Select from the following set of readings for this module. Sleep patterns tend to change as we age, but problems with sleep are not an inevitable part of aging. Disturbed or unrefreshed sleep can be signs of an emotional or physical problem and need careful evaluation by a professional. A good night's sleep is essential for emotional and physical well-being. Sleeping and AgingThe normal sleep cycle consists of periods of rapid eye movement (REM) for dreaming sleep and non-REM for quiet sleep. The requirements for sleep for each individual averages seven to eight hours per day and remains fairly constant throughout life. Older people spend less time in the deepest stage of non-REM for quiet sleep. Therefore, aging reduces the amount of sleep one can expect at any one time. Sleep ProblemsFrequent sleep complaints by elders include difficulty falling asleep, frequent wakings, increased periods of wakefulness in bed, restless sleep and early morning awakening. Most of these complaints are usually related to the decreased sleep efficiency of aging. Understanding the nature of sleep patterns with aging and altering bedtime habits to accommodate them can help improve sleep quality and decrease the emotional distress surrounding sleep difficulties. Sleep SolutionsThe major point to remember is that no good comes of forcing oneself to sleep. Therefore, during times of restlessness it is best to take on some activity. Watching television, listening to the radio, reading, playing cards, knitting, writing letters to friends, and house cleaning are examples of various activities. Most people are not accustomed to activities during the middle of the night, a time of day culturally reserved for sleep. Accepting the possibility that two quality four-hour sleep periods separated by two hours of some activity might be more satisfying than struggling with restlessness in bed for eight hours. In some cases these sleep complaints or insomnia can be a result of a physical problem such as pain or the need for frequent urination. Underlying emotional problems such as worry or fear can also interfere with normal sleep. All too often insomnia is treated with sleeping pills, which in some cases can interfere with quality sleep even more. Dealing with the underlying problem rather than the symptoms of insomnia can alleviate sleep difficulties. SECTION 2: SEXUALITYSexuality is considered a basic human need and in our culture today is increasingly being viewed as a natural and pleasurable experience to be shared. Unfortunately, this viewpoint is usually focused on the young and beautiful. Education and the media seldom speak to the topic of sexuality in older adults. In fact, ignorance is demonstrated by the common label "dirty old man" given an 80-year-old acting like a 30-year-old who would be labeled a playboy. The misbelief that people desire less and are incapable of sexual expression as they age results in a fear of impending loss of sexual function. Therefore, it becomes paramount that sexuality and aging be explored and understood because of the inevitable passage through later adulthood for all of us. Sexual AttitudesThe concept that older people can be and are sexually active is not generally known by most people. That old people are not interested in or capable of having sex is a stereotypical myth that continues to be perpetuated. Social stigma attached to sex was common in previous generations; the information and attitudes were passed from generation to generation. Even with today's open and progressive culture, adult children are uncomfortable discussing sexuality with their parents. It is important to understand that sexuality encompasses more than just a sexual act. Sexuality involves feelings such as being erotic, amorous, romantic, and intimate. Sexual attitudes develop early in childhood, are influenced by our culture and upbringing, and give us our basis of what is right and wrong regarding sex. We pick them up from parents, peers, siblings, and today from mass media. Sexual behaviors such as flirting, affectionate hugs, kissing, and intercourse are expressions of our attitudes. If you were taught as a child that sex is naughty and not to be talked about, you most likely will be uncomfortable with sexual behaviors not in line with those attitudes. Sexual FunctionPhysical aging itself does not interfere with the ability to maintain a healthy sexual lifestyle. However, a variety of factors that accompany aging can threaten one's ability to remain sexually active. AvailabilityThe lack of an available partner naturally interferes with maintaining an active sexual lifestyle. It can result from the loss of a spouse through widowhood or divorce. This loss can also be experienced when the older person still has a partner but the partner is incapable of being sexually active. Psychological BarriersMisconceptions and attitudes, as mentioned previously, can interfere with sexual function. Older people may find it difficult to develop new sexual relationships after the loss of a partner because of the attitudes retained from the time they were socialized. Attempting to overcome old ways of believing and behaving may be so emotionally uncomfortable as to create guilt and anxiety. This discomfort may be enough for some older persons to repress their sexual needs. Physically it takes longer