Abstract

Sexuality is a silent theme concerning the elderly population who is socially perceived as asexual. This qualitative approach paper is part of research on dependent older adults, which aimed to analyze their sexual experiences. The topic was retrieved from interviews with 26 of them, who talked about sex in their lives. The Thematic content analysis identified two main categories in the statements: gender differences in the treatment of sexuality and difficulty in talking about sex. Differences were observed in the perception and valuation of sexuality by gender. Older men give importance to sexual potency, and older women consider the cessation of sexual life in old age to be natural. Older men enunciate a sexuality concept based on biological satisfaction and sexual act, while women value partnership, affection, and fondness. Researchers were silent on the topic, although it was included in the research manual to guide the interview with older adults. However, while only 26 mentioned the subject, sexuality of older adults is modulated by gender perception. It is a poorly studied and challenging theme to approach in research and healthcare settings.

Key word:
Dependent older adults; Sexuality; Gender; Qualitative research

Introduction

Sexual decline is something inevitable and marks a reflection on aging as a prejudice, under the assumption that individuals should adjust to this imperative to enjoy the moral benefits of post-sexual maturity. In the 19^th century, it was believed that a prudent lifestyle would delay this decline, but accepting it was part of the moral exercise of adjusting to the effects of the vital process¹1 Karsch UM. Idosos dependentes: famílias e cuidadores. Cad Saude Publica 2003; 19(3):861-866..

However, in the current scenario, maintaining sexual activity in old age is already a consensus²2 Debert G, Brigeiro M. Fronteiras de gênero e a sexualidade na velhice. Rev Bras. Ci Soc 2012; 27(80):37-54.^,33 Cezar AK, Aires M, Paz AA. Prevention of sexually transmitted diseases in the point of view of elderly clients of a Family Health Strategy. Rev Bras Enferm 2012; 65(5):745-750.. However, it remains in common sense, including researchers and health professionals, prejudice, and silences on this taboo subject, increasing the vulnerability of older adults to psychological and physical problems, such as sexually transmitted diseases and erectile dysfunction⁴4 Frugoli A, Magalhães Júnior CAO. Sexuality in third age in the perception of a female elderly group and indications for the enviromental education. Arq Ciênc Saúde UNIPAR 2011; 15(1):85-95..

Significant body changes occur in the aging process, including loss of desire or sexual potency²2 Debert G, Brigeiro M. Fronteiras de gênero e a sexualidade na velhice. Rev Bras. Ci Soc 2012; 27(80):37-54.. However, how sexuality is perceived and the meaning that aging takes on are specific to each social background and historical moment⁵5 Silva VXL, Marques APO, Fonseca JLCL. Considerações sobre a sexualidade dos idosos nos textos gerontológicos. Rev Bras Geriatr Gerontol 2009; 12(2):295-303.^,66 Almeida T, Lourenço ML. Envelhecimento, amor e sexualidade: utopia ou realidade? Rev Bras de Geriatr Gerontol 2007; 10(1):101-113..

Sexuality can be broadly defined as the social construction of body use and, in particular, but not exclusively, genital organs to obtain physical and mental pleasure. It also includes sorting these activities, which determines a set of rules and norms that indicate, socially, the people with whom such activities may or may not and should or should not be practiced⁷7 Lhomond B. Sexualidade. In: Hirata H, Laborie F, Le Doaré H, Senotier D, organizadores. Dicionário Crítico do feminismo. São Paulo: Ed. Unesp; 2009. p. 231-235..

The WHO⁸8 World Health Organization (WHO). Sexual Health, Human Rights and the Law. Geneva: WHO; 2015. affirms that sexuality is a central component of the human being. It manifests itself throughout life and encompasses sex, gender identities, and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. It is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships.

The complex social phenomenon, sexuality is an integral part of personality, and its development is completed as a basic human need such as the desire for contact, intimacy, emotional expression, pleasure, love, and affection⁹9 Moraes KM, Vasconcelos DP, Silva ASR, Silva RCC, Santiago LMM, Freitas CASL. The beauty of companionship and sexuality for couples in the best age: caring for elderly couple. Rev Bras Geriatr Gerontol 2011; 68(4):662-667..

