Sexuality and Aging: Clinical Perspectives


There are two primary stereotypes associated with the sexuality of aging adults. The First is exemplified by the prowling cougars and elderly Romeos of network TV and film, while the second presents aging adults as lonely, ill, depressed, and above all, sexless. The truth mainly lies between these extremes, reflecting a diversity of experience and behaviors to match a growing and dynamic population.

Sexuality and Aging: Clinical Perspectives assembles the most up to-date ...

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There are two primary stereotypes associated with the sexuality of aging adults. The First is exemplified by the prowling cougars and elderly Romeos of network TV and film, while the second presents aging adults as lonely, ill, depressed, and above all, sexless. The truth mainly lies between these extremes, reflecting a diversity of experience and behaviors to match a growing and dynamic population.

Sexuality and Aging: Clinical Perspectives assembles the most up to-date information on the spectrum of middle-aged and older people's sex related concerns, from HIV to ED from body image problems to dating after 50. This timely volume equips professionals to answer questions more accurately and help clients navigate the multiple changes and challenges that accompany aging. In-depth analysis, empirical findings, and case studies offer a clear pit lure of what clinicians can expect as the baby-boom population grows older. And the author provides helpful advice for clincians seeking a comfort level for discussing sexual matters in practice. Included in the coverage:

An overview of sexuality among middle aged and older adults including historical approaches and current research methodologies.

Specific chapters focusing upon men's and women's concerns.

The impact of prescription and over the counter medicines on sexual function.

Sexuality in the contexts of disability, dementia, and long-term care.

The increasing prevalence of HIV, AIDS, and other SI Ds among adults over 50.

LGBT issues and cross-cultural perspectives.

Sexuality and end-of-life issues.

Sexuality and Aging: Clinical Perspectives provides vital information for therapists, counselors, graduate students, and anyone working with middle-aged and older adults, including both the generalist practitioner and the specialist in gerontology or sexuality.

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Editorial Reviews

From the Publisher
"Sexuality and Aging: Clinical Perspectives by Jennifer Hillman is a welcome addition to the field of geropsychology and mental health, addressing a concern of aging that has been sorely neglected. Attempting to bridge this gap, the American Psychological Association and American Bar Association have collaborated to produce handbooks for psychologists, lawyers, and judges to specifically address issues such as capacity for sexual consent. However, the current book places such issues within a broader, more meaningful framework...The issue of capacity is addressed nicely, and the author highlights the need for a thorough evaluation of why an elder may or may not have the cognitive or psychological skills necessary to make independent decisions regarding his or her sexual behavior. There are links to useful external resources and good summaries of the primary information fromthose resources. The impact and dynamics of family perspectives and participation are well integrated, and Hillman provides concrete ideas on how to increase communication and processing within families...Kudos to Jennifer Hillman for establishing an up-to-date resource that highlights the need for professionals to increase awareness and self-education, becoming advocates for appropriate health care services across age, ethnicity, and sexual expression. Sexuality started way before research and evidence-based practice, and has been an ageless life tradition, a tradition that embraces all emotions of love, intimacy, caring, shock, wonderment, joy, fun, sharing, joining, learning, and embarrassment."Sigmund Hough and Amy S. Schultz (PsycCRITIQUES, Vol. 57)
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Product Details

  • ISBN-13: 9781461433989
  • Publisher: Springer New York
  • Publication date: 3/27/2012
  • Edition description: 2012
  • Edition number: 1
  • Pages: 316
  • Product dimensions: 6.10 (w) x 9.25 (h) x 0.30 (d)

Meet the Author

Jennifer Hillman, Ph.D., is a licensed clinical psychologist and Professor of Psychology at The Pennsylvania State University. She has received specialized training in both geropsychology and neuropsychology, and has worked extensively with older adults in a variety of contexts, including outpatient treatment centers, day treatment centers, inpatient units, community-based educational programs, and nursing homes. She has published numerous articles and books on various aspects of sexuality and aging, and was awarded Fellow of the Gerontological Society of America for her outstanding contributions to the field. Hillman also received a Penn State University Teaching Fellow Award. She teaches courses in clinical psychology and aging.

