Sexual Health and Intimacy in Later Life

The concept that older adults cannot have intimacy or a satisfying sex life is misleading. One basic need involves emotionally based relationships which play a vital role in the overall human experience. People have a universal need to belong and to love and having intimate relationships provides social networks and emotional support to older adults.

Photo Credit: Alex Proimos
Photo Credit: Alex Proimos

As people grow older, they want and need to be close to others. This includes the desire to continue an active and satisfying sex life despite changes in sexual behavior. Older adults may be impaired by infirmity but relationship needs such as closeness and sexual desire still remain. Many seniors can have sexual relationships, and probably a few others find ways to maintain or rekindle intimacy and a satisfying sex life as they age.

Health plays a key role in the level of older adults’ sexual activity. Many chronic health conditions such as pain as well decreased sexual desires due to emotional or health problems can affect sexual health. Health professionals have known that sexual dysfunction is not only a major problem for relationships and mental health, but can be an indicator of serious physical health issues such as heart disease. Older adults need preventive health screenings to reduce sexual problems. In addition, older women can improve the quality of their sexual experiences by aggressively managing their health conditions.

Age does not protect seniors from sexually transmitted diseases. In fact, older adults who are sexually active may be at risk for diseases such as syphilis, gonorrhea, genital herpes, among other sexually transmitted diseases (STDs). It has been reported that the number of older adults with HIV/AIDS is growing. While casual sex offers only a moment of emotional intimacy. It does not provide the love and commitment of a serious relationship.

In conclusion, older adults need to feel a sense of belonging and acceptance, whether it comes from a social group or connections. This desire to belong can bring about companionship and intimacy among seniors. Sex and older adults is still a taboo in some societies and often ignored. It is paramount that sexual health becomes a vital component of the quality of life for seniors.

Sophie Okolo is the Founder and Editor-in-Chief of Global Health Aging.


The Risk of Smoking is Not Just for the Young

It is well-known that smoking and tobacco use are among the leading causes of preventable disability and death worldwide. Efforts to promote smoking cessation have featured prominently on the public health agenda, though rates continue to remain high in many parts of the world. An often under-looked segment of the population that needs access to information about smoking cessation is senior citizens.

Photo Credit: Pixabay
Photo Credit: Pixabay

Like other age demographics, the elderly experience significant health risks associated with smoking. However, in addition to traditional concerns such as increased risk for lung cancer, heart disease, respiratory disease, and many others, older adults also experience risks that are specific to aging. Elderly who smoke are at risk for developing cataracts (the leading cause of blindness worldwide), loss of bone density among postmenopausal women, and increased risk for diminishing cognitive capabilities associated with dementia and Alzheimer’s disease.

Tobacco users over the age of 65 have smoked longer than younger age groups, thus putting them at increased risk for detrimental health effects. It is possible that older adults are less likely to be aware of the potential health risks associated with smoking. A lack of awareness about the negative health effects of smoking may decrease the likelihood of quitting and lead to fewer quit attempts. Also, social issues associated with aging such as life stress, social isolation, and lack of community infrastructure to support positive aging can influence the likelihood that elderly smokers do not quit.

In terms of global smoking rates among the senior citizens, high-income countries have a 10% higher prevalence than low- and middle-income countries. Within Latin America and the Caribbean, a study found that among older smokers in seven major cities (Buenos Aires, Mexico City, Santiago, Havana, Montevideo, Bridgetown, and Sao Paulo), current older smokers were more likely to be male, have begun smoking around the age of 17, and were more likely to smoke cigarettes than other types of tobacco. Smoking prevalence among the elderly was highest in Havana (31.8%), followed by Mexico City (16.5%), and Sao Paulo (15.8%). Promisingly, smoking rates steeply declined with age as the odds of smoking became 5.9 times lower among individuals over the age of 81.

