How a family copes with issues around aging

Chapter 10: Relationships

Chapter Outline

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10.1 Relationship Status of Canadians

  • Diversity in Romantic Partnerships
  • Diversity in Families
  • Marriage in Canada
  • Divorce Trends in Canada
  • Re-partnering in the Context of Widowhood and Divorce
  • Living Apart Together
  • Being Single throughout Life

10.2 Relationships

  • Developmental Pattern of Friendships
  • LGBTQ Older Adults
  • The Sandwich Generation (Consider the Panini)
  • Intergenerational Ties
  • Grandparenting
  • Elder Abuse

10.3 Sexuality among Older Adults

  • Sexual Patterns in Older Age
  • Sexual Expression in Long-Term-Care Settings
  • Dating: It Is Not Just for Young People
  • Sexually Transmitted Infections in Older Adults

10.4 Good Practice

10.5 Summary

“Old age is like climbing a mountain. You climb from ledge to ledge. The higher you get the more tired and breathless you become, but your views become more extensive.”
Ingmar Bergman

In Canada, and around the world, relationships are becoming increasingly diverse and complex. Although married couples with children are still the predominant family structure, common-law or cohabitating relationships are on the rise as are same-sex marriages. Growing up in step families is occurring more frequently as well as growing up in one-parent families. So how does aging play into this diversity in relationships? We will explore this question in this chapter.



Learning Objectives

To understand:

  • the diversity in romantic partnerships
  • the diversity among families in Canada
  • marriage in Canada
  • divorce trends in Canada
  • re-partnering in the context of widowhood and divorce
  • the benefits and challenges of singlehood
  • dating in older adulthood

Diversity in Romantic Partnerships

Although marriage remains one of the most important social institutions in Canada, the marriage rate in Canada is declining and, as a result, the conventional portrait of what a family looks like is changing. For example, in the 1961 Canadian Census, married couples accounted for almost 92 percent of the families surveyed. However, in 2011, this number fell to 67 percent (Statistics Canada, 2012f). According to the Census, there were approximately six million married couples in Canada in 2011. The proportion of married couples in the Census was highest in Prince Edward Island, Ontario, and Alberta (Milan, 2013).

It seems that more and more people are choosing to live common-law or cohabitate. As you can see from Figure 10.1, the number of common-law couples rose considerably from 1961 to 2011. In fact, this is one of the most noteworthy changes in Canadian demographics in the past 20 years (Turcotte&Schellenberg, 2007). Interestingly, according to the 2011 Census, ­cohabitating always has been proportionally higher in the province of Quebec as well as in the territories. In fact, the proportion of couples in Quebec who are cohabitating (38 percent) is higher than in Sweden and Finland where common-law couples constitute a large share of all couples (Statistics Canada, 2012g). The reasons for this are unclear. Cohabitation also is very common in the United States where approximately 50 to 60 percent of marriages are preceded by cohabitation (Stanley, Amato, Johnson, &Markman, 2006).


Reflective Question


Steeping some tea…


Cohabitating before marriage gives couples an opportunity to learn about each other’s quirky habits and work out any kinks in the relationship prior to marriage, right? Well, this is not always the case. Individuals who live together before they get married have a greater risk of a marital breakup than those who do not cohabitate (Rhoades, Stanley, &Markman, 2009). This is referred to as the cohabitation effect. Couples, who probably would not have gotten married had they been living apart, slide into marriage because they are already living together and it appears to be the thing to do next. However, Lu, Qian, Cunningham, and Li (2012) found that it was only serial cohabitators (those who have lived in more than one cohabitating relationship) who showed a high cohabitation effect.

Of note is that cohabitation has grown most rapidly among older age groups in recent years. The number of individuals aged 65 to 69 in common-law unions rose 66.5 percent between 2006 and 2011, the fastest pace of all age groups (Milan, Wong, &Vézina, 2014). Interestingly, older cohabitators tend to perceive their relationships as an alternative to marriage while younger people see cohabitation as a prelude to marriage (Sassler, 2010).


Reflective Question


Steeping some tea…


Although not shown in Figure 10.1, the number of same-sex couples nearly tripled between 2006 and 2011, which reflects the first five-year period since same-sex marriage became legal in Canada (Statistics Canada, 2012g). We will be talking about same-sex couples in relation to older adults later in the chapter.

Diversity in Families

As you can see from Figure 10.1, lone-parent families also increased between 1961 and 2011 in Canada. The 2011 Census data also included information on stepfamilies for the first time. ­Stepfamilies accounted for almost 13 percent of families in 2011. Interestingly, more families in Canada were multi-generational in 2011 than in 2006. Most of these multi-generational households consisted of children, their parents, and at least one grandparent (Statistics Canada, 2012g). It should be pointed out that there have been significant changes in the living arrangements of young adults aged 20 to 29. Approximately 42 percent of young adults aged 20 to 29 lived in the parental home in 2011. Consider that in 1981, only 27 percent of young adults aged 24 to 29 lived at home (Statistics Canada, 2012h). Young men are more likely to live at home than young women.


Reflective Question


Steeping some tea…


According to Statistics Canada (2012h), there are several reasons why young adults in their 20s remain in or return to their parents’ home. Some of these reasons include a breakup of a relationship, cost of housing, pursuit of higher education, cultural preferences, or difficulty finding employment. Those children who return home after an absence are known as boomerang kids.

Marriage in Canada

A fairly recent study by Bibby (2009) showed that 90 percent of Canadian adolescents surveyed expected to get married and stay married. Although divorce is becoming more common, it seems that individuals have hope that their own marriages can last! The average age at which both Canadian males and females first marry is increasing. Have a look at Figure 10.2. For young adults aged 25 to 29, the proportion who were never married rose from about one-quarter in 1981 to almost three-quarters in 2011. Even among individuals in their early 30s, the proportion of men and women who were never married increased significantly from 1981 to 2011 (Milan, 2013). One aspect of marriage that appears to be stable is that, on average, men tend to marry women who are younger.


Reflective Question


Steeping some tea…


According to the 2011 Census, more than three-quarters of men 65 years of age and over and close to one-half of women 65 years of age and older lived as married spouses or were cohabitating (Milan et al., 2014). The number of older adults living as a couple has increased significantly since 1981. One of the reasons is the increased life expectancy of men, which allows relationships to endure further into old age. Another possible reason is that in 2011, older-adult couples were increasingly close in age (Milan et al., 2014). Although older women are more likely to be widowed because they live longer, having a partner closer in age may mean that couples are potentially less likely to experience widowhood until later in their adult years. Interestingly, in 2011, the majority of older adults 65 years of age and older had been married only once. The baby boom generation will surely change this statistic (Milan et al., 2014).

So, are long-term marriages different than those marriages that are just starting? It has been widely accepted among researchers that marriage satisfaction follows a U-shaped pattern in which couples report high satisfaction at the beginning of their marriage and then this satisfaction falls as the couple is raising children. Once the children have left home, marital satisfaction is again high. This pattern is found in married couples and those who cohabitate (Kamp Dush, Taylor, &Kroeger, 2008; Hansen, Moum, & Shapiro, 2007). In general, researchers have found that satisfaction among individuals in long-term relationships tends to continue to increase even after retirement. However, marital satisfaction may decrease if one of the partners develops health problems, and this decrease appears to be directly related to the amount of perceived support that is received by each partner (Landis, Peter-Wight, Martin, &Bodenmann, 2013). In fact, Landis and her colleagues found that the perception of a spouse’s support is the most important predictor of remaining married.

There also has been a good deal of evidence from meta-analytic studies that older married individuals report higher life satisfaction; better health, longevity (especially for men), and well-being; and greater happiness than those who are not married (Proulx, Helms, & Buehler, 2007; Turcotte&Schellenberg, 2007). Naturally, one would think that that there must be several factors at play that will determine both marital satisfaction and the quality of long-term marriages. We speak from experience when we say that staying married for a long time takes a good deal of effort and perseverance. A good sense of humor also is helpful!

Interestingly, some researchers have found that older couples in long-term marriages describe their partner more positively than do middle-aged married couples. They also show reduced marital conflict when compared to middle-age couples (Henry, Berg, Smith, &Florsheim, 2007; O’Rourke &Cappeliez, 2005). However, other researchers have not found an increase in positivity and a decrease in negativity when comparing interactions between older and younger couples (Smith et al., 2009). Smith and his colleagues argue that most of the findings are cross-sectional in nature, and if we are truly to understand what long-term marriages look like, more data from longitudinal studies are needed.

