January/February 2009 Issue

Love and Ageism — A Social Work Perspective
By Amanda Smith Barusch, PhD
Social Work Today
Vol. 9 No. 1 P. 12

Why do thoughts of romance and intimacy in older adults make some people squirm? Find out more about this lingering prejudice from a social worker's research on late-life relationships.

Years ago, when I told a social work colleague that I was writing a book on romantic love in later life, he replied, “You’d better use a pseudonym!” He was serious, and he was not alone in feeling this topic was somehow inappropriate. I wasn’t sure which aspect aroused the greatest objections: age, romantic love, or the combination of the two.

Some gerontologists see ageism everywhere. The term refers to a negative attitude toward older people and the process of aging, which manifests in subtle and varied ways. Ageism permeates our personal and cultural expectations of older adults. It is encountered whenever people of a certain age are considered “too old”—too old to take a new job, to receive healthcare, or to fall in love.

Perhaps ageism’s most damaging aspects come when it is internalized, and personal understandings of late-life possibilities are unnecessarily restricted. Social workers are not immune to ageism. Given our professional mandate to serve vulnerable populations, this is cause for concern.

At the same time, social workers tend to ignore romantic love. Once, while addressing a conference of mental health professionals, I asked my audience about this: “How many of you ask your clients about romantic love as part of your assessment?” In that room of 200 professionals, two hands went up—and one of them was my student! “Why not?” I asked. Several people spoke up to explain that it would be “unprofessional” to ask about love. Unprofessional. As one woman explained, “We can ask clients about their primary relationships, but we should not use the word ‘love.’”

Why not? I wonder. No one can dispute the importance of love. For many people, romantic love is a basic human need. Our Code of Ethics holds that “[t]he primary mission of social work is to enhance human well-being and help meet the basic needs of all people.” But love is complicated and it’s intimate. When we use professional jargon such as “primary relationships” or “attachments,” we distance ourselves from the lived experiences of our clients. We use professionalism to hold ourselves above and away from them and, in the process, we miss opportunities for meaningful connection.

If you think we have “issues” dealing with age and love separately, consider the reaction when the two are combined. Romantic love later in life can evoke strong resistance. This was vividly illustrated in a story by Melinda Henneberger reported June 10, 2008, in Slate magazine. It goes like this: Bob was 95 and Dorothy was 82 when the couple met and fell in love. They were both residents in an assisted-living facility, and they both had dementia. The situation exploded when Bob’s son walked in on the couple enjoying a sexual moment in the privacy of Bob’s bed. The son was furious and demanded that facility staff ensure Bob and Dorothy were never again left alone together. As a result, Dorothy stopped eating, lost 21 pounds, and was treated for dehydration and depression. When Bob was eventually moved out of the facility, Dorothy sat next to the window and waited for him. Her doctor suggested that without the forgetfulness of Alzheimer’s, the loss might have killed her. Commenting on the story, a reader suggested that “the idea of geriatrics having sex squicks people out.” She called it “the ick factor.”

A Role for Social Work
All social workers, not just those who work with older adults, can contribute to the well-being of our clients and communities by fighting ageism. One way to do this is by learning more about the process of aging. For years, the dominant metaphor in research and writing on this process was “decline.” We heard how everything from our intellectual abilities to our sexual appetites diminish with advancing years in a long, slow march toward death (e.g., Wechsler, 1955; Pfeiffer & Davis, 1974).

But current thinking and emerging research largely reject the notion of inevitable decline, even when it comes to physical aging. The physical health of older adults is tremendously variable and can usually be improved by exercise (Bean, Vora, & Trontera, 2004). Beyond this, researchers in the field of cognitive neuroscience of aging have found that our brains are marvelously adaptive and flexible. These fabulous organs are capable of producing new cells and making new connections throughout their lives (Cohen, 2005). Reflexes may slow, but humans can certainly continue to learn and develop throughout our later years.

For these reasons and more, the new metaphor of aging is one of “maturation,” and a new discourse is emerging with terms such as “productive aging,” “positive aging,” and even “successful aging.” Social work professionals can be a part of this discourse, helping our clients, ourselves, and our communities see later life as a time of development and adaptation rather than decline and deterioration. We may also work on eliminating the phrase “too old” from our vocabulary.

Social workers clearly have a role in efforts to reduce the insidious effects of ageism. But what of love? Even apart from sex therapists and marriage counselors, social work practitioners in a wide range of settings can promote healthy romantic experiences among the clients they encounter. Here, too, practice can benefit from increased sensitivity and knowledge of emerging research. At a minimum, we must respect our clients’ romantic involvements. People with disabilities, people who are homeless, and people who are disenfranchised are also people who fall in love. By turning our backs on this aspect of their lives, we miss opportunities for connection and holistic appreciation of the human condition. Effective practice demands recognition of this central aspect of the human experience.