The societal concepts of gender operate as norms and standards that people must follow, including sexual activity. In patriarchal societies, the intergender relationships, marked by male domination¹⁰10 Scott J. Gênero: uma categoria útil de análise histórica. Educação e Realidade 1995; 20(2):71-99., determine what is considered normal and interpreted as natural. Cultural patterns in the form of stereotypes indicate that men need to ensure the right to violence and the domination of women to show their virility, and affirm their sexual potency through the exercise of an erectile and penetrating sexuality¹¹11 Molinier P, Welzer-Lang D. Feminilidade, masculinidade, virilidade. In: Hirata H, Laborie F, Le Doaré H, Senotier D, organizadores. Dicionário Crítico do feminismo. São Paulo: Ed. Unesp; 2009. p. 101-104.. In this model, older men believe that they should or need to continue exercising sexuality as a practice of the sexual act and those who are unable to do so due to some limitations feel diminished and are affected by frustration and sadness, which may accelerate the aging process and harm physical and mental health¹²12 Uchoa YS, Costa DCA, Silva Jr IAP, Silva STSE, Freitas WMTM, Soares SCS. A sexualidade sob o olhar da pessoa idosa. Rev Bras Geriatr Gerontol 2016; 19 (6):939-949..

On the other hand, women are socialized to satisfy male desire, seconding their own, and can thus minimize the importance of sex and sexual pleasure. Attributes such as patience, empathy and compassion are considered natural and thus are socially responsible for reproductive and care work, activities that operate to uphold intergender hierarchy¹¹11 Molinier P, Welzer-Lang D. Feminilidade, masculinidade, virilidade. In: Hirata H, Laborie F, Le Doaré H, Senotier D, organizadores. Dicionário Crítico do feminismo. São Paulo: Ed. Unesp; 2009. p. 101-104..

The cult of the young body idealized by contemporary society perpetuates the conviction that sexuality is linked to youth and beauty¹³13 Goldenberg M. Mulheres e envelhecimento na cultura brasileira. Caderno Espaço Feminino 2012; 25(2):46-56., which results in prejudice against sexuality in old age¹⁴14 Linhares FMP, Pottes AF, Araújo EC, Menezes EP, Siqueira KA. Percepção de idosos sobre o exercício da sexualidade atendidos no Núcleo de Atenção ao idoso em Recife, Brasil. Rev Enferm Herediana 2008; 1(2):93-103., de-eroticizing the body and treating it as incapable of producing desire¹⁵15 Coelho DNP, Daher DV, Santana RF, Espírito Santo FH. Percepção de mulheres idosas sobre sexualidade: implicações de gênero e no cuidado de enfermagem. Revista Rene 2010; 11(4):163-173.. In this sense, women face a more considerable disadvantage in the symbolic field, as the social construction of their identities is strongly associated with body image⁵5 Silva VXL, Marques APO, Fonseca JLCL. Considerações sobre a sexualidade dos idosos nos textos gerontológicos. Rev Bras Geriatr Gerontol 2009; 12(2):295-303..

In the current society, a prejudice that considers older adults asexual remains, which, together with the difficulties of talking about sex, produces discomfort and embarrassment in social relationships and silence on this topic among patients and health professionals¹⁶16 Gewirtz-Meydan A, Hafford-Letchfield T, Benyamini Y, Phelan A, Jackson J, Ayalon L. Ageism and sexuality. In: Ayalon L, Tesch-Römer C, editors. Contemporary perspectives on ageism. International Perspectives on Aging. Cham: Springer International Publishing AG; 2018. p.149-162.. In health care, the sexuality of older adults has been neglected, and the possibility of an older adult being infected with HIV, until recently, was considered remote. However, national data indicates that the HIV rate in older adults already exceeds that of adolescents¹⁷17 Santos AFM, Assis M. Vulnerabilidade das idosas ao HIV/AIDS: despertar das políticas públicas e profissionais de saúde no contexto da atenção integral: revisão de literatura. Revista Brasileira de Geriatria e Gerontologia 2011; 14(1):147-157., and among the explanations for these high rates is the increased sexual practice in old age¹⁸18 Silva J, Saldanha AAW. Vulnerabilidade e convivência com o HIV/AIDS em pessoas acima de 50 anos. Revista Mal Estar e Subjetividade 2012; 12(3-4):817-852..