Divorce Trends in Canada

In 1968, Canada’s first unified divorce law was passed. At that time, divorce became easier to obtain but it was not until 1986 when the Divorce Act was revised that married couples could divorce quite easily. In fact, in the year following, the crude rate of divorce was 364 divorces per 100 000 in Canada, which was a record high (Milan, Keown, & Robles Urquijo, 2011). Although the media would have you believe that the majority of marriages end in divorce, this is not true. The difficulty is that divorce rates are very complex to figure out. The people getting divorced in a given year are not the same people who are getting married so it is difficult to compare marriages to divorces to determine the likelihood of divorce occurring. In addition, the divorce rate in any given year includes individuals who are getting a divorce for the second or third time. The rate of divorce in second and third marriages is about 10 percent higher, which inflates the divorce rate for all marriages (Lambert, 2009).

In 2008, the crude divorce rate was 211 divorces per 100 000 population. Since approximately the late 1990s, the number of divorces and the crude divorce rate have been relatively stable, perhaps because more people are living common-law, are reluctant to legally marry, or both. In addition, some marriage breakdowns might not be formalized by a legal divorce if neither spouse wants to marry again (Milan et al., 2011). Although there is much variability in the length of a marriage nationally, the average length is 14 years, which is similar to other regions of the world (Eichler, 2015).

Interestingly, the number of divorces occurring among older adults is rising. This trend is commonly referred to as grey divorce and this refers to marital breakups among adults over 50 years of age after approximately 20 years or more of marriage. From 1981 to 2011, the proportion of individuals 65 years of age and older who were divorced or separated rose from 4 percent to 12 percent. Even among the population aged 85 and over, 4 percent were divorced or separated in 2011 compared with 1 percent in 1981 (Milan et al., 2014).


Reflective Question


Steeping some tea…


Researchers are not entirely sure what accounts for increased divorce rates and there are likely many contributing factors. For example, the significant increase in women in the labour force and improvements to government sponsored pension programs have been identified as factors contributing to increased divorce rates (Milan et al., 2014). As a result, many women are less economically dependent on their husbands than they have been in the past. The age that people get married also has been identified as a reason for marital breakups with those marrying in their teens and early twenties having more than double the risk of a marital breakup than those individuals who choose to marry in their late twenties and beyond (Milan et al., 2014). The reduction of social and religious sanctions against divorce also are thought to be contributing factors (Eichler, 2015).

But, after living most of one’s life with another person, why get a divorce? Researchers think it is because we are living longer. Wu and Schimmele (2007) argue that long-term marriages may not survive because of the changing needs or desires of the partners as they age in the marriage. Wu and Schimmelle also suggest that some individuals age 55 or 60 who realize that they could live another 25 years choose to leave unhappy marriages to avoid a drawn-out period of marital problems or life dissatisfaction in their old age. Also, couples get busy raising children and they can grow apart. In addition, once children have left home, there may be no reason to stay married.

Other explanations for divorce are similar for both younger and older couples. For example, marital dissatisfaction often is accompanied by an increase in problematic behaviours such as abuse (emotional and physical), and infidelity or financial troubles (Milan et al., 2011). One study of Canadian couples married for at least 20 years indicated long-term gender inequality or role imbalance in the marriage as well as poor communication were reasons for their marital dissatisfaction and subsequent divorce (Canham, Mahmood, Stott, Sixsmith, & O’Rourke, 2012).

Divorcing in later life can come with a host of challenges. For example, an individual might no longer be as financially secure, especially older women (Vespa, 2012). Divorce also affects an individual’s social life in that social networks often become smaller. For example, Connidis (2010) found that divorced older men have the smallest social networks, the weakest ties to their families, and the lowest life satisfaction of any divorced age group.

Re-partnering in the Context of Widowhood ­and Divorce

Much like several other areas in aging research, we don’t know that much about union formation and re-partnering in mid and late life (Sassler, 2010). The little we do know about re-partnering at these life stages comes from studies of people who are widowed. We know even less about the re-partnering experiences of individuals who are divorced or separated cohabitors (Brown, Bulanda, & Lee, 2012). Let’s begin by examining what the research says about widowhood.


Older women are more likely to be widowed than older men. Consider that in 2015, there were over one million widowed females and fewer than 300 000 widowed males in Canada (Statistics Canada, 2012f). That is quite a gender difference and what this means is that the likelihood of re-partnering after widowhood is much greater for men (Connidis, 2010).

For many individuals, losing a spouse is an extremely difficult experience. Bereaved individuals have more somatic problems (e.g., pain or fatigue) and lower life satisfaction compared to their married counterparts (Sasson&Umberson, 2014). Spousal loss has other consequences. Often bereavement is accompanied by a significant change in an individual’s friendships and social relations in terms of reduced social networks and contacts (Perrig-Chiello, Spahni, ­Höpflinger, & Carr, 2016). Bereaved men generally show more emotional vulnerability than women. In fact, widowers typically experience higher rates of both loneliness and suicide than widows (Lee &DeMaris, 2007; Stroebe, Schut, &Stroebe, 2007). Carr (2004) suggests that, overall, this is a reflection of men’s higher levels of practical and emotional dependence on their spouses, combined with relatively few close emotional ties outside the marriage. Death of a spouse also has been associated with depression, but the literature regarding gender differences is mixed. This could be due to the methodology and the different study populations used in previous studies. In an attempt to determine if there are indeed gender differences in depression following bereavement, Sasson and Umberson (2014) analyzed 14 years of longitudinal data from the Health and Retirement Study which began in the United States in 1994. These researchers found no gender difference in depressive symptoms among the widowed in the study. For both men and women, widowhood was associated with an increase in depressive symptoms that diminished over time. However, they found that premature widowhood is associated with poor psychological well-being that does not seem to improve over time. In other words, the consequences of losing a spouse at a younger age are considerable and prolonged for those who remain widowed, whereas those widowed at later ages are more likely to recover, at least in terms of depression.

As you read this you are likely thinking that the research you have just read is really quite negative with regard to widowhood. However, there is research that shows that, in general, older adults cope well with widowhood. Adjusting to life after the death of a spouse is a process that takes time as widowers and widows adjust to their lives without their partners. Even in the oldest-old (85 years and older), Isherwood, King, &Luszcz (2017) found that with the mobilization of social supports, many of the older adults in their study were able to continue to lead socially engaged and meaningful lives.

The phenomenon of re-partnering after widowhood in late life has become more common and accepted in developed and modern individualistic cultures in comparison to more traditional collectivist cultures or developing countries. In collectivist cultures and developing countries, there is a more defined role to widowhood and women often endure significant hardships (Loomba Foundation, 2015). Within cultures located between tradition and modernity, such as Israel, late-life re-partnering is becoming more accepted as a legitimate choice in old age but is not officially recognized (Koren&Eisikovits, 2011).

According to Vespa (2013), the choice to re-partner depends on the perception that the benefits of re-partnering outweigh the benefits of being single. Studies that have been done previously have found that some older individuals choose not to remarry because they prefer the benefits of being single. Some of these perceived benefits are personal and financial independence, preservation of existing social relationships, and avoidance of the burden and personal costs that can accompany caregiving (De Jong Gierveld, 2002; Karlsson&Borell, 2005). In fact, Karlsson and Borell (2005) observed that for older women, widowhood often represents so-called retirement from a caregiver role and becoming a widow reduces their domestic responsibilities. Women often gain a sense of independence and renewed ties with their social network after their bereavement period following the death of their spouse (Vespa, 2013). Because men have a tendency to depend on their wives for social support, the desire to re-partner is higher for widowers than for widows (Brown, Lee, &Bulanda, 2006). However, when widowers have adequate social support, such as friends in the community, their desire to re-partner is not that much different from widows (Schimmele& Wu, 2016).

As you are learning, cohabitating is becoming increasingly popular, especially among older adults. Cohabitation provides the benefits of living with another, but it is a more flexible arrangement than marriage with regard to the pooling of financial resources and division of labour (Brown et al., 2012). Could this be the reason why cohabitation is increasing faster than any other type of living arrangement in the older age groups?

