Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. Objectives To examine the relation between health and several dimensions of sexuality and to estimate years of sexually active life across sex and health groups in middle aged and older adults. Design Cross sectional study. Setting Two samples representative of the US population: MIDUS (the national survey of midlife development in the United States, 1995-6) and NSHAP (the national social life, health and ageing project, 2005-6). Participants 3032 adults aged 25 to 74 (1561 women, 1471 men) from the midlife cohort (MIDUS) and 3005 adults aged 57 to 85 (1550 women, 1455 men) from the later life cohort (NSHAP). Main outcome measures Sexual activity, quality of sexual life, interest in sex, and average remaining years of sexually active life, referred to as sexually active life expectancy. Results Overall, men were more likely than women to be sexually active, report a good quality sex life, and be interested in sex. These gender differences increased with age and were greatest among the 75 to 85 year old group: 38.9% of men compared with 16.8% of women were sexually active, 70.8% versus 50.9% of those who were sexually active had a good quality sex life, and 41.2% versus 11.4% were interested in sex. Men and women reporting very good or excellent health were more likely to be sexually active compared with their peers in poor or fair health: age adjusted odds ratio 2.2 (P<0.01) for men and 1.6 (P<0.05) for women in the midlife study and 4.6
(P<0.001) for men and 2.8 (P<0.001) for women in the later life study. Among sexually active people, good health was also significantly associated with frequent sex (once or more weekly) in men (adjusted odds ratio 1.6 to 2.1), with a good quality sex life among men and women in the midlife cohort (adjusted odds ratio 1.7), and with interest in sex. People in very good or excellent health were 1.5 to 1.8 times more likely to report an interest in sex than those in poorer health. At age 30, sexually active life expectancy was 34.7 years for men and 30.7 years for women compared with 14.9 to 15.3 years for men and 10.6 years for women at age 55. This gender disparity attenuated for people with a spouse or other intimate partner. At age 55, men in very good or excellent health on average gained 5-7 years of sexually active life compared with their peers in poor or fair health. Women in very good or excellent health gained 3-6 years compared with women in poor or fair health. Conclusion Sexual activity, good quality sexual life, and interest in sex were higher for men than for women and this gender gap widened with age. Sexual activity, quality of sexual life, and interest in sex were positively associated with health in middle age and later life. Sexually active life expectancy was longer for men, but men lost more years of sexually active life as a result of poor health than women. Human sexuality is increasingly recognised by doctors and policymakers as an important aspect of health and quality of life throughout the life course.1 2 3 Sexual activity has been associated with health benefits and longevity.4 5 6 Recent data from the US national social life, health and aging project (NSHAP) indicate that more than half of people aged 57-85 and about a third of those aged 75-85 are sexually active and that physical health is significantly correlated with sexual
activity and many aspects of sexual function, independent of age. Since 2000, a focus on sexuality in older adults has been heavily driven by the availability of drugs to treat male erectile dysfunction. Effective treatment of this condition is likely to extend the duration of sexually active life for men and their partners as they age. Problems with sexual functioning are prevalent among older adults in the United States and other countries.1 7 About half of all sexually active men and women aged 57-85 in the United States report at least one bothersome sexual problem; one third report at least two. Yet doctors rarely address sexual concerns in older adults, particularly in women.1 As the older population grows in developed and developing nations,8 projecting the population structure of sexual activity is useful for anticipating need for public health resources, expertise, and services related to maintaining sexual function, regaining sexual function lost as a consequence of disease or treatments for common medical conditions that occur in later life, and preventing sexually transmitted diseases or risky sexual behaviour among older adults. Population estimates of sexual activity in later life can help motivate and inform the design of policies pertaining to sexual expression and rights among cognitively impaired and institutionalised elderly people. In addition, expectations about the duration of sexually active life may influence important health behaviours. For example, patients may be motivated to stop smoking or to adhere to drug regimens if the behaviour changes are expected to prolong or preserve a sexually active or sexually satisfying life. Using two nationally representative datasets, we examined the association between sexuality (sexual activity
and quality of sexual life) and global self rated physical health in middle aged and older men and women. We also estimated the average remaining years of sexually active life gained as a result of good health, using sexually active life expectancy, a new health expectancy indicator for clinical and public health application. The study populations were drawn from two large, publicly available and nationally representative recent health surveys with sufficiently large numbers of older respondents and comparable data on sexuality: the national survey of midlife development in the United States (MIDUS, or midlife cohort) and the national social life, health and aging project (NSHAP, or later life cohort). The 1995-6 wave of MIDUS provides nationally representative data on adults aged 25 to 74. Participants were selected by using a random digit dial sample of the non-institutionalised, English speaking population of the 48 conterminous United States. Participants completed a telephone interview and postal questionnaire. The response rate was 60.8%, with 3032 respondents (1561 women, 1471 men) for both parts of the survey. Sampling weights correcting for differential probabilities of selection and non-response allow estimates from this sample to be generalisable to the United States population in terms of age, gender, race, and education. Details on the design, field procedures, and sampling weights of MIDUS have been described previously.9 The 2005-6 wave of NSHAP provides a nationally representative probability sample of community dwelling people aged 57-85, generated from households screened in 2004 across the United States. African-Americans, Latinos, men, and the oldest old (75 to 84 years at the time of screening in 2004) were over-sampled. Interviews at home and collection of biomeasures were carried
out in English and Spanish by professional interviewers, yielding 3005 respondents and a response rate of 75.5% weighted (74.8% unweighted). Sampling weights account for differential probabilities of selection and differential non-response. Details on the design, field procedures, and sampling weights have been described previously.1 Both datasets are available to researchers through the National Archive of Computerized Data on Aging collection (www.icpsr.umich.edu/NACDA/). This analysis uses version 1.4 of the NSHAP dataset. What is already known on this topic. Many older people are sexually active. Partnership and sexual activity have been positively associated with health in middle age and later life. Knowledge about patterns of sexual activity in the population informs public health policy and patient education and counselling. What this study adds. Frequency of sexual activity, a good quality sex life, and interest in sex are positively associated with health in middle age and later life Interest in sex among middle aged and older men in the United States has increased since 2000. About half of sexually active older women report a poor quality sex life. At age 55, sexually active life expectancy is 15 years for men and 10.6 years for women; although the period is longer for men, they lose more years of sexually active life as a result of poor health than women. University of Chicago; Department of Obstetrics and Gynaecology and Chicago Core on Biomeasures in Population-Based Aging Research, Centre on Demography and Economics of Aging, Department of Medicine, Section of Geriatrics. Stacy Tessler Lindau, associate professor, Natalia Gavrilova, senior research associate. sources: uchicago.edu, bmj.com
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