Despite its importance, older adults’ sexuality is a topic that needs research, and most studies focus on negative physiological aspects, such as sexual dysfunctions¹⁹19 Vieira KFL, Coutinho MPL, Saraiva ERA. A sexualidade na velhice: representações sociais de idosos frequentadores de um grupo de convivência. Psicologia: Ciência e Profissão 2015; 36(1):196-209.. International research on the subject is scarce, and even rarer in Brazil²⁰20 Moreira Júnior ED, Glasser D, Santos DB, Gingell C. Prevalence of sexual problems and related help-seeking behaviors among mature adults in Brazil: data from the global study of sexual attitudes and behaviors. Sao Paulo Med J 2005; 123(5):234-241., although the need to include this issue²¹21 Brasil. Ministério da Saúde (MS). Envelhecimento saúde da pessoa idosa. Saúde da Família. Brasília: MS; 2006. (Cadernos de Atenção Básica 19). has been emphasized in the research of which this study is part.

This paper aims to analyze the experiences of sexuality among dependent older adults as per their viewpoint in the research Situational Study of Dependent Older Adults living with their families to subsidize a Policy of Care and Support to Caregivers²²22 Minayo MCS, Figueiredo AEB, Mangas RMN, Silva RM, Vieira LJES, Souza GS, Meneghel SN, Gutierrez DMD, Figueiredo MLF, Mendonça JMB. Estudo Situa cional dos Idosos Dependentes. Rio de Janeiro: Claves-Fiocruz; 2019..

Method

This work aimed to identify the experiences reported by dependent older adults about their sexuality after the state of dependence or during life. The data were produced through semi-structured interviews, which included a conversation about their sexuality and other aspects of daily life. The question was thus introduced: “Tell me, what is or was sex like to you?”. This question was part of a qualitative study with older adults living in eight Brazilian municipalities, aiming to get to know their opinions, beliefs, and representations regarding their state of dependence²²22 Minayo MCS, Figueiredo AEB, Mangas RMN, Silva RM, Vieira LJES, Souza GS, Meneghel SN, Gutierrez DMD, Figueiredo MLF, Mendonça JMB. Estudo Situa cional dos Idosos Dependentes. Rio de Janeiro: Claves-Fiocruz; 2019..

Only 26 of the 64 older adults interviewed spoke about sexuality. Therefore, the study focuses on the expressions of this small group residing in the cities of Araranguá (3), Brasília (10), Manaus (3), and Porto Alegre (10).

The thematic analysis²³23 Minayo MCS. O Desafio do Conhecimento. Pesquisa Qualitativa em Saúde. 14ª. ed. Rio de Janeiro: Hucitec; 2012.^,2424 Bardin L. Análise de conteúdo. Lisboa: Edições 70; 1977. was used to understand what older adults said about sex in their lives, which considers the relevant structures expressed in the statements, information provided, arguments, and justifications on the subject.

The finding that the subject has not been addressed by most of the researchers who conducted the conversation with the older adults is an indicator of the difficulty they feel in talking about sexuality, which raised a question about the reasons for this difficulty and gave rise to a category of analysis explored in this paper, alongside “difficulty talking about sex with dependent older adults”.

Short reports were produced that contextualized the situation of the disease and dependence to better understand the life scenarios of these older adults and the possibilities of expressing sexuality. We observed that the speech content and the emphasis on enunciation varied by gender of the respondents, showing that the social construction of gender - masculinities and femininities - modulates the behaviors of older men and women concerning performance and expectations on sex life. Thus, we considered that gender is an essential category for analysis : “gender and sexuality in the lives of older adults and dependent older adults”.