Wu, Schimmele, &Ouellet (2015) wanted to investigate the prevalence of cohabitation after widowhood and compare it to the prevalence of marriage after widowhood. These researchers used data from the Canada’s 2007 General Social Survey, which is a nationally representative sample of Canadians aged 45 and older. They found that the majority of re-partnering after widowhood in Canada occurs within 10 years of this event or not at all. However, the rate of remarriage overall was twice as high as the rate of cohabitation for both widows and widowers. The exception to this was in the province of Quebec where there was a far higher percentage of older adults choosing to cohabitate after widowhood rather than remarry. This makes sense as cohabitation is a more prevalent choice than marriage at any age in that province. Okay, let’s think about something for a minute. We know from the 2006 to 2011 data from Statistics Canada that the rate of cohabitation rose the fastest in the older age groups. So why is this not reflected in the results of Wu and colleagues? It is likely because the research of Wu and colleagues is based on data from 2007 and does not capture the rising trend of cohabitation in the more recent Statistics Canada survey. It will be interesting to see what the next round of Statistics Canada data shows.

Re-Partnering After Union Dissolution

The baby boom generation experienced higher rates of divorce and remarriage than any generation before it (Brown & Lin, 2012). As the baby boomers continue to age, we will likely see more changes regarding marital status than are currently being reported. Before we begin, we need to clarify something. “Union dissolution” is the term now used in the literature to describe marital breakups. The term is more encompassing than the term “divorce,” and it includes marital breakups and those breakups that occur when cohabitating.

Using data from the Canada’s 2007 General Social Survey, Schimmele and Wu (2016) found that among people aged 45 and older, the mean age of union dissolution was 59 years for women and 56 years for men. For more than two-thirds of the study population, this event represented the breakup of a first union whether it be a marital union or a cohabitating union. These researchers also found cohort differences in the type of re-partnering after union dissolution. Among those aged 45 to 64, there was a preference for cohabitation over marriage. However, they found a preference for marriage over cohabitation among older adults aged 65 and over. This could reflect more negative attitudes towards cohabitation held by individuals who grew up in the cohort before the baby boomers. Or, it could be again that these data do not capture the trend in increased cohabitation seen in the 2006 to 2011 Statistics Canada data.

Like their widowed female counterparts, the re-partnering after union dissolution was much lower for women than for men. Schimmele and Wu (2016) ask an interesting question. How much of this gender gap in re-partnering is attributable to a smaller pool of available men to re-partner with versus gender differences in the perceived costs and benefits of re-partnering at older ages? Hopefully, future research will explore this question.

Living Apart Together

As you have learned, many older women are reluctant to get tangled up with a new partner, perhaps because of the domestic and caregiving workload it tends to involve. But living alone does not necessarily mean being single. A number of older people are opting for Living Apart Together (LAT) relationships. LAT unions are intimate relationships between unmarried partners who live in separate households but identify themselves as part of a couple (Duncan & Phillips, 2010) (see Figure 10.3). Establishing an LAT relationship allows individuals to maintain their own living space, their personal freedom, and pre-existing relationships with family and friends.

This was confirmed in a study by Kobayashi, Funk, & Khan (2016). They examined the various reasons for choosing a LAT relationship among 28 older couples (mean age=59 years) living in Victoria, British Columbia. Participants disclosed that they chose to enter into an LAT relationship because it gave them the opportunity to remain independent, and it protected them from the financial and legal risks associated with living together. An interesting option for sure. However, in 2011 in Canada, this union was rare with 4 percent of those aged 50 to 59 and 2 percent of those aged 60 and older in such a relationship. Young adults, many of whom live with their parents, were much more likely to be part of an LAT couple. For example, among 20- to 24-year-olds, nearly one in three individuals were in an LAT relationship (Turcotte, 2013).

Being Single throughout Life

Historically, never-married singles in various cultures have been stigmatized (Band-Winterstein&Manchik-Rimon, 2014). Perceived as a burden to their families due to mental and/or social problems, singles were viewed as cold and less caring than married people or those in intimate relationships (Hertel&Schütz, 2006). Greitemeyer (2008) found that both female and male single individuals were rated as more neurotic, less satisfied with their lives, less sociable, ­lonelier, and having lower self-esteem than those individuals in partnerships. ­However, ­Greitemeyer and other researchers (e.g., Sarkisian&Gerstel, 2016; Simpson, 2016) have not found this to be a true characterization of individuals who are single. Although societal views on singlehood are changing, there is still considerable stigma attached to being single, especially in older ages and especially for women. Consider terms such as “spinster” or “old maid.” While these terms may be outdated, their stereotypical meaning persists. Interestingly, we can’t think of a comparable term for men.

In Canada, the proportion of Canadians aged 65 and over who are single and never married is around 5 percent (Turcotte&Schellenberg, 2007). Again, we do not know very much about the lives and social relationships of single older adults, especially men. But, like their younger counterparts, they often are viewed as lonely and socially disconnected (DePaulo& Morris, 2006).

It appears that how individuals perceive their singlehood (e.g., as a choice or circumstance or as temporary or permanent) can influence their satisfaction with being single, and can influence their overall well-being. For example, singlehood for some individuals is a conscious choice, but for others, becoming single occurs following a chain of life events that are not the result of a conscious choice (Band-Winterstein&Manchik-Rimon, 2014). For example, Timonen and Doyle (2014) interviewed men and women aged 64 to 85 who lived in Ireland. These researchers found that the women and men who had chosen singlehood associated this status with self-fulfillment, independence, and autonomy throughout their life course. In other words, they were happy with their choice to be single. McDill, Hall, and Turell (2006) interviewed single females over 40 years of age living in the United States. They also found that the participants in their study who chose to be single or fully accepted their singlehood were self-satisfied, socially productive, and well-­adjusted to their single status. In contrast, older adults who perceived that they had no choice in their singlehood because of caregiving, poverty, family roles, or cultural norms expressed regret and dissatisfaction with their single status.



Learning Objectives

To understand:

  • the developmental pattern of friendships
  • gay and lesbian relationships among older adults
  • the responsibility of the sandwich generation
  • intergenerational ties
  • the joys and challenges of grandparenting
  • elder abuse and its risk factors

Developmental Pattern of Friendships

Research has shown us how friendships change over the lifespan. For example, as young adults, individuals typically have more friends than at any other time during their life (Blieszner& Roberto, 2012). Generally speaking, married individuals have fewer friends than their single counterparts, and as individuals age, their circle of friends becomes smaller still. However, regardless of the size of your friendship circle, friendship is important to both men and women over the life course (Marion, Laursen, Zettergren, & Bergman, 2013). In fact, there is a lot of evidence to suggest that having friends is associated with better physical and mental health (Cable, Bartley, Chandola, & Sacker, 2013; Fiori, Antonucci, & Cortina, 2006). Interestingly, friends seem to be more important than family as a protective factor against poor mental health among older adults. Fiori and her colleagues (2006) found that older adults aged 65 years and older who had no friends but had family had significantly higher depressive symptomatology than did those who had a family network but no friends. These findings suggest that the absence of family in the context of friends is less detrimental than the absence of friends in the context of familial support.


Reflective Question


Steeping some tea…


It was originally thought older adults had fewer friends simply because of the fact that friends die. However, recent research paints an entirely different picture. It appears that having fewer friendships in older age may be due more to the fact that older adults are more selective in their friendships. Conscious of the time they have left to live, older adults seek out meaningful relationships and they have less time for drama. This phenomenon is part of a theory called socio-emotional selectivity developed by Carstensen and her colleagues (Carstensen, 2006; Charles &Carstensen, 2010; Reed &Carstensen, 2012). These researchers argue that social contact is motivated by a variety of goals including information seeking, self-concept, and emotional regulation. When information seeking is the goal, which tends to be the goal of young adults, individuals are trying to figure out who they are and their place in the world. Meeting new people and having friends is part of that process. When emotional regulation is the goal, as it is with older adults, they become highly selective in their choice of friends and prefer to hang out with individuals who have similar values and interests. Both of these goals are balanced in mid-life.

