Association between sexuality and quality of life in older adults

Cross-sectional study developed with a total of 300 older adults living in northeastern Brazil. Data collection was carried out entirely online between August and October 2020. Participants completed the online questionnaire containing three instruments for assessing bio sociodemographic data, sexuality and quality of life. Data analysis was performed using the Mann-Whitney, Kruskal-Wallis, Spearman correlation and multivariate linear regression tests, adopting a 95% confidence interval (p < 0.05).

Results:

Older adults experience better affective relationships and have better quality of life in sensory abilities and intimacy. In the regression analysis, only affective relationships (β = 0.510; [95% CI: 0.340–0.682]; p < 0.001) and physical and social adversities (β = −0.180; [95% CI:−1.443–0.434]; p < 0.001) remained associated with the general quality of life of older adults.

Conclusion:

Health professionals must invest in training, development of individual and group educational interventions, in addition to promoting the strengthening of bonds between older adults so that they feel free and comfort in expressing their intimate needs.

DESCRIPTORS
Public Health; Health of the Elderly; Health Promotion; Family Health Strategy.

Variables	n	%
Gender
Male	206	68.7
Female	94	31.3
Age
Between 60 and 64	128	42.7
Between 65 and 69	105	35.0
Between 70 and 74	49	16.3
Between 75 and 79	15	5.0
Between 80 and 84	3	1.0
Religion
Catholic	187	62.3
Protestant	37	12.3
Spiritualist	27	9.0
Religions of African origins	5	1.7
Others	13	4.3
No religion	31	10.3
Education
Primary	30	10.0
Elementary I	18	6.0
Elementary II	19	6.3
High school	95	31.7
Higher education	137	45.7
No education	1	0.3
Marital status
Married	210	70.0
Stable union	42	14.0
With a regular partner	48	16.0
Time spent with the partner
≤5 years	43	14.3
Between 6 and 10 years	22	7.3
Between 11 and 15 years	18	6.0
Between 16 and 20 years	16	5.3
>20 years	201	67.0
Sexual orientation
Heterosexual	264	88.0
Homosexual	5	1.7
Bisexual	4	1.3
Others	27	9.0

Variables	Median (IQ)
Sexuality
Sexual intercourse	74.00 (63.00–80.00)
Affective relationships	75.00 (67.00–81.00)
Physical and social adversity	7.00 (5.00–9.00)
QoL
Sensory skills	75.00 (68.75–93.75)
Autonomy	68.75 (56,25–75.00)
Past, present and future activities	68.75 (56.25–75.00)
Social participation	68.75 (56.25–75.00)
Death and dying	68.75 (56.25–75.00)
Intimacy	75.00 (68.75–81.25)
General QoL	68.75 (60.41–78.12)