It is important to consider that smoking is not just a young person’s habit. Efforts to reduce smoking among all age demographics, especially the elderly, should continue to be a vital consideration within the global public health community. Moreover, promoting smoking cessation and highlighting the significant health risks associated with smoking must persist across the life span.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

Increasing Access to Oral Health Care for the Elderly


Oral health, which includes adequate care for teeth, gums, and mouths and screening for oral diseases, is an important contributor to health and well-being. Access to oral health services is necessary for oral health maintenance, but varies across the globe, as well as across age segments within the population. Globally, an increase in the aging population calls for a need to consider oral health among the elderly, an often-overlooked component of physical health. Among the concerns associated with poor oral health for adults are constrained food choice, weight loss, reduced chewing ability, diminished communication ability, low self-esteem, and decreases in self-reported quality of life. The World Health Organization (WHO) has called for a greater public health response to the oral health needs of the elderly. Included within this call to action are improved public health policies that target oral health, improved access to oral health services for older adults, and increased efforts to improve dental hygiene among older adults.

Poor oral health among the elderly typically manifests as high levels of tooth loss, dental caries, periodontal disease, xerostomia, and oral cancer. According to the global World Health Survey, approximately 30% of adults aged 65-74 years across the globe are impacted by complete tooth loss. When considering prevalence of tooth loss by demographic characteristics, this problem is particularly pronounced among individuals in the lowest economic strata living in low- and middle-income countries. In Latin American and Caribbean countries, it has been noted that the adult population is aging at “unprecedented rates”. It is estimated that the elderly population will increase by about 300% by 2050 in developing countries, particularly those in Latin America. While access to oral health services are high in developed countries, utilization among the elderly remains low. In developing countries, where access to care is diminished, elderly people report higher levels of oral health problems.

In the U.S., the Centers for Disease Control and Prevention (CDC) states that many oral diseases are common for older Americans who did not grow up with fluoridation, a process that has been shown to improve oral hygiene and health. Decreased access to dental insurance, low income, increased use of prescription drugs, and being disabled, home bound, or institutionalized are also contributing factors for diminished oral health among older Americans. It has been noted by the CDC that about 25% of adults 60 and older in the U.S. “no longer have natural teeth”, a phenomenon that varies state to state. To improve the quality of life of the elderly across the globe, oral health should be included in physical health assessments. Increased access to oral health care should also be advocated. Improvements to the oral health of older adults can contribute to improved quality of life and improved management of additional health concerns that are associated with aging.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

The Problem with Being Old and Incarcerated

In the January issue of The New Statesman, Britain’s leading weekly magazine of politics, culture, and international affairs, Andrew Katzen examined elderly inmates in British prisons. His article, “Should we be sending the elderly to prison”, argues that British prisons are slowly turning into dysfunctional nursing homes. According to Katzen, Partner at Hickman & Rose, prison conditions for the elderly are tough and little, if any, rehabilitative purpose is served in holding them. His main point is that Britain’s aging population is causing an increase in the number of old people behind bars hence a new and improved prison reform has to be considered.

This topic is quite controversial because it focuses on criminals who have broken the law. Therefore we need to be mindful of how these offenses were committed and to whom, especially since both victim and perpetrator are human beings. The ethical component of this issue is complex because, while the range of offenses differ, the state of elderly care in prisons needs improvement. Before this article tackles the reasons, there are a few things that need to be clarified. This article is not whether the elderly deserve imprisonment or about the type of sentence older prisoners deserve. Everyone is entitled to their opinions due to strong views about this subject. As a health care professional, the goal is to improve the social and natural environments in order to better the health of marginalized populations.

The world’s population is aging. According to the National Institute on Aging, the number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050. This trend may result in a shift in prison demographics as prisoners will grow older whether they are young or new. A prime example is 82-year-old Teresa de Jesus Tello who was incarcerated in a Peruvian prison for an alleged case of drug trafficking…and she isn’t the only elderly prisoner. In Peru, there are 2,500 inmates over the age of 60 in prisons. Most of the elderly women are imprisoned for drug trafficking. While prison reform is important, it is important to tackle these issues in a sensible and sensitive way, involving all facets of society such as the public and private sectors.

Katzen’s article also discusses the design of prison estates stating that current designs are only suitable for the young and able. Although the issue is important, he fails to take into account the extra costs needed to build prison estates that are suitable for older prisoners. In developed nations, this cost can result in a tax increase which is often debatable. Alternatively, developing nations can make a case for better living conditions as prisons can be characterized as hazardous and chaotic places for offenders.