Indeed, if my research does nothing else, I hope it will persuade you that romantic love can be an important part of later life. As such, it deserves consideration by anyone providing services to older adults. Elders are aware of, and some even share, the ageist belief that romance and sex are the province of the young. They’ve heard about the ick factor, and many have confronted it firsthand. So older adults may not discuss their romantic experiences, even if those experiences are intense or haunting. This may be particularly true of men. Social work practitioners can create a space for discussion by gently asking about love. Usually it doesn’t take much. Particularly when older adults are experiencing infatuation, a gentle permission can unleash a torrent of material.

Understanding Infatuation
Yes, adults can and do experience intense infatuation at advanced ages. Results of our Internet survey suggest that adults over the age of 50 who were in new relationships experienced even greater romantic intensity than younger adults involved in new romances. When I think of infatuation, I think of an 83-year-old woman I interviewed whom I call Barbara. A people person who radiated vitality, Barbara found herself wildly infatuated at the age of 79. She had met a man who made her laugh so hard, she peed her pants, and one sunny California day saw her skipping down the street with her beloved singing, “I love you! I love you! I love you!”

And Barbara was not alone. Older adults aged 64 to 88 described the thrill of being in love, often saying, “I feel like a teenager!” Like those of any age, older adults who are infatuated welcome the opportunity to share their experiences with a trusted, nonjudgmental confidante.

This is vital because infatuation can be hazardous. American culture puts great weight on infatuation, giving a central role in our approach to romance. We idealize a relationship trajectory that begins with infatuation and results in long-term commitment. We expect people in committed relationships to forsake all others, which means that outside infatuations are widely condemned. Yet, as we all know, they happen, and their results can be devastating.

Carl Jung taught that infatuation is based on illusion (see Johnson, 1983). As reality intrudes, infatuation either matures into love or it disappears. Most older adults know that infatuation is temporary, but it’s easy to forget when you’re in its grip. An infatuated man in his late 50s once shared his plan to leave his wife of 30 years and live with his new love. Over a period of several months, he spoke for hours at a time about this infatuation. Later, he told me I had saved his marriage with one statement. As he fantasized about life with his beloved, I asked about his children, wondering whether his new love would be as interested in his children as their mother and how that might play out when grandchildren came along. He felt this conversation was a tipping point, setting the stage for the infatuation’s slow fade. Eventually, he was able to rededicate himself to the marriage. Social workers who understand infatuation can help insulate older adults and their families from the devastating results of misplaced infatuation. We can gently encourage reality testing while respecting older adults’ pleasure in this intoxicating experience. We can use the “teenager” metaphor to sound a note of caution about life-changing decisions. But most importantly, we can be nonjudgmental confidantes for older adults as they negotiate this surprising whirlwind of emotion.

But What About the Children?
In later life, the experience of newfound romance can be complicated by the presence of adult children, even as the lives of adult children can be enriched by happy, loving relationships among the older generation. In one noteworthy study on this question published in 2001 in the Journal of Personality and Social Psychology, Paul Amato, PhD, and Alan Booth, PhD, followed a national sample of 297 parents and their married offspring between 1980 and 1997. They reported that both discord and improvement in the parental marriages were later reflected in their children’s relationships.

On an intuitive level, most people realize this. Adult children often say, “As long as he makes Mom happy, he’s great with me!” Most older adults with newfound love report that their children rejoice in their happiness. Unfortunately some offspring strongly disapprove of their parents’ romantic involvements, causing aging expert Robert N. Butler, MD, to conclude that “many adult children continue to be bound by a primitive childhood need to deny their parents a sex life…” The ick factor again. Or, as some argue, children may worry about their own inheritance.

With awareness of the possibility and the complications of late-life romance, social workers may see opportunities to help families negotiate these conflicts and tensions. On their own, some older adults elect not to pursue romantic involvement for fear of hurting or irritating their children. Others press on, risking intergenerational alienation. And still others pursue their romantic interests through innovative arrangements.

Love, Together or Apart
Living apart together (LAT) is one such arrangement (Levin, 2004). In this new family form, the couple does not share a household but nonetheless view themselves as committed to the relationship. They identify themselves as a couple, as do their family and friends. Partners in these relationships report that having their own homes gives a measure of autonomy they could not enjoy if they moved in together. Several of the people we interviewed were involved in LAT relationships, though they did not describe them as such, referring to their partners instead as a friend, a special friend, or a boyfriend. As baby boomers age we can expect to hear more about LAT and other creative approaches to late-life romance.

When it comes to romance, older adults living in nursing homes and other congregate settings must of necessity be among the most creative (e.g., Ray, 2008). Given the complications associated with frail health, limited privacy, and diminished cognitive functioning, nursing homes are ill equipped to support the romantic and sexual needs of their residents. Under the medical model that serves as the framework for most institutional care settings, these needs are not even recognized.