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Table of Contents

1 An Introduction including Media, Boomer, and Cross-cultural Perspectives 1

The Importance of Sexuality and Aging 1

The Relevance of this Text 2

Aging Demographics 3

Defining Older Adulthood 3

The Oldest-Old as a Distinct Population 4

Gender, Racial, and Economic Diversity 5

Middle-Aged Adults 6

Baby Boomers' Unique Characteristics 6

What Clinicians Can Expect 8

Intimacy, Sexuality, Sensuality 10

Historical Context 11

Cross-cultural Perspectives 13

An African Perspective 14

Asian Perspectives 15

Indian and Middle-Eastern Perspectives 16

Evolutionary and other Perspective 17

Contemporary Portrayals in US Culture 18

The Implied Value of Youth 18

Limited Media Portrayals of Sexuality and Aging 19

Extreme Representations in Middle Adulthood 20

The Impact of Mixed Messages 23

Understanding Research Methods 24

ABrief Review of the Literature 26

Summary 27

2 Knowledge of Sexuality and Aging 29

Frequency and Types of Sexual Behaviors 30

Early Research Findings 30

US Population Data 31

Cross-national Findings 35

What Is Average and What Is Normal? 36

Alfredo 37

Predictors of Sexual Behavior and Satisfaction 38

Availability of a Partner 38

Physical Health 39

Sexual Dysfunction 40

Sexual Satisfaction 42

Sexuality Across the Life Span 44

What Is Abnormal? 45

Anna 46

A Self-Test for Knowledge 47

The Importance of Sexual Histories at Intake 52

How to Gather Information 53

Requisite Information 53

Summary 57

Appendix: Knowledge Section of the ASKAS 57

3 Attitudes toward Sexuality and Aging 59

Attitudes Toward Sexuality and Aging 60

Implicit Attitudes Toward Aging 61

Geriatric Sexuality Breakdown Syndrome 64

Jayne 66

Attitudes in the Therapeutic Relationship 67

Countertransference 67

Lorraine 69

Additional Reactions to Sexuality and Aging 71

Allen 72

Transference 74

Eroticized Transference 74

Mario 75

June 78

Guides to Managing the Transference 80

Summary 80

4 Sexuality in Long-Term Care 83

Differences Among Settings 84

Typically Negative Countertransference 87

Assessing Attitudes 88

The Relationship Between Knowledge and Attitudes 89

Richard 90

Gregory 92

Sexual Abuse 94

Edward 96

Management of Inappropriate Behavior 97

Antonia 100

Walter 101

Capacity for Sexual Consent 102

Emma and Paul 105

Familial Concerns and Influence 106

Practical Considerations 109

LGBT Issues 110

Benchmark Policies and Training 111

Summary 113

Appendix 113

5 Coping with Chronic Illness and Disability 115

Prevalence of Chronic Illness 115

Successful Coping 116

The Critical Need for Patient Education 117

Guidelines for Psychotherapy 118

Arthritis and Pain 119

Diabetes 120

Amputations as Complications 121

Heart Disease 122

Recovering from a Heart Attack 122

Stroke 125

High Blood Pressure 126

Incontinence 127

Parkinson's Disease 130

Depression 131

Differential Symptoms Among Older Adults 131

Issues in Treatment 132

Mario 133

Dementia 134

Caring for the Caregiver 134

Changes in Sexual Behavior 135

Schizophrenia 137

Paul 138

Sequela of Sexual Trauma 140

Barbara 140

Summary 143

6 HTV/AIDS and Other STDs among Adults over 50 145

Relevant Statistics 145

New HTV/AIDS Diagnoses 145

Older People Living with HTV and AIDS 146

Increased Incidence of Additional STDs 147

Age-Related Risk Factors 148

Cultural Factors 150

The Need for a Correct and Timely Diagnosis 151

HTV-Associated Dementia 152

Adults Over 50 Living with HIV/AIDS 154

Stigma and Isolation 154

Secondary Prevention 155

Knowledge Among Practitioners 156

Issues in Assessment 157

Questions at Intake 157

The Presence of Family Members 158

Queries about Caregiving 158

The Benefits of a Team Approach 159

The Importance of Follow-Up 159

Case Examples 160

Marsha 160

Gerald 161

Florence 162

A Call for Prevention and Advocacy 164

Summary 165

Appendix 165

7 Women's Issues in Sexuality and Aging 169

Physiological Changes 170

Menopause 170

Sexual Response Cycle 171

Prevalence of Sexual Dysfunction 173

Clinical Assessment 174

Dangers of Incomplete Assessment 175

Specific Areas of Inquiry 175

Side Effects of Medication 177

Evidence-Based Interventions 179

Topical Lubricants 179

Masturbation 182

Hormone Replacement Therapy and Supplements 183

Cognitive-Behavioral therapy 183

Changes in Sexual Self-Concept 184

Sexual Identity for Women with and Without Partners 184

Margaret 185

Concerns About Body Image 186

Practical Issues 187

Eating Disorders 188

Ruth 189

Exacerbation of Existing Psychopathology 190

Yolonda 190

Nancy 192

Positive Changes 193

Amy 193

Breast and Cervical Cancer 194

Detection 194

Treatment Issues 195

Summary 197

8 Men's Issues in Sexuality and Aging 199

Historical and Societal Context 199

Normal Changes in the Sexual Response Cycle 200

Clinical Interviewing and Assessment 202

Erectile Dysfunction 203

Definitions and Prevalence 203

Clinical Stereotypes and Assumptions 204

Mike 204

Underlying Causes 206

Side Effects of Medication 208

Ralph 210

Treatments for Erectile Dysfunction 211

PDE-5 Inhibitors as a First Line Medical Approach to Treatment 211

Myths and Misconceptions about PDE-5 Inhibitors 214

Mass and Black Market Influences 216

Impact Upon Partners 217

Medical Vacuum, Injectable, and Implant Therapies 218

Integrated, Psychologically Based Approaches 219

Fred 221

Prostate Issues 222

Body Image 225

Summary 226

9 Sexuality and Aging with LGBT Populations 229

Challenges for Clinicians 229

Historical Context 230

Emergent Research 231

Age Cohorts Within LGBT Populations 232

Myths About LGBT Elders 234

Unexpected Benefits and Resilience 235

The Need to Differentiate Among LGBT Populations 236

Lesbian Elders 237

Gay Male Elders 237

Bisexual Elders 239

Transgender Elders 240


Issues in Caregiving 242

Lifestyle Changes Across the Life Span 243

Georgette 244

Recommendations for Clinicians 246

Legal Issues 248

Summary 248

Resources for Professionals 249

Academic Journals 249

Continuing Education 250

Education for the Workplace 250

Resources for Consumers 251

10 Emergent Issues in Sexuality and Aging 255

The Internet 255

Online Dating 257

Pornography and Online Purchases 259

Sexual and Health Education 261

Issues Related to Divorce and Remarriage 262

Justine 263

Sexuality in Long-Term Relationships 266

The Hortons 267

The Albertsons 268

Sexuality at the End of Life 270

Benefits 271

Barriers to Expression 272

Talking with Patients and Clients 273

Practical Suggestions 274

The Medicalization of Sexuality and Aging 276

Summary 276

References 279

Index 307

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