Although this topic is complex, societies can start with meeting the most basic personal activities such as carrying their meals and washing themselves, especially if prisoners are unable to care for themselves. Addressing the existence of chronic illnesses in older prisoners is vital and designing new environments should be considered for easier access and mobility for older populations. Moreover, appropriate medical care needs to be a priority for older prisoners as this can improve quality of life. As societies start to tackle this issue, the goal should be to prevent prisons from turning into dysfunctional nursing homes.

Sophie Okolo is the Founder of Global Health Aging.

Low Birth Rates and Unemployment: The Effects of Changing Demographics in Italy and Japan

As many already know, Japan has the largest population of people over 65 in the world at 25 percent in 2013. Since the Japanese are known for their longevity, this number may seem like an isolated phenomenon but the rest of the world is catching up. Almost every major country went through a birthing boom after World War II and people are starting to wonder how they are going to take care of the large number of elderly citizens. Italy already has a 65 and over population at 21 percent and by 2050, Americans aged 65 and above are expected to make up at least 21 percent of the population. As soon as 2025, the U.S. spending on Medicare, Social Security, and Medicaid is projected to double, which means there will be yet more strain on state and federal budgets.

If that is not food for thought, birth rates in Japan are at an all-time low. With decreased birth rates, there will be a hole in the future workforce when it comes time to take care of the elderly. Japan owns the second largest amount of U.S. debt, and with two economies so intimately connected, both can decline at the same time. The Japanese media has begun dubbing the citizenry’s lack of interest in the opposite sex as “celibacy syndrome.” While choosing a lifestyle outside of traditional marriage is a personal decision, so many people making this choice will eventually cause an economic downturn when it comes to needing resources for the elderly. Fewer babies were born in 2012 than any other year on Japanese record and not so funnily, adult diapers outsold baby diapers.

In Italy, there is a similar picture, not in terms of birth rates, but in terms of young adult employment. Unemployment is at a staggering 44.2 percent for people ages 15 to 24. An alarming statistic by itself, it is compounded by the fact that Italian pensions take up 15.6 percent of the country’s Gross Domestic Product. This rate is the highest in all of Europe and with jobs so scarce, young Italians are either moving abroad with their college degrees or have given up the job search entirely. Even those who are lucky enough to find jobs are not faring much better. The average salary for a person born post-1980s is a mere $1,375 a month, making it nearly impossible to afford home payments, car payments, and child payments. In addition, people are living in their parents’ homes longer and using their parents’ money as well. This postpones starting a family of one’s own and prevents the older generation from saving for retirement. With smaller retirement savings, older people are staying in jobs longer.

The only economies with less growth than Italy’s since 2001 are Haiti and Zimbabwe. Italy has the oldest working population out of any European nation and when that population retires, it puts enormous strain on the government because their tax base is exceedingly diminished with so many young people unemployed.

Jacob Edward is the Manager of Prime Medical Alert and Senior Planning in Phoenix, Arizona, USA. Jacob founded both companies in 2007 and has helped many Arizona seniors and their families navigate the process of long-term care planning. Senior Planning provides assistance to seniors and people with disabilities in finding and arranging assisted living in Phoenix, as well as applying for state and federal benefits.

Ebola and the Elderly: Focusing on a Vulnerable Population

Certain diseases like pertussis and dementia are associated with distinct populations. Pertussis is generally linked to children and dementia is generally linked to older adults. While both diseases can affect atypical populations, health professionals cannot have the same mindset when rare diseases like Ebola are concerned.

The Ebola outbreak continues to make headlines around the world and the focus has been on adults and children. If one studies the media and research papers, older adults are nearly absent. The aging population remains sidelined from the Ebola epidemic although the disease has affected the elderly around the world. Some may argue that Ebola mainly affects adults and children but few reports have shown that the elderly are also casualties. The rate of casualties regarding the elderly may not be accurate since there is little focus on this population. How long will older adults continue to be sidelined from issues that also affect them? Ebola attacks the elderly in unique ways compared to adults and children. For instance, older adults are prone to disease and disability because of their age. Specific risk factors that affect older adults also include:

  • Injury and poverty
  • Development of non-communicable diseases
  • Social isolation and exclusion, mental health disorders
  • Elder maltreatment.

These medical conditions in addition to contracting the Ebola virus disease (EVD) make matters worse for the elderly.