Until recently, not only were older adults thought to have fewer relationships, but also these relationships were thought to be less satisfying (Luong, Charles, &Fingerman, 2011). However, recent research has found that older adults generally experience more satisfying and positive relationships than younger adults. Why might this be? Luong and colleagues suggest that because of the awareness of the limited time left to live, older adults become more motivated to have social experiences that are more meaningful.

There is research that suggests that women have more friends and form more intimate relationships than men do (Adams & Ueno, 2006). However, Gillespie, Lever, Frederick, and Royce (2015) found different results in their survey using anonymous data collected via a survey posted on The 25 185 respondents were stratified by age and gender. On average, young and middle-aged men and women both reported having approximately the same number of friends they could talk to or call when in trouble. As expected, older adults identified having fewer friends. So, what might account for the finding that men and women had a similar number of friends? Well, the researchers think it might be how they asked the questions about friendship. For example, they stayed away from what they called “female-­typical’’ definitions of friendship that assess only personal disclosure and other intimate talk but neglect to include instrumental support as a critical aspect of friendship. These researchers included instrumental support as part of their definition of friendship. Their data challenge previous studies that conclude that women have more friendships than men. Another area where more research is needed.

LGBTQ Older Adults

Historically, non-heterosexual orientation was understood as a mental illness. In fact, the American Psychiatric Association (APA) listed homosexuality as a sociopathic personality disturbance in 1952, and it was not removed from the Diagnostic and Statistical Manual of Mental Disorders until 1973. In Canada, it was not until 2004 that the Supreme Court of Canada declared that an individual could not be discriminated against because of his or her sexual orientation (Egale Canada, 2004). Even though there have been changes in law and social policy that acknowledge the rights and welfare of many LGBTQ individuals, the job of tearing down multiple forms of social and institutional discrimination has been largely left up to individuals and groups of LGBTQ activists (Brotman, Ferrer, Sussman, Ryan, & Richard, 2015). It is notable that for the first time in Canadian history, the Right Honourable Prime Minister Justin Trudeau recently marched in Gay Pride parades in Vancouver and Toronto. In short, legal rights and social policy for the LGBTQ community have come a long way, but there is still more work to do, especially in terms of de-stigmatization. Consider that homosexuality currently is illegal in 75 countries and punishable by death in five (Carroll &Itaborahy, 2015).

Approximately 4 percent of adults aged 65 and over were part of a same-sex couple in 2006 (Milan et al., 2011). However, this number could be much higher because older adults are less likely to disclose their sexual orientation. Approximately 50 percent of same-sex couples in Canada live in Montreal, Toronto, and Vancouver, which makes sense as these three cities are in the provinces that legalized same-sex marriage a couple of years prior to the national legalization of same-sex marriage in 2005 (Milan et al., 2011). It should be noted that although research on LGBTQ and aging has grown in the last decade, the majority of this work addresses only gay men and lesbian women.

In a review of the literature on same-sex couple characteristics, Peplau and Fingerhut (2007) concluded that there are some differences between same-sex couples and heterosexual couples. For example, there is a greater sharing of household chores and child care among same-sex couples. Although this is changing, domestic chores and childcare responsibility often are left up to the female in heterosexual relationships.

We think it’s important to remember that many older LGBTQ individuals lived through a time where disclosure of their sexual orientation could result in imprisonment or enforced medical interventions (Barrett, Whyte, Comfort, Lyons, &Crameri, 2015). For example, Alan Turing was a gay man who had a key role in cracking intercepted coded messages from the Germans during World War II. He did his best to hide his sexuality but, eventually, the authorities found out that he was gay and they imprisoned him. Unfortunately, he died in prison. The Imitation Gameis a movie about his experiences. For more information on Alan Turing, please go to Alan Turing  — a short biography.

While they have lived through social and political transitions of LGBTQ rights and liberations, older LGBTQ individuals today still are less likely than their post-liberation peers to have had their sexual orientation acknowledged or celebrated. They also are less likely to have developed a positive self-esteem and self-image (Brotman et al., 2015; Cronin & King, 2014). In fact, older adult participants in one study reported that sharing their sexual orientation with family frequently resulted in negative responses from family members, which, in turn, eroded the participant’s self-esteem, confidence, and trust in other people. In addition, disclosure to an individual’s family most often resulted in very limited contact with them from that point forward (Barrett et al., 2015). Because LGBTQ older adults are less likely to have children and less likely to have contact with family than their younger counterparts, they are more likely to rely on partners and friends for support (Croghan, Moone, & Olsen, 2014; Guasp, 2011; McParland&Camic, 2016).

Older LGBTQ individuals often are in poorer health and have higher rates of depression and loneliness than their heterosexual counterparts (Fredriksen-Goldsen et al., 2011). However, they are less likely to seek out help because of fear of discrimination. In fact, all LGBTQ individuals, regardless of age, have reported a range of negative reactions from service providers including rejection, outright hostility, refusal of treatment, and breach of confidentiality (Brotman et al., 2015). Based on these findings, it is not surprising to find that older LGBTQ individuals are not likely to disclose their sexual orientation to healthcare providers or other people for that matter (Jenkins Morales, King, Hiler, Coopwood, & Wayland, 2014). When you think about it, older individuals who are LGTBQ are rarely visible in healthcare institutions, mainstream networks for older adults, and society in general (Brotman et al., 2015).

Many older individuals who are LGBTQ want to remain in their home and community as they age (“aging in place”) like many of their heterosexual counterparts. Aging in place often requires the assistance of home-care providers. However, Brotman and colleagues (2015) found that homophobia was problematic among providers of home care. This is important to consider. Many older adults have had to hide their sexuality from others. Often their own home is the only safe place to express their sexuality. Requiring home-care assistance may result in the loss of the only space where in LGBTQ individuals can be themselves (Brotman et al., 2015).

Most of what we know about the experiences of LGBTQ individuals in long-term-care (LTC) facilities comes from studies done in the United States. However, the few studies done in Canada have found similar results. For example, Brotman and her colleagues (2015) concluded that many older adults who are LGBTQ worry about becoming a resident in LTC facilities for fear of discrimination and violence. Although policies are changing on several fronts with regard to the welfare and rights of all LGBTQ individuals, it seems that action with regard to carrying out these policies is a little further behind. In a recent study in Canada, 31 LTC and retirement facilities in Ontario, Quebec, and British Columbia that were considered to be sensitive to LGBTQ issues were surveyed. Sussman and colleagues (2012) found that only 20 of these facilities had engaged in some types of staff training, only seven had made efforts to connect with the LGBTQ community, and only four had adapted materials that were more inclusive of their LGBTQ residents. Clearly, we are a long way away from implementing many practice recommendations found in the literature regarding the LGBTQ community, and much more work needs to be done. As researchers have pointed out, attitudes of LTC staff and the larger community will need to change before any real implementation of the many recommended policy changes occurs (Brotman et al., 2015; Grigorovich, 2013).

The Sandwich Generation (Consider the Panini)

Much of the focus in the caregiving and aging literature has been on adult children who provide care to their aging parents or parents-in-law. However, more and more people are finding themselves looking after their aging parents as well as children of their own. The term sandwich generation was first coined by Miller (1981) to describe these typically middle-aged caregivers who are sandwiched between the demands of caring for their own children and their aging parents. Traditionally, the term referred to middle-aged caregivers who were looking after aging parents and children younger than 18 who were still living at home. But, these days, it also could refer to young adult children who no longer live at home but who rely on their parents financially or to boomerang children who left home but have returned to live with their parents. In 2012, 28 percent of Canadians were considered sandwiched with similar trends being found in the United States (Boyczuk& Fletcher, 2016).

Sandwich caregiving is associated with increased rates of depression and decreased well-being. In addition, it has been found that the stress of being sandwiched can cause job burnout and failure to meet obligations at work (Lero, Spinks, Fast, Hilbrecht, & Tremblay, 2012; Pines, Neal, Hammer, &Icekson, 2011). In fact, addressing the needs of employees providing care for older parents is an emerging concern within the Canadian workplace. Lero and colleagues (2012) found that common consequences of employees providing care for parents included arriving late, leaving early, and unscheduled absenteeism. Of concern is that 58 percent of the organizations he investigated in his study considered providing support for employees with eldercare responsibilities a low priority. This is troublesome as we will likely see more individuals sandwiched in terms of caregiving roles over the next several decades. As Boyczuk and Fletcher (2016) point out, having a better understanding of the root causes of stress for individuals who find themselves sandwiched between care of children and parents can lead to the development of better support services.

