships, four were no longer sexually active,
and one did not think sexual pleasure was an essential part
of life.
Older adults in residential care were viewed by partici-
pants as sexual beings with human and civil rights. However,
issues of implied ageism and sexual discrimination were
identified:
Older people are still sexual…with a strong
need for physical contact, comfort and com-
pany…[they] are adults with full rights and
should be allowed all the adult rights that they
have on the outside, as long as they are safe and
capable of making decisions. It's normal to want
to have sexual contact all your life till [sic] the
day you die, if at all possible.
(FR5)
I would be concerned about people who are not
vanilla in their sexual tastes. [I] Reckon there is
no catering for them at all in aged care. That's
a real denial of human rights. Having things
that have been part of one's intimate life denied,
made shameful or treated with contempt would
be a really bad outcome.
(FR104)
The provision of sexual health information was favoured,
especially by aged care workers, provided it was offered com-
passionately, respectfully and discreetly:
I believe that if elderly people are still able to
enjoy sexual intimacy whilst living in nursing
facilities, then this should be acknowledged by
having such services in place. This would sup-
port ‘choice’ in residential aged care.
(FR26)
TABLE 4 Responses to questions about remaining sexual in residential care settings
Question: “How important is it that your sexual choices be respected by your family?”
Answers
Born 1946-55
(N=98)
Born 1956-65
(N=49) Total (N=147) Women (N=123) Men (N=24)
Very 80 (81.6%) 42 (85.7%) 122 (83.0%) 101 (82.1%) 21 (87.5%)
Somewhat important 12 (12.2%) 4 (8.2%) 16 (10.9%) 14 (11.4%) 2 (8.3%)
Not important 6 (6.1%) 3 (6.1%) 9 (6.1%) 8 (6.5%) 1 (4.2%)
Total 98 (100%) 49 (100%) 147 (100%) 123 (100%) 24 (100%)
Question: “How important is it that your sexual choices be respected by care staff?”
Answers
Born 1946-55
(N=93)
Born 1956-65
(N=48) Total (N=141) Women (N=118) Men (N=23)
Very 79 (84.9%) 43 (89.6%) 122 (86.5%) 101 (85.6%) 21 (91.3%)
Somewhat important 8 (8.6%) 3 (6.2%) 11 (7.8%) 10 (8.5%) 1 (4.35%)
Not important 6 (6.5%) 2 (4.2%) 8 (5.7%) 7 (5.9%) 1 (4.35%)
Total 93 (100%) 48 (100%) 141 (100%) 118 (100%) 23 (100%)
Question: “Do you think sexual health information, products and services should be provided in RACFs?
Answers
Born 1946-55
(N=104)
Born 1956-65
(N=51) Total (N=155) Women (N=131) Men (N=24)
Yes 72 (69.2%) 37 (72.5%) 109 (70.3%) 89 (67.9%) 20 (83.3%)
It depends 22 (21.2%) 8 (15.7%) 30 (19.4%) 27 (20.6%) 3 (12.5%)
No 10 (9.6%) 6 (11.8%) 169 (10.3%) 15 (11.5%) 1 (4.2%)
Total 104 (100%) 51 (100%) 155 (100%) 131 (100%) 14 (100%)

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RAHN et Al.
[It depends if a service] is delivered in a pa-
tronising manner or if it is kept confidential in a
non judgmental manner. Older people…should
not be treated like naughty little children or be
bullied by well meaning staff.
(MR50)
Access to products (such as condoms and lubricants) was
considered important to protect residents’ health and save
them the embarrassment of having to ask family:
It would be important to be able to obtain prod-
ucts (eg lubricants etc) without the embarrass-
ment of having to ask family etc.
(MR113)
People may not be able to get out to a pharmacy
or they may not have the privacy they need to
speak about intimate issues to their GP [general
practitioner] so they would need products and
information on site.
(FR29)
Some contemplated what it might be like to ask staff to
obtain products designed purely for pleasure, such as vibra-
tors and erotica:
I can just imagine the raised eyebrows and
comments that would flow from a request for
a vibrator and lube!! I wonder if pornographic
materials or content would be tolerated in an
aged care facility as well?
(MR50)
Several respondents (principally those working in the aged
care sector) thought residents should be consulted about their sex-
ual needs. This was contingent on normalising the topic of sexu-
ality and creating a safe environment to discuss sexual concerns:
Sexuality is part of life. If not discussed then
people can assume that their inherent sexuality
is invalid after a certain time of life’.
(FR3)
Having [products and information] available…
may help to normalise the sexual/intimate side
of life.
(FR136)
However, care workers were perceived as either inade-
quately trained or time-pressured, and, as such, were deemed
inappropriate to raise sexual concerns with:
Carers are not properly educated about the
older people's sexual intimacy.
