Supporting intimacy and relationships in later life

A lack of knowledge, confidence or skills can prevent practitioners from opening a discussion on sexuality with people in later life because they may perceive it as deeply personal, feel embarrassed, or may not appreciate how or why it is relevant to social care. A new Practice Tool aims to support intimacy and relationships in later life.

There is a growing body of research that can be used to address ways in which the intimacy and sexual needs of older people with diverse identities are recognised and supported. As someone who has been researching and teaching on issues concerning sex, sexual and gender identities in later life, the following resources aim to stimulate awareness and challenge readers to make a step change in addressing these issues in their everyday practice.

This chapter of the Ageing well: Evidence Review summarises the social and political context regarding sex, intimacy and relationships in later life from a human rights perspective and how changing societal and cultural norms – for example, historical, social and political movements – has led to significant changes, particularly for LGBTQ+ people. They will have witnessed dramatic changes in their lifetime in relation to their rights to relationships and families of choice. The Evidence Review also considers older peoples’ own perspectives, which are less often heard.

There may be challenges in supporting an ageing ‘baby boomer’ population, who may have more liberal sexual attitudes and are more likely to have had ready access to information and media about sex. They may expect greater bodily and sexual autonomy, for example in how they negotiate their relationships and seek sexual pleasure. This poses the question as to whether practitioners are ready to support lifestyle choices, such as those involving different relationship conventions that perhaps challenge more traditional views of how sexual intimacy is practised.  

Working with issues of sexuality and intimacy, and with people who have sexual and gender diversities, challenges us to draw on our personal values and beliefs as well as professional ones. These may interact with religion, culture, race, ethnicity, gender and class and, in turn, determine how we present ourselves and relate to others. The use of an intersectional lens, a degree of self-awareness and a willingness to engage can help with exploration of how people’s needs differ, and to clarify what those needs are, in a respectful and dignified way.

Talking about intimacy and sexuality in later life raises awareness about citizenship and social inclusion. For example, humour can be a powerful method to connect, but also to dismiss or silence uncomfortable feelings.

Ignorance or lack of attention to diverse lifestyles and cultures can also cause people to become marginalised. For example, if we consider the implications for migrant older people whose intimate relationships may have been disrupted or are unavailable to them in later life. To provide another example, how flexible are services in being able to support an older working-class lesbian of Black African heritage living in a care home, who will have significantly different needs around sexuality and intimacy compared to a White middle-class older man?

The Supporting intimacy and relationships in later life: Practice Tool offers a range of learning opportunities for practitioners and their supervisors, and their teams, to explore some of these issues through reflective exercises, case discussions and a structured review of their services. These activities address how to include enquiries about who people are committed to and with whom they feel closeness, romantic love or sexual attraction. The tool helps to trigger ideas on how to signpost or establish relationships with relevant support services, utilising practitioners and providers who can provide expertise and help with facilitating better access to care and support services in different situations.

Both the Practice Tool and the Evidence Review also cover some of the complex issues that can arise within intimate relationships in later life. They are for everyone - including frontline practitioners, managers, and service providers. Sexual violence, the need for informed consent and decision-making, and recognising discrimination and ageism, are all underpinned by the principles of promoting wellbeing in the Care Act 2014 and adhering to the principles of the Mental Capacity Act 2005.

Within adult social care, achieving the right level of emotional intimacy requires a degree of confidence and familiarity between people, their formal carers, and professionals. Practitioners will tread a fine line in balancing people’s need for recognition and intimacy with respect, dignity and privacy. This can also bring to the forefront older people’s potential loss of other social contacts and the significance of life changes. However, a reflective approach that is based on knowledge and evidence-based practice is a precondition for meaningful ethical action in this challenging area.