Finally, there is the Panini sandwich. It is not always the case that children look after their parents. Abramson (2016) would like us to think about the older adults who often are simultaneously pressed between caring for themselves as they age and caring for others. Consider those who are in a lifelong role of caring for a child who is developmentally delayed or who has struggles with mental illness. Abramson calls this the “Panini sandwich.” Abramson (2016) argues that it is of utmost importance that we begin to provide supports and interventions to help older adults who are in these roles cope with the numerous strains and stressors and worries that result from being sandwiched between a lifetime of caregiving and their own aging experiences.

Intergenerational Ties

Over the past 30 years, relationships among adults and their parents have become stronger (Fingerman, Sechrist, &Birditt, 2013). Research has demonstrated that behavioural indicators of the parent–child relationship such as frequency of contact, co-residence, or exchanges of support have increased especially among young adults and their parents (Fingerman, Cheng, Tighe, &Birditt, &Zarit, 2012). This is demonstrated in the United States Family Exchange Study (FES), which has examined the relationships among baby boomers aged 42 to 60 and their spouses, parents, and multiple grown children since 2008. Most boomers reported frequent contact and exchanges of support with both parents and grown children. Findings indicate that middle-aged baby boomers offered their children emotional support and a listening ear more than once a week, advice at least once a month, and practical and financial assistance anywhere from monthly to several times a year on average (Fingerman, Miller, Birditt, &Zarit, 2009) (see Figure 10.4).


Reflective Question


Steeping some tea…


Baby boomers are much more involved with their own children than their parents were with them. Data from the National Survey of Families and Households collected in 1988 showed that less than half (46 percent) of parents offered advice to an adult child in the past month and only 31 percent provided practical assistance (Eggebeen, 1992). By contrast, in 2008, 89 percent of parents gave advice to at least one child every month, and almost 70 percent gave practical support (Fingerman, Kim, Tennant, Birditt, &Zarit, 2016).

So, will baby boomers get the care in their older years that many have lavished on their children? This is a very interesting question. Supporting aging parents may be more difficult for the children of baby boomers: Poor economic times have the potential to limit job or career opportunities, which may mean that they are working in jobs that are not stable in the long run or working several jobs. They simply may not have the resources or time to look after aging parents. Another factor that may prove to be significant in determining parental support is that there have been tremendous changes in the structure of families in recent decades. Since the baby boom cohort, there has been a noteworthy increase in divorce and remarriage and an increase in cohabitation. As a consequence, more complex family structures have displaced the traditional nuclear family. Consider stepfamilies for a minute. It is not really clear what role stepchildren should play in providing assistance to their step-parents (Pezzin, Pollak, &Schone, 2013). In fact, recent research has shown that older adults who have only stepchildren for support had worse health outcomes than older adults with biological children. Using data from the U.S. Health and Retirement Study, Pezzin and her colleagues (2013) found that older adult mothers with only stepchildren become physically unwell and institutionalized sooner than their counterparts with biological children. Furthermore, disability and institutionalization outcomes for mothers with only stepchildren were significantly worse than those of childless women. Pezzin and her colleagues also found that older men with only stepchildren have shorter longevity relative to their counterparts with only biological children. They also found that the effect of membership in a blended family (i.e., a family of biological and stepchildren) differs by gender. Relative to those with only biological children, mothers in blended families have greater longevity and become disabled later. The researchers suggest that this may be because mothers in blended families strive for equality, thereby investing equally in all children in the household; this results in enhanced relationships among children, which translates into more support in their older years. In contrast, the results of the health outcomes for men in blended families were very similar to those older men with stepchildren in that they had greater rates of institutionalization and reduced longevity. These results raise concerns about the support networks available to older parents in step families and blended families. This will have implications for public programs that may have to fill in the gap of care resulting from changing family patterns (Pezzin et al., 2013).


Reflective Question


Steeping some tea…


One final comment on intergenerational relationships. As of late, there has been growing concern about intergenerational conflict. This term refers to the potential conflict between older and younger generations as they compete for jobs and resources. One of the key factors driving attention to the possibility of future intergenerational conflict is the aging of the baby boom cohort. The issue of the potential for intergenerational conflict surfaced in Canada during the mid-1990s with the fear that funding for the Canada Pension Plan might run out as the cohort of older adults is living into their 80s and 90s (Foot &Venne, 2005). Population aging further affects intergenerational relationships as it raises fundamental questions about how resources are shared between generations. In the research, at least three major issues are regularly discussed within the context of intergenerational equity: (1) the distribution of resources between children and older adults, including healthcare; (2) the apprehension over large national deficits caused by expansive programs such as Social Security and Medicare in the United States and healthcare and government-sponsored pension plans in Canada; and (3) the fairness of financing Old Age Security programs by younger generations. If the younger generation starts perceiving that the older generation is holding them back in term of accessing resources such as work and public programs, their reactions are likely to be strong (North & Fiske, 2012). However, there is a debate in the literature as to whether or not intergenerational conflict will actually occur.


According to Statistics Canada, in 2011, there were about seven million grandparents aged 45 and over in private households, representing 57 percent of the population in this age group. However, if you look at Canadians aged 75 and over, 94 percent were grandparents in 2011 (Milan, Laflamme, & Wong, 2015). On average, grandparents have four grandchildren but this will likely decline in the future if fertility rates remain low. In 2011, approximately 4 percent of grandparents lived with their grandchildren with either one or both parents of the grandchildren.

In 2011, the number of Indigenous and immigrant grandparents who lived with their children and grandchildren was much higher for cultural and economic reasons (Milan et al., 2015). Those immigrants who arrived after the age of 60 were even more likely to live with grandchildren as most of them immigrated to Canada for the purpose of family reunification and were a key source of child care. Approximately 12 percent of grandparents lived in a skip-generation household, in which the parents of the grandchildren were absent (Milan et al., 2015). In skip-generation households, grandparents look after their grandchildren because the grandchildren’s own parents are unable to provide care. Raising grandchildren is not easy and, not surprisingly, it can create a lot of stress as grandparents learn to juggle their needs with those of their grandchildren. It also can create financial stress. However, this type of care situation can create close emotional bonds between grandchildren and their custodial grandparents. Fortunately, the majority of custodial grandparents are able to cope. In addition, most of these grandparents think that raising their grandchildren themselves is better than other alternatives (Hayslip et al., 2013; Thompson, Cameron, & Fuller-Thomson, 2012).

Research has shown that grandparents positively influence their grandchildren’s lives in a variety of ways such as contributing to their development in terms of their values, their emotional and spiritual well-being, and their cultural identity (Manssoon, 2014). Grandparents also are seen as dispensers of wisdom, family historians, and someone to play games with and have fun with. In turn, grandchildren contribute positively to their grandparents’ well-being and overall life satisfaction (Di Gessa, Glaser, & Tinker, 2014; Manssoon, 2014; Powdthavee, 2011).

The role of grandparents is less defined when the parents of their grandchildren are divorced. Often grandchildren are closest to maternal grandparents and are likely to see more of them than their paternal grandparents after a divorce (Monserud, 2011). Further, former daughters-in-law and sons-in-law can interfere with children seeing grandparents by keeping their former spouse from seeing the children. As you can see, divorce is much more complex than two people splitting up. Did you know that grandparents do not have an automatic right to see their grandchildren? Following a parental divorce, grandparents can go to court and apply for access to see a grandchild. But, access is not automatically granted and this process can be very stressful for both the grandparents and the grandchildren they would like to see.

There are several not-for-profit organizations across Canada of which the purpose is to support grandparents who are denied access to their grandchildren (e.g., Volunteer Grandparent, Canadian Grandparents Rights Association). Another organization in Canada is called Grandparents Requesting Access and Dignity (GRAND). All of these organizations provide support to grandparents who are denied access to their grandchildren, usually because of family court sole-custody decisions or other conflicts that show no fault or unfitness of the grandparents. GRAND has made several lobbying attempts to modify the federal Divorce Act. The goal is to have the Divorce Act modified so that parents cannot interfere with the grandparents’ visitation of their grandchildren without a serious reason (Novak, Campbell, &Northcott, 2014).