(FR30)
As a registered nurse who has worked in aged care
for over 20 years, sexuality and intimacy is not a
consideration…Staff are struggling to attend [to]
basic care…Sexual health is not even considered.
(FR6)
However, being able to raise sexual concerns with suitably
qualified professionals was considered important:
It’s important to keep a relationship alive and if
intimacy is an important part of your relation-
ship it should be encouraged. A lot of people
have some problem with intimacy as they age
so having someone that can help is vital to them
(be it medical or emotional).
(FR73)
3.4
|
Privacy
While central to maintaining sexual relationships, privacy
had multiple meanings for participants. It included staff pro-
viding partnered residents with uninterrupted time alone or
together, not entering rooms uninvited and discreet handling
of residents’ sexual concerns.
Whatever is needed to support and maintain a
healthy sexual relationship should be encour-
aged and supported and not [be] a source of
embarrassment or ridicule.
(MR98)
A significant majority (n=133, 86%) preferred “as much
privacy as possible” to conduct their relationships (Table 5).
Collectively, visual privacy and private space were prior-
itised. However, the (albeit small) sample of men valued
protected communication above all (Table 5 provides further
explanation). Conversely, men's need for bodily privacy was
lower than women's.
4
|
DISCUSSION
In contrast to aged care literature generally on resident ex-
periences after admission, consumers’ expectations prior to
entering RACFs are under-researched.2 This current study ex-
tends the literature by highlighting the concerns of partnered

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RAHN et Al.
baby boomers contemplating life in residential care. Above
all, participants expected themselves and their relationships to
be treated with respect. Important considerations were main-
taining their intimate relationship and continuing to live and/
or sleep with their partner once in care. Older people were
viewed by participants as sexual beings deserving access to
the same sexual health services available to non-institutional-
ised community-dwelling individuals. Within a RACF, such
services might include freely available sexual health litera-
ture, referrals to sexual health specialists and/or access to a
pharmacy that sells condoms and lubricants. Participants’
responses have policy implications for aged care providers,
placing the onus on them to: provide private, couple-friendly
environments; allow residents to choose their own living/
sleeping arrangements; and conduct themselves discretely
and professionally in relation to couples’ sexual concerns.
The current study corroborates evidence that older cou-
ples’ primary relationships remain important in later life.5
Relationship quality has the potential to profoundly influ-
ence partner health, well-being and longevity.10 Poor qual-
ity relationships can be harmful to health9; likewise, poor
health may indicate relationship discord.6 Consequently,
offering partners choices about their living arrangements
may provide significant health benefits and increase their
quality of life.
Entering residential care alone can be a distressing expe-
rience19, especially when simultaneously losing the benefits
that cohabitation can provide—companionship (a safeguard
against loneliness)20; a secure, predictable environment21;
and socially contracted mutual caregiving.17 However, as in
the current study, even non-cohabiters desire companionship,
intimacy and emotional support.8 As a result, non-resident
partners also need to be catered for in RACFs.
In prior research,11 relationship quality and sleep quality
were reported as interrelated. Contingent on partners feel-
ing safe and secure, sleeping together (as a social activity)
reduced stress and vigilance, leading to better quality sleep,
health and well-being.11 Many participants in the present
study provided further corroboration—they regarded sleep-
ing with one's partner as vital, or at least somewhat important
to their well-being.
In the current study, respondents’ characterisation of older
people as sexual beings confirms the importance (to them) of
sexuality throughout life, as identified in prior studies.12,13
Furthermore, the “asexual older woman” stereotype was de-
bunked by this largely female sample. Participants reported
that as they aged, they continued to value their sexual re-
lationships, considered sexual expression integral to one's
identity and remained sexually active where possible, which
corroborated prior studies.11 Consistent with evidence of in-
creased sexually transmitted infections in older age groups,27
protecting older people from sexually transmitted infections
was also considered important by current study participants,
particularly those working in the aged care sector.
TABLE 5 Responses to questions about privacy in residential care settings
Question: “How much privacy would be comfortable when relating intimately/sexually with your partner(s)?”
Answers
Born 1946-55
(N=104)
Born 1956-65
(N=51) Total (N=155) Women (N=131) Men (N=24)
As much as possible 88 (84.6%) 45 (88.2%) 133 (85.8%) 114 (87.0%) 19 (79.2%)
A little 6 (5.8%) 4 (7.8%) 10 (6.5%) 6 (4.6%) 4 (16.7%)
It's not important 7 (6.7%) 2 (3.9%) 9 (5.8%) 8 (6.1%) 1 (4.2%)
It depends 3 (2.9%) 0 (0%) 3 (1.9%) 3 (2.3%) 0 (0%)
Total 104 (100%) 51 (100%) 155 (100%) 131 (100%) 24 (100%)
Question: “Which types of privacy are important to you?”