This research was approved by the Research Committee of the Nursing School/UFRGS and the Research Ethics Committee of the Federal University of Rio Grande do Sul.

Gender and sexuality in the lives of older dependent men and women

In this paper, we worked with a sample of 12 and 14 dependent older men and women, respectively. Of these, 17 considered themselves white, eight brown or black, and one did not report on color. Seven of them had more than 11 years of study, and more than half were Catholic. Most of the older adults (16) lived with a partner, and reported maintaining social activities.

Interviews with the older males revealed that they express an appreciation of sex and sexuality related to biological aspects, therefore, the ability to perform the sexual act and the presence or not of penetration. For them, sex means sexual intercourse; sexual intercourse means vaginal penetration and vaginal penetration requires a penile erection.

The impasse experienced by some of them in situations with sexual desire and loss of sexual function causes feelings of anguish, disappointment, frustration, and fear of failure, while it generates sadness, suffering, and depression in others. This picture confirms the perception that erectile dysfunction highly affects the core of masculinity, making men feel that they have lost the vitality that makes them men²⁵25 Gewirtz-Meydan A, Hafford-Letchfield T, Ayalon L, Benyamini Y, Biermann V, Coffey A, Jackson J, Phelan A, Voß P, Zeman MG, Zeman Z. How do older people discuss their own sexuality? A systematic review of qualitative research studies. Cult Health Sex 2019; 21(3):293-308..

This statement was made by a relatively young man with a degenerative neurological disease. Before the illness, he was the family’s provider, centered his life on work and financial gains. At the onset of the interview, he said that what most affected him was not working. However, when asked about the exercise of sexuality, he stated that it was not about work, sex was the most important in his life, placing the loss of sexual potency as the worst consequence of the disease. The sexual dysfunction of this older man and the loss of work made him feel worthless and depressed: a disabled person. Some older adults feel diminished in the reductionist cultural conception of sexuality’s experience only through coitus, as the sexual act is affected by inexorable bodily changes from age, such as erectile dysfunction and hormonal changes²⁶26 Queiroz MAC, Lourenço RME, Coelho MMF, Miranda KCL, Barbosa RGB, Bezerra STF. Representações sociais da sexualidade entre idosos. Rev Bras Enferm 2015, 68(4):662-667..

The statements of these two older adults, living respectively in the south and north of the country, announce emphatically the end of sexual life, showing feelings of loss and irreversibility. The first one suffered a stroke and has little autonomy. The disease brought him erectile dysfunction and functional losses that interfered with his plans for the future. The second has a history of several morbidities. He reports that he and his partner no longer have sex and even sleep in separate beds. He associates distance in the relationship with the wife with the loss of sexual potency. He feels sad, isolated, and, as most of the older adults interviewed, physically impaired. Both consider sexuality a synonym for the sexual act and do not consider other forms of expression, whether verbal or through touching and other desiring and affective expressions. In a way, the statements corroborate that the presence of illness is related to the lack of or reduced sexual practice, mainly when the disease occurs in men and affects male potency²⁷27 Alencar DLM, Marques APO, Leal MCC, Vieira JCM. Fatores que interferem na sexualidade de idosos: uma revisão integrativa. Cien Saude Colet 2014; 19(8):3533-3542..

Regarding older adult asexuality’s stereotype, it can be said that society contributes older adults’ perceived worthlessness because they have always been imagined as those who are saying goodbye to life. It is deduced then that, as they retired from work, older adults also retired from life, including sexual life.

Some older adults accept their functional losses, as indicated by the statements that refer to “the normality” of not having more sex in the marital relationship. These two older adults have a history of chronic illnesses, and both do not share a bed with their wives. One of them remains most of the time sitting in an armchair in the living room, where he usually sleeps. Both reported that they had not had sexual intercourse for many years. Faced with the reductionist view of sexuality as the practice of the sexual act, in the case of sleeping in separate beds or another room, physical withdrawal seems to have been an arrangement for them to experience the mourning of the end of their sexual life.