	Sexuality					QoL
	SI	AR	PSA	SS	AUT	PPFA	SP	DD	INT	GQL
Health centers
Gender
Male	145.61	145.41	153.47	143.44	150.27	150.23	151.18	155.17	148.31	149.29
Female	161.22	161.66	143.99	165.97	151.01	151.09	149.02	140.26	155.29	153.15
p value	0.148	0.132	0.376	*0.035^ Statistical significance by Mann-Whitney test (p < 0.05).*	0.945	0.936	0.839	0.165	0.507	0.721
Age range
60–64 years old	155.21	152.28	142.63	145.31	157.46	153.37	149.16	148.08	152.39	150.98
65–69 years old	156.35	155.32	151.59	146.51	155.15	148.23	150.85	160.18	156.77	156.09
70–74 years old	145.83	141.08	163.42	170.48	134.68	153.01	160.31	138.62	146.42	146.88
75–79 years old	108.17	144.73	145.90	162.97	124.40	147.40	151.03	134.00	120.07	139.10
80–84 years old	32.83	88.50	260.50	122.67	79.67	82.00	32.67	191.50	69.00	50.50
p value	0.039 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.634	0.129	0.411	0.184	0.703	0.174	0.468	0.239	0.311
Marital status
Married	134.46^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	139.66^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	155.41^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	143.35^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	143.66^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	151.73	150.02	151.77	146.49	147.19
Stable union	176.10	174.50	160.61	185.60^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	179.26^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	149.42	155.07	155.67	164.21	165.67
Regular partner	198.27^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	176.91^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	120.16^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	151.09	155.24	146.06	148.58	140.41	156.05	151.71
p value	<0.001 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.004 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.027 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.015 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.046 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.915	0.918	0.654	0.408	0.449
Time living together
≤5 years	184.09^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	165.65	136.27	152.43	166.05	161.87	149.74	148.13	163.02	159.55
6–10 years	204.34	186.16	126.07	169.75	166.36	160.2	165.64	160.32	173.93	169.27
11–15 years	174.78	161.78	178.03	155.19	175.47	141.53	172.28	158.00	175.25	172.11
16–20 years	191.84	173.44	142.06	163.88	197.16	158.59	153.03	184.69	157.97	185.91
>20 years	131.96^‡ ‡Differences between groups by Bonferroni post-hoc. SI: sexual intercourse; AR: affective relationships; PSA: physical and social adversity; SS: sensory skills; AUT: autonomy; PPFA: past, present and future activities; SP: social participation; DD: death and dying; INT: intimacy; GQL: general quality of life.	140.52	154.43	146.50	139.49	147.16	146.85	146.54	142.45	141.76
p value	<0.001 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.058	0.252	0.736	0.020 ^† †Statistical significance by the Kruskal-Wallis test (p < 0.05).	0.796	0.693	0.497	0.189	0.119

Dimensions of ASESOA	Facets of QoL	Spearman’s ρ	p value
Sexual intercourse	Sensory skills	0.069^† †Weak correlation.	0.235
	Autonomy	0.392^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Past, present and future activities	0.395^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Social participation	0.396^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Death and dying	0.195^† †Weak correlation.	*0.01^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Intimacy	0.520^§	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	General quality of life	0.497^‡ ‡Moderate correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
Affective relationships	Sensory skills	0.074^† †Weak correlation.	0.200
	Autonomy	0.372^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Past, present and future activities	0.390^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Social participation	0.353^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Death and dying	0.227^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Intimacy	0.558^§	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	General quality of life	0.490^‡ ‡Moderate correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Sensory skills	–0.267^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
Physical and social adversity	Autonomy	–0.218^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Past, present and future activities	–0.248^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Social participation	–0.235^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Death and dying	–0.159^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	Intimacy	–0.265^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*
	General quality of life	–0.340^† †Weak correlation.	*<0.001^ Statistical significance by Spearman’s ρ (p < 0,05).*

	β	Standardized β	CI 95%	p	Durbin-Watson	R²
Sensory skills
Physical and social adversity	−1.689	−0.251	−2.482 – −0.896	<0.001	2.008	0.057
Autonomy
Affective relationships	0.501	0.335	0.218 – 0.784	0.001	1.824	0.221
Physical and social adversity	−0.849	−0.109	−1.685 – −0.014	0.046	1.824	0.221
Past, present and future activities
Affective relationships	0.645	0.453	0.384 – 0.906	<0.001	2.034	0.266
Physical and social adversity	−0.807	−0.109	−1.578 – −0.037	0.040	2.034	0.266
Social participation
Affective relationships	0.364	0.243	0.078 – 0.650	0.013	1.932	0.202
Death and dying
Affective relationships	0.647	0.328	0.241 – 1.052	0.002	1.801	0.074
Intimacy
Affective relationships	0.906	0.678	0.705 – 1.107	<0.001	2.086	0.507
General quality of life
Affective relationships	0.511	0.510	0.340 – 0.682	<0.001	1.869	0.365
Physical and social adversity	−0.938	−0.180	−1.443 – −0.434	<0.001	1.869	0.365

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Edison Vitório de Souza Júnior, Av. dos Bandeirantes, 3900, Monte Alegre, 14040-902 – Ribeirão Preto, SP, Brazil, edison.vitorio@usp.br