for older men and women to become sexually aroused. A lack of understanding about this slower response can lead to anxiety. In the male the fear of impotence can become reality because of the anxiety. Issues of love, caring, and boredom are also barriers to a fulfilling sexual relationship. In many situations, older individuals were not taught loving, caring behaviors by their parents and do not realize their importance in maintaining relationships. Body image and self-concept play an important role in our society that fosters youth and beauty. The fear of being considered unattractive and rejected because of aging features prevents some people from seeking satisfying sexual relationships. Physical BarriersPhysical barriers are diseases that can affect libido, genital function, or result in physical discomfort that impairs sexual function. Cardiovascular and respiratory diseases may cause shortness of breath and frequent coughing. These symptoms prevent sexual gratification because of physical exhaustion and the fear of having a heart attack during sex. Arthritis limits movements due to pain and deformity. Diabetes mellitus can inhibit orgasm and erection due to the effect of the disease on the nervous system. Decreased libido and paralyzed or weak extremities can result from a stroke. Alcoholism can result in decreased potency in men and delayed orgasm in women. In most cases, education through counseling about alternative forms of sexual expression coupled with disease intervention can dramatically improve sexual lifestyle. MedicationsMany medications frequently prescribed to older adults negatively affect sexual function. Impotence and decreased libido are side effects of drugs commonly prescribed to older adults. Examples include antihypertensives, sedatives, diuretics, and some cardiac medications Women and the Estrogen ControversyWomen lose the ability to bear children as they age, but the ability to maintain a sexually active lifestyle remains. One of the suggested physical age changes related to lowered levels of estrogen during menopause is decreased vaginal secretions. This change causes painful or difficult intercourse and is thought to be one reason why women may become less sexually active in later life. Recent research findings indicate that sexual activity stimulates vaginal secretions; women who remain sexually active throughout life experience no decrease in vaginal secretions. This example is only one of the controversies that exist about the relationship between menopause symptoms and estrogen. Another controversy that exits about menopause and estrogen is the debate about the necessity of hormone replacement therapy (HRT) for women after menopause. Proponents suggest that HRT relieves the distressful menopausal symptoms and reduces the risk of heart disease and osteoporosis that older women inherit from the lowered levels of estrogen. Opponents of estrogen or hormone replacement therapy attempt to demonstrate a relationship between high levels of estrogen in later life and increased incidence of breast and endometrial cancer. The risk of cervical cancer has been dramatically reduced by adding the hormone progesterone to the estrogen, hence the treatment being called hormone replacement therapy rather than estrogen replacement therapy. Opponents add to their debate against HRT that the risk of osteoporosis and heart disease can be better addressed through dietary and lifestyle changes, with the added benefit of avoiding the increased risk of developing breast cancer. The risk of breast cancer with estrogen administration remains controversial (Steinberg et al., 1991; Colditz et al., 1990). Disturbing side effects can also accompany estrogen administration. They include headaches, allergic bronchiospasm, water retention and weight gain, elevated blood pressure, painful swelling of the breast, and gastrointestinal upset (Dukes, 1992). To date, most physicians support HRT even amid the controversy. They propose the therapy as an optimistic solution because the benefits (heart disease and osteoporosis prevention) outweigh the risks (developing cancer) (Goldman & Tosteson, 1991). Not all women are candidates for HRT or want to take replacement hormones. This list includes reasons for not taking HRT:
Colditz, G.A., Stampfer, J.J., Willett, W.C. et al. (1990). Prospective Study of Estrogen Replacement Therapy and Risk of Breast Cancer in Postmenopausal Women. JAMA 264:2648-53. Dukes, M.N. (1992). Meyer's Side Effects of Drugs (12th ed.). New York: Elsevier Science. Goldman, L. & Tosteson, A. (1991). Uncertainty about Postmenopausal Estrogen. N Engl J Med 325:800-802. Steinberg, K.K., Thacker, S. B., Smith, S.J. et al. (1991). A Meta-analysis of Estrogen Replacement Therapy on the Risk of Breast Cancer. JAMA, 265:1985-90. Weil, A. Pollutants Linked to Breast Cancer. Natural Health Nov/Dec 1993. Hormone mimics fabled fountain of youth, Science News vol 147, June 24, 1995. Progestin fails to cut breast cancer risk. Science News, Vol 147, June 17, 1995, pg 375. Seniors gain gut protection. Science News vol 146, No 10 Sept 3, 1994. Treating old age with testosterone, Science News vol 148, July 1, 1995. Additional source of dietary Estrogens, Science News, Vol 147 June 3, 1995. Forever Smart:Does Estrogen enhance memory? Science News vol 147 Feb 4, 1995.
|