Elder Abuse

Elder abuse is not a new problem and, in fact, the term “granny bashing” first appeared over 30 years ago in the British Medical Journal (Baker, 1975). The World Health Organization (2016b) defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” However, many key organizations across the world have created their own definition of abuse and neglect of older adults. Let’s pause for a moment to think about this last statement. Do you see any difficulties with this? Although the WHO definition is arguably the most widely used, the problem is that despite more than three decades of research and discussion on the issues, there are ongoing challenges concerning the conceptualization and definition of elder abuse. This in turn makes elder abuse hard to detect and even harder to measure.


Reflective Question


Steeping some tea…


According to the National Seniors Council of Canada (2007), elder abuse can take numerous forms: financial, physical, emotional or psychological, sexual abuse, and neglect. Depending on how elder abuse is conceptualized, other forms of elder abuse may include systemic and spiritual abuse. The five most common types of elder abuse talked about in the literature are presented in Table 10.1. Of these, financial abuse appears to be the most common (Government of Canada, 2016c).

In Canada, it is estimated that between 4 percent and 10 percent of older adults are abused in some manner (National Seniors Council of Canada, 2007). However, these numbers are thought to be substantially higher because of healthcare professionals’ limited knowledge of elder abuse, a lack of protocols to identify abuse, reluctance on behalf of the victims to acknowledge the abuse, and the small number of services available to support older adults in these situations (Hirst et al., 2016). To make matters worse, until recently, there were no clinical guidelines for preventing and addressing abuse and neglect in older adults. In a review of recent literature on elder abuse, Hirst and her Canadian colleagues (2016) also found that there is no solid evidence to support the idea that the practice of screening for elder abuse actually reduces its occurrence.

So, why does elder abuse happen? The short answer is that we don’t know for sure. Ageism and a general negative attitude towards older adults, substance abuse on the part of the abuser, mental health problems, caregiver burden, and a cycle of family violence have all been identified as factors contributing to elder abuse in the community (Government of Canada, 2016). According to Edwards (2012), dependency is a characteristic of both the victims and perpetrators of elder abuse. For example, having a cognitive impairment such as a dementia increases dependency on a caregiver which may increase the risk of abuse. In turn, abusers may be dependent on the victim (e.g., financial reliance on the victim) especially if the abuser has a substance abuse problem. Older adults who have greater functional impairment are at more risk of elder abuse, especially for emotional and physical abuse as it is more difficult to defend oneself (Burnes et al., 2015).

Does elder abuse occur cross-culturally? Yes, but Tam and Neysmith (2006) caution researchers in the field of elder abuse “about applying elder abuse categories derived from a Western cultural perspective to understand or account for abuse in other cultures” (Tam &Neysmith, 2006, p. 149). There is very little published literature on the perception of elder abuse among Canadian cultural groups (Ploeg, Lohfeld, & Walsh, 2013). According to Lai, Daoust, and Li (2014), Canadian researchers studying older immigrants and diverse ethno-cultural populations have emphasized that emotional and verbal abuse, particularly being disrespected, is perceived as especially serious in the context of traditional family values and expectations. For example, Chinese women who immigrated to Canada and lived with their adult children saw losing traditionally expected positions of respect within the family as abusive. Ploeg and her colleagues (2013) conducted focus groups with various older minority populations in Canada to determine their understanding of elder abuse. Aboriginal men and women disclosed that the type of abuse they mostly experienced was financial abuse by their adult children in the form of taking their pension or disability cheque or abusing their power of attorney responsibilities. The Aboriginal participants also provided examples of neglect, such as withholding food. Female refugees from Afghanistan and Iran talked mostly about the continuation of culturally sanctioned physical, emotional, and sexual abuse at the hands of their husbands. Interestingly, all groups saw institutionalization (i.e., placing a parent in long-term care (LTC)) as a form of abuse as the participants viewed this as neglect and abandonment by family members. As you can see, individuals from different cultures understand elder abuse differently, and this highlights the fact that we need much more research if we are to fully understand elder abuse cross-culturally (McDonald, 2011).

Using a focus group format, Haukioja (2016) interviewed front line workers from the Inter-Cultural Association of Greater Victoria (ICA), which is a not-for-profit, multicultural services organization for immigrants and refugees, to get their perspective on elder abuse. Although the sample size of four was small, the participants provided insights into elder abuse in the Chinese and East Asian community in Victoria, British Columbia. The participants reported that older immigrant adults will stay with their family members despite experiences of elder abuse. How can this be so? Well, the participants explained that there are several reasons why. For example, many of the older immigrants they work with are very dependent on their family members because of language barriers, financial vulnerability, lack of affordable housing, lack of transportation, and sponsorship policies. In terms of sponsorship policies, older immigrants do not qualify for rent or income subsidies because the family sponsored them to come to Canada. The ICA front line workers reported that many family sponsors use this dependency as a way to exercise control. For example, the ICA workers reported that a number of adult children force older adults to stay home to babysit, clean, and cook, and often use threats such as “If you don’t do what I tell you then I send you back home” (Haukioja, 2016, p. 58). The ICA front line workers made an interesting point in terms of resources needed to address the issue of elder abuse. Because of significant language barriers, the participants explained that a visual resource containing concise information would be the most appropriate way to address elder abuse in minority communities. If information is presented visually, the older immigrant would be able to see the images of abuse and relate to them. It was emphasized that resources such as this need to be made available and accessible in several locations, including physician’s offices, pharmacies, recreation facilities, places of worship, and the main ferry terminal. Another point made by the participants was that awareness of the issue of elder abuse should be targeted towards the whole family, not just the victim. In this way, the “parents can understand [what elder abuse is] and children can understand that it is a crime” (Haukioja, 2016, p. 61).

Before we move on, you should know that there is a growing concern about the abuse occurring in LTC facilities; both staff-to-resident and resident-to-resident. What is particularly disturbing is that, over the course of a one-year investigation, W5 (which is an investigative journalism show) uncovered at least 23 521 cases of abuse in LTC facilities in 2013. That number is likely higher due to under-reporting of incidents. For more information on abuse in LTC settings, please read Box 10.1.

McDonald and her colleagues (2015) undertook a scoping review to enhance the understanding of resident-to-resident abuse in LTC homes in Canada. These researchers found that the majority of residents in LTC are over age 80 and tend to be frailer and more dependent on others to provide care than they were a decade ago. As a result, they may be more vulnerable to abuse from staff and other residents. In addition, residents are more likely to exhibit complex behavioural disturbances due to an increase in chronic disability and cognitive impairment that may result in expressions of aggression, which, in turn, can act as a trigger for abusive behaviour from staff.


BOX 10.1


In March 2012, W5 aired a broadcast on abuse in long-term-care facilities in Ontario. Following the broadcast, they received many emails and phone calls from across Canada telling them of similar cases. Looking for national statistics, they discovered none were kept so they decided to compile their own. In the course of their investigation, W5 obtained the data by filing access-to-information requests with 42 provincial, territorial, and regional health authorities seeking statistical information and incident reports of staff-to-resident abuse for the 2013 calendar year. The documents obtained under the Access to Information (ATI) requests showed 23 521 occurrences of all types of abuse in one year. In 26 of the 38 jurisdictions, the data provided specific information about the type of incident—6494 resident-on-resident altercations. They also uncovered at least 1500 cases of staff-to-resident abuse and neglect in nursing homes across Canada in that time period. And given the culture of under-reporting that is prevalent in the long-term-care sector, the real number is likely higher. One of the immediate outcomes of working with W5 and analyzing the data collected through ATI requests is that Lynn McDonald, a professor at the University of Toronto’s Institute for Life Course and Aging, and her team will continue the research “on our own accord, to dig further into the data and collect more in order to better understand the scope of elder abuse in Canada.” For access to the videos Crisis in Care, Parts 1 to 3, go to Nursing home residents at risk.