This 82-year-old man seems to address the issue more openly and he remains sexually active despite age-related limitations. He reports a recent hospital stay, complications, and loss of autonomy, but with progressive gain in functionality. He attends seniors’ balls, has a good relationship with his wife, sleeps in the same bed, and has sex with her. It shows that he is aging healthily, even with dependence, keeping his sex life alive with a good mood.

This and other older adults, unlike most, show that sexuality continues in old age, lived, and enjoyed throughout life⁴4 Frugoli A, Magalhães Júnior CAO. Sexuality in third age in the perception of a female elderly group and indications for the enviromental education. Arq Ciênc Saúde UNIPAR 2011; 15(1):85-95.. Although the aging process traverses physical, biochemical, and functional changes that interfere with sexual activity, they maintain sexual interest at 70, 80, and even 90 years of age²⁸28 Gott M, Hinchliff S. How important is sex in later life? The views of older people. Soc Sci Med 2003; 56(8):1617-1628., which is shown through affection, touch, and companionship²⁹29 Bastos CC, Closs VE, Pereira AMVB, Batista C, Idalêncio FA, Carli GA, Gomes I, Schneider RH. Importância atribuída ao sexo por idosos do município de Porto Alegre e associação com a autopercepção de saúde e o sentimento de felicidade. Rev Bras Geriatr Gerontol 2012; 15(1):87-95..

The older women expressed a different view of sexuality, albeit in the same way as men, marked by culture and social conventions. These women were educated half a century ago, at a time when gender standards were stricter, dictating what would be appropriate or inappropriate for each sex. The conduct concerning sexuality was impregnated with norms, prejudice and moralism. Submission and subordination to the husband was more common³⁰30 Oliveira EL, Neves ALM, Silva IR. Sentidos de Sexualidade Entre Mulheres Idosas: Relações de Gênero, Ideologias, Mecanicistas e Subversão. Psicol Soc 2018; 30:e166019.. In the interviews, the different meanings attributed by the older women who spoke about sexuality are observed, highlighting life stories marked by the repression of desires and affections³¹31 Botacci LFG. A construção social do sexo: alguns aspectos a considerar sobre a terceira idade. Revista Trilhas da História 2011; 1(1):145-158..

The selected passages were enunciated by elderly widows, who, after losing their partner, did not allow themselves other experiences and affirmed that sexuality was never relevant in their lives and that they do not miss sex. Even those who assume they still feel sexual desire do not allow themselves other relationships. They consider that it would not be appropriate because they do not have a husband.

Gender socialization in conservative societies assumes that a woman without a man cannot or should not have sex, let alone enjoy it. In the case of the older adults, the bodily transformations, and the message of a culture that values ​​youth and makes the old invisible, sustains the impossibility of being seen as attractive and desirable³⁰30 Oliveira EL, Neves ALM, Silva IR. Sentidos de Sexualidade Entre Mulheres Idosas: Relações de Gênero, Ideologias, Mecanicistas e Subversão. Psicol Soc 2018; 30:e166019.. Sociocultural aspects reinforce gender standards, as women’s expectations are submission, dependence, and care for others, and this is observed in the statements in which they incorporate behaviors that include the sexual abdication and self-abdication³²32 Souza M, Marcon SS, Bueno SMV, Carreira L, Baldissera VDA. A vivência da sexualidade por idosas viúvas e suas percepções quanto à opinião dos familiares a respeito. Saude Soc 2015; 24(3):936-944..