Cases regarding the elderly and EVD are not widespread in the media hence this piece will highlight just a few of these instances. The first case is an elderly woman who tested positive of the Ebola Virus Disease in Port Harcourt, Rivers State, Nigeria. The elderly woman had been quarantined in the Ebola Isolation Centre because she shared the same ward with the late Dr. Ike Enemuo, a Port Harcourt-based medical practitioner who treated an ECOWAS diplomat with the Ebola virus. Dr. Enemuo was ill and receiving treatment at the Good Heart hospital in Port Harcourt. He died of Ebola on August 22, 2014. The second case is an 87-year-old woman from Madrid, Spain, who was isolated in the senior center where she lives. The elderly woman was driven in the same ambulance as Nurse Teresa Romero, the first person to become infected in Europe. A key point about this case is that the elderly woman had suffered a fall which made matters worse. Another case in Spain is 75-year-old Miguel Pajares, an elderly priest who was working in Liberia. He was carrying out missionary work when he tested positive for Ebola.

The goal is not to ignore populations that are affected by certain diseases. Health professionals need to have a holistic view for disease outbreaks, knowing that outbreaks still affect populations that are marginalized. As Ebola remains in the news, let us remember the elderly, people with disabilities, and more because each population faces unique challenges during disease outbreaks. Treatment is not just for certain groups, it’s for all groups affected. Health and media professionals can think outside the box when it comes to reporting events. If not, public health interventions may continue to ignore elderly issues around the world.

Sophie Okolo is the Founder of Global Health Aging.

The Threat of Food Insecurity Among the Elderly in the U.S. and Beyond

In 2012, 1.1 million (9.1 percent) U.S. senior citizens living independently were considered food insecure. This number is expected to increase by 50 percent in 2025 as the U.S. population continues to age. Data reported by American Association of Retired Persons (AARP) described increases in the number of older adults experiencing food insecurity since 2007. It was shown that food insecurity rose by 25 percent among individuals aged 60 and older between 2007-2009. According to AARP, individuals were more likely to report food insecurity if they were non-white, Hispanic, renters, widowed, divorced or separated, high school dropouts, unemployed and with a disability, had an income below the federal poverty line, and those with grandchildren living in the household.

                                                                                                        Photo Credit: Pixabay

Defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”, food insecurity is directly related to a household’s ability to acquire the foods that are necessary for daily living. Among vulnerable and dependent populations such as the elderly, food insecurity can be particularly pronounced.

Individuals who are considered food insecure are at risk for experiencing poor health due to malnutrition. Health risks of particular relevance to the elderly include impaired cognition, diminished immune function, and the potential decrease in life expectancy. In addition to physical health concerns, mental health risks may also accompany malnutrition including feelings of powerlessness and isolation as well as stress and anxiety. Among the elderly, feelings of anxiety related to food insecurity are more pronounced than among young people. For the elderly living with chronic diseases (a number that has grown exponentially worldwide) such as cancer, heart disease, and diabetes, having access to a nutritious diet is a key factor in their ability to manage their condition.

While food insecurity is closely tied to having the financial resources necessary to purchase food, among the elderly, additional barriers may impact their access. In a series of interviews conducted with 46 elderly households in New York state, additional barriers to food access that participants reported were: transportation limitations, mobility limitations, lack of motivation/ability to prepare meals, financial compromises (purchasing food vs. other expenses), and food compromises (quality vs. quantity).

From a global perspective, ensuring that the aging population has adequate access to the resources necessary for healthy living (including safe, nutritious, and affordable food options) should be a priority. Advocating for such resources requires concerted efforts locally, regionally, and nationally. This is particularly important as our global society continues to confront multidimensional problems that threaten environmental, economic, and social stability.

Diana Kingsbury
is a PhD student and graduate assistant in prevention science at Kent State University College of Public Health.

Aging, Health, and Social Networks

Across the globe, nearly every country of the world is experiencing population aging. According to the United Nations, the number of people aged 60 years or older is expected to increase to more than 2 billion by 2050. While this shift in demographics carries implications for the social and economic makeup of our global society, it is important to also consider the unique health needs of the aging population.