Reflective Question


Steeping some tea…


McDonald and her colleagues (2015) also identified a number of circumstances that can initiate resident-to-resident abuse. For example, invasion of personal space especially such issues as crowding, TV volume/channel, room temperature, and lighting were noted to have fuelled aggression between residents. In addition, hostile actions such as physical violence, sexual aggression, and theft have been shown to trigger abusive reactions from the resident being targeted. Furthermore, they found that self-reported victimization was associated with a reduction in life satisfaction and a greater risk for depression, anxiety, loneliness, low self-esteem, and overall negative mood. Finally, victims of resident-to-resident abuse were found to be four times more likely to experience neglect from nursing home staff, which may be why the victimization occurred in the first place.

Of note is that LTC facilities in the United States have been criticized because of the lack of guidelines for reporting and documenting abuse (Teresi et al., 2013), and it seems that the same could be said about Canada (McDonald et al., 2015). Currently, police are very rarely involved in abuse cases in LTC, especially in resident-to-resident sexual abuse cases (Ramsey-Klawsnik, Teaster, Mendiondo, Marcum, &Abner, 2008). It seems to be the case that situations involving sexual abuse are difficult to substantiate due to cognitive impairment present in both the victims and the initiators. McDonald and her colleagues highlight that resident-to-resident abuse is a serious societal issue that is under-researched and requires further investigation in order to minimize its occurrence and to develop strategies to appropriately manage its consequences. It often is too easy to forget that LTC facilities are now home for a portion of the older adult population. It should be a given that older adults living in these facilities have an environment that preserves their well-being, safety, and dignity (McDonald et al., 2015). One day it may be you.



Learning Objectives

To understand:

  • sexual patterns in old age
  • the ins and outs of online dating for older adults
  • the challenges of sexual expression in long-term-care settings
  • HIV-AIDS in older adults

Sexual Patterns in Old Age

One of the pervasive stereotypes of older age is that an individual becomes asexual; that is, they no longer are interested in engaging in sexual activities. Despite much research evidence to the contrary, this stereotype persists. Several large nationally representative research studies conducted in the United States have demonstrated that many older individuals have an interest in sex throughout life (Lindau et al., 2007; Waite, Laumann, Das, &Schumm, 2009), especially if an individual is in good health and has a partner. This is wonderful news if you consider that there is much agreement about the beneficial effects of sexuality for older people, which include pleasure, intimacy, decreased pain sensitivity, increased relaxation, and lower levels of depression (Ni Lochlainn& Kenny, 2013; Syme, 2014). As you may have guessed, women tend to stop having sexual relations earlier than men because of a lack of a partner due to widowhood and a smaller available pool of men. The frequency that individuals have sex declines with age. However, those older adults who remain sexually active report having partnered sex fairly often and these rates remain constant through the ages of 65 to 75 (Waite et al., 2009). Have a look at Table 10.2. You might find it hard to believe, but 54 percent of older adults have sex two to three times a month or more. Notice also the difference in sexual activities by age (e.g., oral sex). Waite and her colleagues explain that this variation in sexual practice could be the result of cohort differences in patterns of sexual behaviour established at younger ages and carried over into old age. For example, the youngest respondents to the National Social Life, Health and Aging Study are part of the baby boom cohort who experienced the sexual revolution. The oldest respondents were teenagers during the 1940s, a period of more conservative sexual attitudes and behaviors. On the other hand, these age differences also could be from changes in sexual repertoires due to changes in health and functioning. It would make sense that specific types of sexual activity desired or engaged in may change or need to be adapted in order to accommodate for the physical realities of older bodies (Fileborn, Thorpe, Hawkes, Minichiello, & Pitts, 2015).

Waite and her colleagues (2009) concluded that for partnered women and men, sexual inactivity occurs because of declining physical vigour rather than declining interest in sexual activity. Lindau and her colleagues (2007) also concluded from the data from a nationally representative sample of 3005 older Americans that physical health is more strongly associated with sexual functioning than is age. Lindau suggested that older adults who have medical problems and who are seeking treatment that might affect sexual functioning should be counselled according to health status rather than age. However, these researchers also found that older adults rarely talk about their sexual functioning with their physicians. Some of the reasons given by participants were the negative attitudes of physicians towards sexual expression among older adults and gender and age differences.

Many older adults report feeling more experienced, more relaxed, and more satisfied in their sexual relations in old age than when they were younger (Carpenter &DeLamater, 2012; Novak et al., 2014). Sexual expression among older adults often includes more touching, hugging, and holding hands than younger adults (Hurd Clarke, 2006).

In terms of sexual problems in late life, Lindau and her colleagues (2007) and Waite and her colleagues (2009) reported that the most frequently reported sexual dysfunctions for women were low desire, difficulty with vaginal lubrication, and an inability to have an orgasm. The most frequently reported sexual dysfunctions for men were erectile difficulties. It is good news for many that there are numerous medications available on the market to treat sexual difficulties. It is rare that one can get through an evening of watching television without seeing a commercial for Viagra. Anyway, a quote by Thomas (1982) sums up sexuality in older ages quite nicely and with humour. He compared sexuality in older ages to popcorn: “It is not harmful nor is it essential but it is one of the pleasures of life.” By the looks of the literature, it is a pleasure for many throughout their lives.

Sexual Expression in Long-Term-Care Settings

Living in LTC facilities poses many significant barriers to sexual activity among the older adults who live there. Lack of privacy and staff attitudes have been identified as major barriers to sexual activity in LTC facilities (Parker, 2006). For older adults in long-term-care settings, intimacy is further complicated by the pervasive stigma about sexuality and commonly held ageist attitudes. Nonetheless, many older adults who live in LTC have expressed a desire for sexual intimacy (Hillman, 2012). However, several studies have shown that staff in LTC tend to view any attempts at sexual intimacy as problematic rather than expressions of love (Cornelison& Doll, 2013; Mahieu, Van Elssen, &Gastmans, 2011). Further, many individuals in LTC have a dementia and sometimes individuals who have a dementia behave in a sexually inappropriate way. This behaviour may include but is not limited to touching intimate body parts of care providers and visitors, masturbating in social areas, disrobing oneself and others, and using sexually suggestive language. Care providers often do not receive adequate training about appropriate sexual expression—never mind the inappropriate sexual expression that may occur by residents—and are therefore not prepared to respond appropriately (Bentrott&Margrett, 2011; Dominguez &Barbagallo, 2016). This lack of training can lead to inconsistent and even punitive responses. In the absence of formal policies and guidelines, care providers often respond to sexual expression in informal and inconsistent ways. To complicate matters, there are no uniform standards that exist to assess sexual consent capacity in older adults in LTC. It is very important to identify those older adults who are able to provide sexual consent and support these individuals who can make their own sexual decisions, while protecting those who may not be able to (Connolly et al., 2012; Hillman, 2012). The legal ramifications of sexual relations between individuals who are cognitively impaired and are not able to consent are significant.

After reviews of the literature on sexual expression in LTC facilities, researchers have concluded that, in general, staff often are not well equipped to cope with sexual relationships between residents in LTC. Further, they found that educational programs often are non-existent or are inadequate (Cornelison& Doll, 2013; Elias & Ryan, 2011). In the words of a Canadian researcher, “We must ensure that we live up to the moral imperative of creating long-term-care environments that are genuinely welcoming and prepare to meet the needs of the of the older adults who present with a range of gender and sexuality identities” (Sokolowski, 2012, p. 4). For sure, there is a lot of work to be done.

Dating: It Is Not Just for Young People

It is increasingly common for single older adults to be involved in dating relationships (­Alterovitz& Mendelsohn, 2009). And why not? In fact, an analysis of widows and widowers ages 65 and older found that 18 months after the death of a spouse, 37 percent of men and 15 percent of women were interested in dating (Carr, 2004).

Older adults are becoming more comfortable with social media. Consider that in the United States, between April 2009 and May 2010, social media use by older adults nearly doubled from 22 percent to 42 percent (Madden, 2010). Currently over half of adults c(Smith & Duggan, 2013). In response to this growing market, many dating sites have begun catering specifically to an older adult market. Google “older adults and dating” and you will see what we mean!


