Assoc. Prof. Dr. Hasanah Che Ismail
Consultant Psychiatrist, School of Medical Sciences, Universiti Sains Malaysia

Sexuality does not necessarily abate with age. Prevalent misconceptions are that older people are unable to perform sexually because of physical changes related to aging, that older adults are not interested in sex, or that those who do express an interest are demented or perverted. Further, elders and health care providers alike may erroneously assume that sexually transmitted infections are not common in this population.
 
Physical, psychological, cultural, and social issues affect sexuality. Along with the occurrence of chronic conditions, medications have the potential for sexual side effects. Medications are not limited to antidepressants, antihypertensive, opioids, anxiolytics, psychotropics/neuroleptics, corticosteroids, and diuretics. The use of recreational or illicit drugs, alcohol, and nicotine also result in sexual dysfunction.
 
Cultural and religious beliefs about sexuality also greatly influence sexual behavior. Spousal illness and social isolation that are common to the elderly alter opportunities for sexual expression.
 
Psychological factors play a significant role in sexuality later in life. Prior positive or negative sexual experiences, issues of body image and self-esteem, and frank mental disorders such as depression and anxiety may influence the frequency and quality of sexual relations.
 
Finally, sexual expression in the elderly may be affected by living arrangements, as a substantial number reside with family members or in long-term-care facilities. Inadequate privacy inhibits sexual expression and activity. In addition, the values, beliefs, and biases of the facility staff or family members influence sexual expression among residents. Facility staff and health care providers may not feel comfortable dealing with the sexual needs and interests of elderly residents and perceive sexual expression as problematic behavior.
 
As the aging population expands, it is increasingly important for health care providers to become aware of and sensitive to the needs and concerns of older adults. The step forward is getting adequate information and skill to deal with this issue and being open and facilitative in helping elderly persons with needs.
 
Each and every person is unique and what constitute a satisfactory and meaningful QOL may widely differ between one person to another, or between caregiver and patient.