Thank you for coming this morning. It is always fun to talk about relationships and sex. We met through our shared interest in older adult relationships and sexuality. The intersection of our respective PhD projects is a fascinating look at changing relationships and social mores in the baby boomer and older adult cohorts.

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I’m Linda Kirkman from La Trobe University. My qualitative research project investigates the experience and wellbeing of rural baby boomers who have had a friends-with-benefits relationship within the previous five years. Inclusion criteria are: to have been born between 1946 and 1965, and to live outside a capital city. The 22 participants are 15 women and 7 men who represent diverse sexual orientations including heterosexual, homosexual, mostly heterosexual and bi-curious. The duration of their relationships ranged from six months to 15 years. Some were monogamous and some had multiple partners.

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We will start with some background information, then report from our individual PhD projects on the topics of agency and sex. The combined elements of structural ageing of the population, an increased divorce rate and large numbers of single older adults who have low remarriage rates make for fascinating relationship and sex research. There is very little research on dating and new romantic relationship formation in later life; as it is assumed that older adults do not re-partner. They do, in interesting ways and while having a good time. Intimate relationships and friendships contribute significantly to the social, emotional and physical wellbeing of people of all ages (Hinchliff & Gott, 2004). Many people who superficially appear to be single are in fact in a relationship. Of the approximately one third of Australians aged over 20 years not living with a partner or spouse, who could be classified as single, approximately 24% were in a relationship, and older people are more likely to live independently by choice (Reimondos, Evans, & Gray, 2011). Twenty-eight percent of Australian baby boomers have had a FWBR or booty call relationship (RSVP, 2014). In this presentation we will focus on the aspects of agency and sex. We will take turns to present examples from our respective projects to illustrate agency. Then in discussing sex Sue will focus on pleasure and wellbeing while Linda will present on sexual health and sexual health services. We will finish by drawing our findings together, concluding with some recommendations.

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Agency is defined as the sense of individual influence the person has over their life and the society in which they live (Germov, 2005).

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For some participants an unconventional relationship was a progression from an unconventional or open-minded upbringing, whereas for others it was a conscious effort to create a life that was different from a restrictive, gendered, religious childhood. They took time to reflect, be mindful, see counsellors, and worked at developing the confidence to be assertive in their relationships. Women who had experienced freer childhoods still needed to stand up for what they wanted from their relationship and not fall into conventional patterns. Overcoming bullying and sexual abuse was part of the story for some, and they describe conscious steps to learn communication skills and develop self confidence and assertiveness. For many their FWBR came after marriage and children. Thelma described this as coming up from underground’. Participants demonstrated courage and determination as they developed agency over their lives, wrote new life maps for themselves and chose their own adventure.

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Toby, a gay man who grew up in a Jehovah’s Witness family, found that the rigid world they wanted did not match the universe as he saw it.

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Goldie left home at 16, travelled the hippie trail overland to Europe and enjoyed sexual freedom. She carries this comfortably into her 60s.

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Sue: Despite much evidence to the contrary, in society we persist in viewing older adults as non-sexual. My study showed this was not the case as the older adults continually emphasised the ongoing importance of sexuality in their lives. For Linda, sexual health was a research focus, as she was motivated to find evidence to inform sexual health promotion needs. In this section therefore Sue will focus on her findings about the sexual nature of relationships and Linda on sexual health, including safe sex and health service use.

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When we think about older adult relationships – if we think about them at all, that is – we usually think about them like this.

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So despite the negative stereotyping, Sue’s study shows that older adult relationships can be and are often like this.

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Midlife and older adults having sex with new partners are at risk of poor health outcomes because of sexually risky behaviour, limited choice of sexual health services, lack of communication about sexual health with practitioner and patient, a growing STI incidence, and poor knowledge about STI symptoms. People living in rural areas have an increased disadvantage. Risk behaviours in older people are similar to those of younger people (UNAIDS, 2013) countering the assumption that older people are necessarily wiser and more careful.

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George would judge by visual cues such as how the woman presented herself, and her home environment. He acknowledges that this is not a fool proof strategy: That’s some form of a risk, but you don’t know that she might have had sex with some druggie the night before that’s carrying all sorts of things. George’s use of druggie suggests he associates STI or blood borne virus risk with certain population groups and with drug use behaviour rather than sexual activity alone. Despite acknowledging there is some form of a risk the risk is not perceived to be great enough to warrant action, and George is confident about his just a bit of common sense judgement. From 2007-2011 in Australia in the 40-60+ age groups chlamydia and gonorrhoea notifications rose dramatically, while HIV notifications rose slightly (The Kirby Institute, 2013). The most significant increases can be seen in rates of gonorrhoea notifications. The reported infection levels, while still low, indicate a trend which registers concern. Surveillance may not accurately reflect incidence.

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There is a lot of stigma and anxiety surrounding sexual health. Some of that is about sexual behaviour itself and some is to do with lack of confidence to discuss sexual health at all. The manner of the health practitioner in the consulting room is an important factor. The patient and the practitioner both bring their respective levels of comfort, knowledge and beliefs about sexuality and sexual health to the consulting room. This includes practitioners’ incorrect assumptions about the sexual activity of midlife people, usually that they are not sexually active, or at least not outside conventional relationships, and are not at risk of STIs (Minichiello, Hawkes, & Pitts, 2011). Unless the patient introduces the topic of sexual health the practitioner is unlikely to ask about it or see a need to suggest testing. Lilly observed, Well it never comes up with my doctor, and it would have to be me initiating [discussion on sexual health]. Her explanation was that she was not at risk because she was practicing serial monogamy rather than having multiple partners.

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People in relationships other than heterosexual monogamy, like Abe who identifies as polyamorous and a swinger, might project their fear of judgement onto the practitioner who has to justify the expense of the tests. If the patient did not want to disclose sexual behaviours to a local health practitioner because of shame, fear of judgement, and concern about confidentiality then they may never be addressed.

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In this presentation we have emphasised the importance of avoiding assumptions about the sexuality or relationship situation of midlife and later life adults. We have highlighted changing social mores and recommend that by asking, not assuming, and being respectful of people’s choices, practitioners will be in a position to work effectively with these cohorts to promote good health and wellbeing.

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