The functional losses and changes that time imposes on bodies reap the masculine potency and, differently, but just as hard, they mean losses to the feminine potency. The 79-year-old female resident of Manaus, who has leprosy, mentions the losses due to age and the severe aesthetic changes produced by the pathology. Body image has meaning and is relevant in the practice of sex, especially for women. Thus, dissatisfaction with appearance leaves many insecure, leading them to deny or block the possibility of starting emotional relationships, in such a way that not accepting oneself means, as a result, refusing sex²⁷27 Alencar DLM, Marques APO, Leal MCC, Vieira JCM. Fatores que interferem na sexualidade de idosos: uma revisão integrativa. Cien Saude Colet 2014; 19(8):3533-3542.^,3333 Alencar DL, Marques APO, Leal MCC, Vieira JCM. O exercício da sexualidade em pessoas idosas e os fatores relacionados. Rev Bras Geriatr Gerontol 2016; 19(5):861-869..

Sexuality is a physiological function that minimizes emotional and subjective aspects, feelings and affections, companionship, and tenderness among couples²⁹29 Bastos CC, Closs VE, Pereira AMVB, Batista C, Idalêncio FA, Carli GA, Gomes I, Schneider RH. Importância atribuída ao sexo por idosos do município de Porto Alegre e associação com a autopercepção de saúde e o sentimento de felicidade. Rev Bras Geriatr Gerontol 2012; 15(1):87-95.. However, some of the women mentioned this broader dimension, focusing on experiences that do not only include physical aspects and bring up a view of sexual interaction as a complex process in which friendship, empathy, communication skills, and even spirituality are part¹⁹19 Vieira KFL, Coutinho MPL, Saraiva ERA. A sexualidade na velhice: representações sociais de idosos frequentadores de um grupo de convivência. Psicologia: Ciência e Profissão 2015; 36(1):196-209..

This 84-year-old woman is a wheelchair user and came from a conservative family. She married a man who was also a wheelchair user, and rediscovered her sexuality after becoming a widow. The statement shows open-mindedness concerning the ever-present possibilities of remaking and recreating love relationships, reiterating that sexuality permeates all phases of the human life cycle, from birth to death⁶6 Almeida T, Lourenço ML. Envelhecimento, amor e sexualidade: utopia ou realidade? Rev Bras de Geriatr Gerontol 2007; 10(1):101-113..

Finally, concerning gender, older men perceive sexuality linked to the biological and sexual act’s performance, showing intense suffering in the face of their physiological limitations because of illness. On the other hand, women affirm that they do not feel the need for sex, and are trained to control or hide their desires. However, some older adults enjoy pleasurable relationships even in old age, and older women perceive the exercise of sexuality beyond the biological sphere, including affection, tenderness, and companionship.

Healthy masculinities and femininities mean inhabiting and loving one’s own body, enjoying it in erotic relationships and accepting losses and limitations¹¹11 Molinier P, Welzer-Lang D. Feminilidade, masculinidade, virilidade. In: Hirata H, Laborie F, Le Doaré H, Senotier D, organizadores. Dicionário Crítico do feminismo. São Paulo: Ed. Unesp; 2009. p. 101-104.. In situations of aging and illness, the male obligation to show power and virility at any cost and female conformity to end sexual life without considering possibilities of overcoming losses can become painful and unbearable.

In this study, gender-modulated variability³⁴34 Jen S. Older women and sexuality: Narratives of gender, age, and living environment, J Women Aging 2016; 29(1):1-11. in the perceptions and experiences reported by the respondents when talking about sex in their lives is clear, evidencing how much the nuances of gender shape different behaviors and expectations concerning the exercise of sexuality in old age.

Difficulty talking about sex with dependent older adults

Questions about the sexuality of dependent older adults, which were part of the research roadmap, were not investigated and questioned in more than half of the interviews. The interviewers, all health professionals, or students in the field, showed two types of justification for not asking the question: “the older adult showed no interest in the subject” or “the interviewer felt uncomfortable asking”.

When affirming the discomfort of talking about sexuality, one can think of the researcher’s difficulty as a cultural projection of prejudice, which believes this subject is not suitable for older adults. Research³⁵35 Bauer M, Haesler E, Fetherstonhaugh D. Let's talk about sex: older people's views on the recognition of sexuality and sexual health in the health-care setting. Health Expect 2016; 19(6):1237-1250.suggests that both in the academy and health care, professionals have little knowledge about sexuality in aging and are unable to address the topic adequately. As a result, they display negative attitudes or avoid talking about it.