Included among the most pressing health needs for the aged are managing chronic disease, preventing falls, maintaining cognitive function, and ensuring improved quality of life throughout the life span. Of additional importance to healthy aging, particularly in terms of health related quality of life, is the social support older adults receive from their family, friends, and communities. A known contributor to health related quality of life (HRQOL) is the strength of one’s social networks. It has been shown that individuals who report close bonds with family and friends are more likely to positively self-report their health. This was shown to remain true among elderly in the U.S., who reported improved health if they felt satisfied with the support available to them from family members, friends, and their communities.

From the perspective of the elderly, however, changes that occur late in the lifespan also translate to changes in their social networks and their social support. Social networks have been defined to include family members, friends and acquaintances, work and school connections, and relationships built in formal and informal organizations. Among the elderly, connections may be lost for a variety of reasons throughout the aging process, including retirement, limited mobility that prevents participation in previous activities, as well as the aging and death of close connections. Such changes to the social fabric, that a person formerly engaged with, carries implications for the health related quality of life an individual experiences.

For the elderly, a strong social network often translates into diminished feelings of loneliness, support for mental and physical health needs, as well as improved cognitive functioning. The elderly who feel supported by their community are less likely to report feelings of isolation and report better health than those who do not feel supported. With global population aging, ensuring that all individuals age with dignity, respect, and support should be of paramount importance.

The lengthening of the lifespan should also come as an increase in the number of years lived in high quality health. To protect the health of the aging population, concerted efforts should be made on the part of health care providers, communities, governments, families, and friends to ensure that all individuals enter into the late stages of life with the support that is necessary to live positively and healthfully.

Diana Kingsbury is a PhD student and graduate assistant in prevention science at the Kent State University College of Public Health.

June is Alzheimer’s and Brain Awareness Month

Photo Credit: Pixabay
                                                                                                                          Photo Credit: Pixabay

June is Alzheimer’s and Brain Awareness Month. Worldwide, there are at least 44.4 million people living with Alzheimer’s disease and other dementia’s. Dementia is a non-communicable disease and one of the main health challenges for the elderly in continents such as Africa and Asia. The current health systems of these continents are not designed to meet such chronic care needs, hence dementia is set to become a major problem in the long run.

The World Alzheimer report 2013, from Alzheimer’s Disease International, estimated that by 2050 the number of people living with dementia would rise from 44.4 million to 135.5 million. The proportion living in low- and middle-income countries would rise from 62% to 71% therefore much of the increase will be in developing countries. If current population trends continue, the number of people with Alzheimer’s disease will increase significantly unless the disease can be effectively treated or prevented. The increase in population aging is also linked to Alzheimer’s since the risk of Alzheimer’s increases with age. China, India, and their south Asian and western Pacific neighbors are the fastest growth in the elderly population.
Alzheimer’s disease is the most common cause of dementia and may contribute to 60–70% of cases and dementia is one of the most common diseases among elderly people. It is a leading cause of disability, institutionalization, and mortality; therefore it has a tremendous impact on both the individual and society. This month, there are many ways to help raise awareness and inspire action. These include:

  • Talk about Alzheimer’s each time you meet other people
  • Post, tweet and share the facts about Alzheimer’s disease and other dementia’s
  • Show your commitment to the cause by wearing purple, the official color of the Alzheimer’s movement

According to World Health Organization, health systems around the world, especially in Africa and Asia need to adapt to meet the chronic care needs of the elderly as the shift to aging populations gathers pace in low- and middle-income countries in the world. As populations age rapidly, infrastructure must be put in place to address the needs of elderly with dementia. The United Kingdom is a great example because they are leading the way in tackling the global crisis of dementia. These are not limited to websites about dementia, books that raise awareness of dementia among young people, or hosting the 2013 G8 Dementia Summit in London. The 2013 G8 Dementia Summit launched the World Dementia Council that exists to stimulate innovation, development and commercialization of life enhancing drugs, treatments and care for people with dementia, or at risk of dementia, within a generation.

This June, let’s observe Alzheimer’s and Brain Awareness Month. Everyone who has a brain is at risk to develop Alzheimer’s – but everyone can help to fight it, according to the Alzheimer’s Association. The goal is for the public to get involved and hopefully end Alzheimer’s disease.

Sophie Okolo is the Founder of Global Health Aging.