Answers
Born 1946-55
(N=104)
Born 1956-65
(N=50) Total (N=154) Women (N=130) Men (N=24)
Visual privacy 88 (83.7%) 50 (100.0%) 138 (89%) 117 (90%) 21 (81%)
Private space 93 (89.4%) 44 (88.0%) 137 (89%) 116 (89%) 21 (81%)
Bodily privacy 78 (75.0%) 49 (98.0%) 127 (82%) 111 (85%) 16 (62%)
Acoustic privacy 74 (71.2%) 50 (100.0%) 123 (80%) 104 (80%) 19 (73%)
Communication privacy 76 (73.1%) 42 (84.0%) 118 (77%) 95 (73%) 23 (88%)
Social privacy 76 (73.1%) 41 (82.0%) 117 (76%) 98 (75%) 19 (73%)
Personal information 70 (67.3%) 40 (80.0%) 110 (71%) 95 (73%) 15 (58%)
Note: Visual privacy=seeing/being seen; private space=one’s own private domain; bodily privacy=bodily procedures requiring consent; acoustic privacy=hear-
ing/being heard; communication privacy=protected communication while using communication technologies; social privacy=choosing who one socialises with;
personal information=verbal and written data/information.

|
57
RAHN et Al.
The term “facilitated sexual expression” has sometimes
been used to describe the provision of sexual information,
products and services in health settings.28 It encapsulates a
variety of possible activities, ranging from fostering a sup-
portive environment; sharing information and advice; procur-
ing sex-related goods; helping dress residents; and lighting
candles to positioning a person in bed and shutting the door,
and so forth. Participants in the current study indicated some
need for facilitated sexual expression in the form of sexual in-
formation, products and services. Furthermore, as with prior
research,29 other issues raised were access to qualified sexual
health professionals, sex toys and erotic material in RACFs.
Such a cultural shift would require that staff become accus-
tomed to residents with moral values perhaps different from
their own.16 Current study participants’ expectations (that
their sexual choices be respected in care settings) further re-
inforce this need and desire.
In the current study, participants placed great importance
on couple privacy, particularly visual privacy (ie the ability
to close doors to prevent uninvited entry by care workers),
private space and protected communication. Altman30 con-
ceptualised privacy as a constant process of boundary regula-
tion undertaken to achieve desired levels of social interaction.
Poor boundary regulation results in undesirable levels of pri-
vacy—either too much (perceived as isolation) or too little
(perceived as intrusions). He described privacy invasions as
especially harmful because they destroy individual auton-
omy, self-respect and dignity, which is contrary to current
study participants’ explicit desire to retain personal agency.
5
|
CONCLUSIONS
Participants in the current study placed importance on main-
taining their sexual relationships as they age. Furthermore,
they reported a high degree of support for access to sex-
ual health information, products and services in RACFs.
Currently, such features are not commonplace, to the detri-
ment, we contend, of residents. Moreover, these findings
point to the need for comprehensive sexuality training of aged
care managers and staff to facilitate the sexual health needs of
the next generation. This has significant implications for aged
care providers. Considerable cultural change will be required
to raise RACFs to the standard required by partnered and/or
sexually active residents. For the majority of study partici-
pants, treating residents respectfully, as competent adults with
rights, and providing them with privacy for intimate time with
partners were important to their imagined well-being. Given
that sexuality-related issues in aged care are not exclusive to
partnered individuals—they apply also to singles and people
diagnosed with dementia/cognitive loss—further analysis of
this issue is required to meet the needs of all residents.
The current findings are not generalisable given the small, fe-
male-dominated (largely heterosexual) sample, the use of social
media recruitment and volunteer sampling, and the high number
of respondents with work-related experience of RACFs. However,
while not statistically representative of all Australian baby boom-
ers, participants expressed a range of attitudes that aged care
workers may expect to encounter. To enable change, further larg-
er-scale quantitative research is needed to compare community
expectations with current service delivery for couples.
ACKNOWLEDGEMENTS
The Australian Association of Gerontology and COTA
(Council on the Ageing) deserve acknowledgement for gen-
erously promoting this study.
CONFLICT OF INTEREST
The authors declare no conflicts of interest.
ORCID
AlisonRahn https://orcid.org/0000-0002-7572-5749
TiffanyJones https://orcid.org/0000-0003-2930-7017
CaryBennett https://orcid.org/0000-0003-4820-075X
AmyLykins https://orcid.org/0000-0003-2930-3964
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SUPPORTING INFORMATION
Additional supporting information may be found online in
the Supporting Information section.
How to cite this article: Rahn A, Jones T, Bennett C,
Lykins A. Baby boomers’ attitudes to maintaining
sexual and intimate relationships in long-term care.
Australas J Ageing. 2020;39(Suppl. 1):
49–58. https ://doi.org/10.1111/ajag.12732