In the case of health professionals, there are at least two problems in approaching the theme. On the one hand, they feel inhibited from asking questions of a sexual nature, considering them to lack respect. On the other hand, it is common for the elderly to be ashamed and not have the courage to ask questions about the subject because they fear being misinterpreted. Because of ignorance, taboo, and cultural pressure, many experience guilt and shame for feeling sexual desire³⁶36 Vieira KLF. Sexualidade e qualidade de vida do Idoso: desafios contemporâneos e repercussões sociais [tese]. João Pessoa: Universidade Federal da Paraíba; 2012., and these may be the same reasons that affected researchers, most of whom work in the health field.

Several barriers hinder the discussion about sexuality with older adults, such as lack of confidence and experience, little knowledge, shame, and prejudice concerning the topic³⁷37 Heath H. Sexuality and sexual intimacy in later life. Nursing Older People 2019; 31(1):40-48.. Pascual³⁸38 Pascual CP. A sexualidade do idoso vista com novo olhar. São Paulo: Loyola; 2002. argues that our society has a negative concept of old age, especially in the sexual sphere. As a result, the subject is not talked about, older adults are considered asexual, and relatives set obstacles to prevent them from being sexually active.

Health professionals and field researchers are members of the societies in which they operate, so they may share with respondents and the population moralistic or conservative viewpoints and express opinions that reflect only common sense³⁹39 Meneghel SN, Andrade DNP. Conversas entre mulheres durante o exame citopatológico. Saude Soc 2019; 28(2):174-186..

In the research on dependent older adults, the high number of older adults for whom the question about sexuality was not asked reveals the interviewer’s embarrassment. Silence signals malaise in this delicate topic, particularly in the face of the older adults in a state of limitation and dependence.

Silence can also bring attention to the need to talk about a forbidden subject with the most significant possible number of actors: older adults, family, caregivers, health professionals, researchers, and managers, contributing to demystifying prejudice and pointing to the idea that sexual activity has no expiration date.

Final considerations

Active aging advocates the possibility of having sex until the end of life²2 Debert G, Brigeiro M. Fronteiras de gênero e a sexualidade na velhice. Rev Bras. Ci Soc 2012; 27(80):37-54.^,1919 Vieira KFL, Coutinho MPL, Saraiva ERA. A sexualidade na velhice: representações sociais de idosos frequentadores de um grupo de convivência. Psicologia: Ciência e Profissão 2015; 36(1):196-209.. In this sense, the inclusion of this question in a survey of dependent older adults was an opportunity to know how older men and women experience, at the limit, hardships in this area.

One of the limitations of this paper is the relatively small sample of participants who have talked about the subject. However, what has been heard shows how relevant the sexual issue is, either through the underlying taboos or the repression that implies suffering for some older adults, who continue to have desires and wants to relate. In this sense, the research contributed to the deconstruction of the idea that older adults are asexual⁴⁰40 Fileborn B, Lyons A, Hinchliff S, Brown G, Heywood W, Dow B, Malta S, Minichiello V. Improving the sexual lives of older Australians: Perspectives from a qualitative study. Australas J Ageing 2017; 36(4):E36-42., understanding that the exercise of sexuality is part of this stage of life⁴¹41 Gewirtz-Meydan A, Levkovich I, Mock M, Gur U, Karkabi K, Ayalan L. Sex for seniors: how physicians discuss older adult's sexuality. Isr J Health Policy Res 2020; 9(1):8.^,4242 Evangelista AR, Moreira ACA, Freitas CASL, Val DR, Diniz JL. Sexualidade de idosos: conhecimento/atitude de enfermeiros da Estratégia Saúde da Família. Rev Esc Enferm USP 2019; 53:e03482..

It is believed that talking openly about sex with older adults, including those who are dependent and, therefore, with performing limitations, contributes to breaking the prejudice and taboos surrounding this subject.

References

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