Sexuality in Older Adults: Addressing the Elephant in the Room

Q&A

We are pleased to present this Q&A with Sarah Mourra, MD, chair and presenter for the American Psychiatric Association Annual Meeting in a symposium titled “Goldmine or Minefield: Navigating the Spectrum of Sexual Feelings and Behavior in Older Adults.” Dr Mourra’s presentation will specifically cover erotic transference in older adults. The symposium will include several other topics, including sexuality in aging (Kirsten Wilkins, MD), ethics of sexual consent in senescence (Louis Trevisan MD), and management of inappropriate sexual behaviors in dementia (Rajesh Tampi, MD).

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Q: The title of your symposium seems fairly provocative. Why did you select this topic?

A: Sexual attraction and longings within the therapeutic relationship are frequently considered more taboo than other forms of transference, and are infrequently discussed in terms of perspective and management, despite sometimes being the elephant in the room. This issue is made more complex by issues of aging, loss, and medical comorbidity that arise in elderly populations. I hope my audience will view erotic transference in older patients as an opportunity to understand the inner lives of our patients in a more comprehensive way.

Q: What aspects of this topic do you plan to cover?

A: I plan to discuss the multitude of reasons that sexual transference may emerge in the clinical encounter, obstacles to recognizing it, and strategies for managing and conceptualizing it in terms of complex psychodynamics and issues like organic brain disease. It will also cover relevant issues of ageism and cultural factors that influence the approach of clinicians to sexual feelings and behavior in the elderly.

Q: How is this topic relevant to psychiatrists who consider themselves “medication management only” clinicians?

A: Erotic transference can occur even when the psychiatrist is not performing weekly psychotherapy. Dr. David Mintz of the Austin Riggs Institute frequently describes how even the administration of a medication can be loaded with psychodynamic meaning. Additionally, these issues may emerge around other members of a treatment team, including caregivers, and psychiatrists should be able to assist in understanding, processing, and managing these dynamics within a team context as well.

Q: Why should general adult psychiatrists stay informed about this topic within geriatric psychiatry?

A: We predict that the number of adults age 65 and older in the US will grow to more than 72 million by 2030, with 14% to 20% of the elderly population expected to carry mental health or substance use diagnoses, such as depressive disorders and dementia-related behavioral and psychiatric symptoms. As indicated in the Institute of Medicine report, “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands,” the rate of specialized providers entering the workforce is dwarfed by the pace at which this population is growing.

Increasingly, mental health care for older adults will fall to non-geriatric psychiatrists and other providers who may be unaccustomed to the special needs of this population. I believe that for this reason, recognition, management, and understanding of the broad range of sexual feelings in older adults is a key component to providing humane and competent care.

Disclosures:

Dr Mourra is Bureau of Health Professions Fellow in Geriatric Psychiatry at Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences. She also maintains a private practice in Los Angeles, California. She reports no conflicts of interest concerning the subject matter of this article.