But the Eden Alternative and other innovative approaches are changing the way Americans think about institutional care. Social workers already play an important role in humanizing these settings, and the coming decades should see expanded opportunities to develop and test new paradigms for institutional care of older adults, paradigms that take into account the not-so-remote possibilities of romance, new love, and yes, even sex.

Finally, and this does not go without saying, social workers can support the romantic experiences of older adults by reminding them that age does not confer immunity to sexually transmitted disease. The rising incidence of HIV/AIDS among those aged 65 and over stands as a stark reminder that this cohort did not receive the indoctrination in safe sex that is now widely available to high school students (Emlet & Poindexter, 2004).

Romantic love is a powerful force in human development, shaping the events of our lives and the people we become. Love changes people, communities, and societies. As agents of change, social work professionals can harness and channel love’s power “to enhance human well-being and help meet the basic needs of all people,” including older adults experiencing the delights and tortures of romantic involvement.

— Amanda Smith Barusch, PhD, is a professor and head of the department of social work and community development at the University of Otago in New Zealand. She has been teaching and researching in the field of aging for more than 25 years, mostly as a faculty member of the College of Social Work at the University of Utah. Her most recent book is Love Stories of Later Life: A Narrative Approach to Understanding Romance.

References
Bean, J. F., Vora  A., & Frontera, W. R. (2004). Benefits of exercise for community-dwelling older adults. Archives of Physical Medicine and Rehabilitation, 85(7 Suppl 3), S31-S42.

Cohen, G. D. (2005). The mature mind: The positive power of the aging brain. New York: Basic Books.

Emlet, C. A. & Poindexter, C. C. (2004). Unserved, unseen, and unheard: Integrating programs for HIV-infected and HIV-affected older adults. Health and Social Work, 29(2), 86-96.

Johnson, R. A. (1983). We: Understanding the psychology of romantic love. New York: Harper Collins.

Levin, I. (2004). Living apart together: A new family form. Current Sociology, 52(2), 223-240.

Pfeiffer, E., & Davis, G. C. (1974). Determinants of sexual behavior in middle and old age. In: Palmore, E. (ed.). Normal Aging II: Reports from the Duke Longitudinal Studies, 1970-1973. Durham, NC: Duke University Press, 251-262.

Ray, R. (2008). Endnotes: An intimate look at the end of life. New York: Columbia University Press.

Wechsler, D. (1955). Manual for the Wechsler adult intelligence scale. New York: The Psychological Corporation.

Sexual Intimacy in Nursing Homes
Do not disturb signs aren’t just for newlyweds anymore. They are also a way to give nursing home residents some privacy for sexual expression, according to Kansas State University aging experts.

“By law you can’t always lock a room, but you can offer residents some privacy,” said Gayle Doll, PhD, who directs Kansas State’s Center on Aging. She said semiprivate rooms pose a problem for nursing home residents who want to engage in sexual activity, either alone or with a partner. That’s why two of the center’s researchers are looking at ways to make nursing home staff more comfortable with accommodating the sexual needs of residents.

Majka Jankowiak and Laci Cornelison, research assistants at the Center on Aging, studied nursing home staff attitudes about sexuality in three Kansas nursing homes. The research was presented in October 2008 at the American Association of Homes and Services for the Aging conference. The researchers surveyed the staff before and after a workshop they presented. The surveys, as well as anecdotal feedback from the participants, showed a marked change in attitudes.

“They really felt this was a topic that they needed to be educated on,” Jankowiak said. “Part of it is that American society is not supportive of older people and sex. It’s been a taboo, and it’s an even bigger taboo in nursing homes. After the presentation, the participants felt more confident talking about it and dealing with sexual expression of residents.”

The researchers said that sexuality and nursing home residents brings up issues beyond just acknowledging and accommodating sexual expression. HIV and other sexually transmitted diseases can be concerns for a generation that may not have the same awareness that younger people do. Also, adult children may have concerns about their parent’s safety or how a new relationship will affect the family or their inheritance. The researchers are developing materials to help family members deal with these questions. “What they fear is exploitation or that the role the parent played will go away,” Doll said.

In addition, Alzheimer’s and dementia raise questions about the ability to consent, and these conditions also may spur sexual behavior that’s inappropriate. “Even though we advocate for residents’ rights, there are things that are inappropriate,” Doll said. “But staff must be able to handle this without residents feeling embarrassed. Inappropriate behavior can just come from people needing relationships, not necessarily sexual ones.”

Doll said the researchers hope to see federal guidelines developed to help all nursing homes deal with sexuality in a positive way, especially as baby boomers age and bring their attitudes about sex with them to the nursing home. “Nursing homes are the second most regulated industry next to nuclear power, and yet these regulations don’t address sexuality,” Doll said.

— Source: Kansas State University