Reflective Question


Steeping some tea…


According to Fileborn and colleagues (2015), the ways in which older adults enter into or seek out new relationships tend to follow highly gendered patterns. For instance, older men tend to seek younger partners and place an emphasis on attractiveness. In comparison, older women often seek older partners, and value intelligence and socio-economic status over physical qualities. In another study, Alterovitz and Mendelsohn (2009) analyzed 600 personal ads from Yahoo! They found that women remained the choosers (in other words, they decided if a date was to occur) at all ages. It is not clear why this should be the case given the increasing ratio of women to men in later life. Alterovitz and Mendelsohn suggest that the reason for this is that older men are not as selective as women when choosing a person to go on a date with because they are more willing to re-partner than are older women. Given that the baby boomers are getting more comfortable using social media, online dating will surely increase in the older adult population. This is good news given that loneliness and social isolation can be issues for many older adults.

Sexually Transmitted Infections in Older Adults

In Canada and around the world, sexually transmitted infections are rising among older adults (Minichiello, Rahman, Hawkes, & Pitts, 2012). According to the Public Health Agency of Canada (2013b), rates of chlamydia, gonorrhea, and syphilis in Canada have been steadily rising since the late 1990s. While young Canadians have the highest reported rates of sexually transmitted infections, increasing numbers of cases are being reported among middle-aged and older adults. In terms of gender differences, among 40- to 59-year-old Canadians, males accounted for approximately 60 percent of reported chlamydia cases, 88 percent of reported gonorrhea cases, and 93 percent of reported infectious syphilis cases (Fang, Oliver, Jayaraman, & Wong, 2010). If we look at the prevalence rates of HIV-AIDS, this also is increasing in older adults. But, before we begin looking at the number of older adults who are living with HIV/AIDS, let’s look at the number of individuals worldwide who have HIV/AIDS. We thought you might be interested in knowing that there are two different types of HIV epidemics. In “concentrated” epidemics, transmission occurs largely in defined vulnerable groups such as sex workers, men who have sex with men, and people who use injection drugs. In “generalized” epidemics, transmission is continued through sexual behaviour in the general population and persists despite effective programs for vulnerable groups. North America has a concentrated epidemic of HIV/AIDs whereas sub-Saharan Africa has a generalized epidemic (Canada’s Source for HIV and Hepatitis C Information, n.d.).

According to the United Nations (2016), an estimated 36 million people were living with HIV globally in 2015 and an estimated two million new HIV infections occurred worldwide. This means that approximately 5700 people became infected with HIV every day in 2015. Almost 70 percent of new cases are in sub-Saharan Africa (United Nations, 2016). Approximately 75 500 individuals in Canada were living with HIV in 2014 (Government of Canada, 2015b). This represents a 6 percent increase since 2011. As you can see from Figure 10.5, the largest proportion of HIV cases was diagnosed among individuals aged 30 to 39 years of age followed by the 40 to 49 age group. The proportion of HIV cases among those aged 50 and over increased from 15 percent in 2009 to almost 22 percent in 2014. Certain populations in Canada have higher rates of new infections of HIV. For example, Aboriginal peoples have incidence rates of new HIV infections that are 2.7 times higher than people from other ethnicities. Men who have sex with men are in the highest risk group for new HIV infection. Males also have incidence rates much higher than females in Canada (Canada’s Source for HIV and Hepatitis C Information, n.d.). Figure 10.6 shows the all-age diagnosis rate of HIV cases (per 100 000 population) by province/territory in 2014.

The U.S. Centers for Disease Control and Prevention estimates that by 2020, older adults will account for 70 percent of all HIV/AIDS cases in the United States (Centers for Disease Control and Prevention, 2017). There are two reasons for this increase in HIV/AIDs in older adults in Canada and the United States: individuals who were diagnosed at a younger age and who are growing old with the disease and individuals who are diagnosed as older adults (Sankar, Nevedal, Neufeld, Berry, &Luborsky, 2011). In spite of the trend of increasing numbers of older adults contracting HIV, they are rarely targeted for HIV/AIDS prevention programs (Altschuler& Katz, 2015). Sexual contact is the main risk factor for new HIV/AIDS cases among older adults.

Researchers are quite certain that we do not have a good understanding of the prevalence of HIV-AIDS in older adults due to under-reporting (Brennan, Emlet, Brennenstuhl, Rueda, & OHTN Cohort Study team and staff, 2013). Because of the widespread belief that older adults are asexual, physicians and other healthcare providers commonly do not address issues of sexuality with older adults. Further, older adults have been overlooked in HIV testing, prevention, and research because of this misconception (Levy, Ding, Lakra, Kosteas, &Niccolai, 2007). To make matters worse, many older adults do not think they are at risk for HIV infection. For these older adults, HIV is an infection that occurs in younger people (Brennan et al., 2013). Because older adults do not see the risk, they are unlikely to use condoms when having sexual relations (Emanuel, 2014; Schick et al., 2010; Zona et al., 2012). This lack of awareness of the risk of contracting HIV/AIDS among older adults themselves, as well as healthcare professionals, can result in a late diagnosis of HIV/AIDS. The consequences of a late diagnosis are increased morbidity and mortality and reduced responses to HIV treatment (including antiretroviral therapy) for older adults (Mugavero, Castellano, Edelman, & Hicks, 2007). Additionally, a late diagnosis may result in an undiagnosed person’s continued engagement in unprotected sex, unaware of the infection.

Psaros and her colleagues (2015) interviewed women over 50 to get an understanding of their perspectives of living with HIV. The women described a clear progression of feelings such as shame and disbelief at the time of diagnosis to acceptance and survivorship at the time of the study. The authors believe this resiliency is related to the fact that older adults recognize that their time left on earth already is short and as a result are able to moderate their responses when faced with negative events. These researchers suggest that this is another area where older adults could share their wisdom with younger adults who are dealing with an HIV diagnosis.



  • Relationships are becoming increasingly diverse and complex with married couples with children still the predominant family structure in Canada. Marriage satisfaction follows a U-shaped pattern over the age range. Older long-term married individuals have higher ratings on numerous measures of wellness than those who are not married.
  • Cohabitating is becoming increasingly popular, especially among older adults. Living together apart is another option for older adults who do not want to cohabitate or get remarried.
  • Over the last 20 years in Canada, divorce rates have been fairly stable. Rates for widowhood have increased over time with many more widowed women than widowed men in the older population.
  • Bereavement is very difficult for many although, in general, older adults cope well with time. More widowers re-partner than do widows.
  • The view of singlehood is changing and those older adults who choose to remain single are happy with their choice.
  • According to the socio-emotional selectivity theory, there is a developmental pattern to friendships. Interestingly, friendships seem to be more important to health and well-being than family in old age.
  • Older individuals who are LGBTQ are often in poorer health and have higher rates of depression and loneliness than their same-aged heterosexual counterparts. Much work needs to be done to support and accept the aging LGBTQ community in Canada.
  • The sandwich generation consists of those middle-aged caregivers who are sandwiched between the demands of caring for their own children and their aging parents. The term “panini sandwich” refers to older adults who care for themselves as well as others such as a dependent child.
  • Baby boomers are much more involved with their own children than their parents were with them. However, the children of baby boomers may not be so involved with their parents (or grandparents).
  • There has been growing concern about intergenerational conflict with the aging of the population. However, there is a debate in the literature as to whether this conflict will occur.
  • Most grandparents live in separate households although some grandparents live with their grandchildren. This is especially true of Aboriginal and immigrant families for cultural and economic reasons.
  • Skip-generation households are those households where grandparents are raising grandchildren in the absence of the middle generation.
  • The role of grandparents is less defined when their children are divorced. Children most often are closest to maternal grandparents and are likely to see more of them than their paternal grandparents after a divorce.
  • Elder abuse is a significant social issue and one that is significantly under-­reported. There is growing concern about staff-to-resident and resident-to-resident abuse in LTC facilities. Dementia can exacerbate abuse among residents and between staff and residents.
  • Although there is a persistent stereotype that older adults are asexual, this is not the case. Having a reasonably active sex life is associated with good health and well-being.
  • More and more older adults are using online dating sites to find friendships and relationships.
  • An increasing number of older adults are contracting STIs and HIV. Sexual contact is the main risk factor for acquiring HIV among older Canadians.

Key Terms

Boomerang Kids
Cohabitation Effect
Complex Families
Gender Inequality
Grey Divorce
Instrumental Support
Intergenerational Conflict
Intergenerational Trauma
Living Apart Together Relationships
Panini Sandwich
Sandwich Generation
Simple Families
Skip-Generation Households
Socio-emotional Selectivity


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