Abstract
Introduction:
Sexual activity in later life is increasingly being researched, but there is a gap in knowledge about the Global South, mainly Latin America.
Objective:
The objective of this article is to evaluate how biological, psychological and social factors influence active sex life in older Chilean people, using a gender-stratified analysis.
Methodology:
The study is based on secondary data analysis of the fifth National Survey of Quality of Life in Old Age, carried out in Chile in 2019 with a sample of 2,132 people aged 60 and over. Bivariate analysis was conducted to test the influence of biological, psychological and social variables on having an active sex life. Additionally, multiple hierarchal logistic regressions were carried out using a gender-stratified analysis to explore whether the independent variables predict active sex life.
Results:
Self-perceived health and chronic illness did not have predictive value regarding active sex life in older Chilean adults. However, partner health was a significant factor in predicting active sex life, particularly for women. People who reported being dissatisfied with life had 55 percent lower chance of having an active sex life than those who reported being very satisfied with life. Attitude towards sexuality, relationship status and education level were other variables that predicted an active sex life for older adults in Chile. Still, there were significant gender differences in the results.
Conclusion:
Interpersonal, psychological and social factors are more relevant than biological factors (except for age) when predicting sexual activity for older Chileans, and gender differences are central when analysing sexual activity.
Introduction
Sexuality, according to the World Health Organization (2010: 4), is ‘a central aspect of being human throughout life […] influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors’. Despite sexuality’s importance throughout life, later life sexuality has been overlooked in the policy architecture, which is mainly focused on the reproductive years, leaving older people’s sexual health and sexual rights unseen (Aboderin, 2014; Sladden et al, 2021).
Evidence about sexual engagement shows that sexual expression is present even in the oldest stages of life (Lindau et al, 2007; DeLamater, 2012; Lee et al, 2016a). For example, Lee et al (2016a) and Lindau et al (2007) analysed data from nationally representative studies in England, covering ages 50–89, and the US, covering ages 57–85, respectively, concluding that many individuals continue to have active sex lives well into their eighties. However, these studies also found that levels of sexual engagement differ greatly depending on gender and that the frequency of sexual activity declines with increasing age. In these studies, being ‘sexually active’ was operationalised as having had partnered sexual activity (Lindau et al, 2007) or any type of sexual activity (Lee et al, 2016a) in the previous 12 months.
Over the past decade, evidence has been accumulating regarding the benefits of sexual activity for older adults, showing that being sexually active positively impacts physical health by improving physical activity (Allen and Desille, 2017), improving sleep quality (Gianotten et al, 2021) and tempering the possible onset of frailty (Soysal and Smith, 2022). Likewise, there is a positive impact on mental health through reducing stress (Zhang and Liu, 2019), improving well-being (Laumann et al, 2006; Lee et al, 2016b; Jackson et al, 2019) and enhancing relationship quality (Galinsky and Waite, 2014).
Although there has been growing interest in academia regarding later life sexuality, the focus has been on biomedical influences on sexuality, with less attention to emotional, interpersonal and sociocultural factors (DeLamater, 2012; Træen et al, 2017a; Træen et al, 2017b; Sinković and Towler, 2019). As a response to this scenario, DeLamater (2012) suggests applying George Engel’s biopsychosocial model of health to studying sexuality in later life. This approach considers the interaction of a person’s genetics, physiology, anatomy and nutrition (bio); their feelings, thoughts and behaviours (psycho); and their social context, from interactions with others to sociocultural factors (social; see Woods, 2019).
Evidence shows that factors such as age, gender and health status influence engagement in sexual activity; also the presence of chronic illnesses, their treatment and lifestyle factors are among other influences for sexual activity (Flyckt and Kingsberg, 2011; Allen and Desille, 2017; Slack and Aziz, 2020). Being older, female and in poor health (physically or mentally) will significantly lower the chances of being sexually active (Lindau et al, 2007; DeLamater, 2012; Lee et al, 2016a; Træen et al, 2017a; Træen et al, 2018).
Taking the psychological dimension, a person’s values, beliefs and attitudes are factors that can influence sexual activity, as these constitute core aspects of a person’s identity and ways of experiencing the world (DeLamater, 2012). It has been shown that both self-directed positive attitudes towards ageing and giving significance to sexual expression are related to more frequent sexual activity and better quality of sex for older adults (DeLamater, 2012; Estill et al, 2018; Syme et al, 2022). Findings from a recent study of partnered sexual activity found positive correlation between sexual activity and both positive attitudes regarding the value of sex for well-being and positive attitudes about changes in the ageing process (Fischer et al, 2021). Another relevant factor when analysing influences on sexual activity from a psychological perspective is well-being (Laumann et al, 2006; Jackson et al, 2019). Vasconcelos et al (2022), in their recent literature review, found significant associations between sexual health indicators (satisfaction, function, behaviours, attitudes, knowledge) and subjective well-being in older people, and conclude that the different sexual health indicators are markers of subjective well-being. Therefore, how a person feels and interprets their sexual experience are relevant factors for engagement in sexual activity (Laumann et al, 2006; DeLamater and Koepsel, 2015; Hinchliff, 2016).
The social dimension includes interpersonal factors, such as a person’s relationship status and satisfaction with one’s relationship (DeLamater, 2012; Syme et al, 2022), and the influence of the sociocultural environment. Evidence shows that having a partner is one of the strongest predictors of engaging in sexual activity for older people; however, this factor does not relate to both sexes equally (Træen et al, 2019). Moreover, the sociocultural context influences sexual engagement in later life because culture not only shapes sexual expression through attitudes, values, roles and behaviours (Aboderin, 2014) but also structures older people’s roles and practices in society, influencing how they experience their sexuality (Ayalon and Tesch-Römer, 2018). In this scenario, age can constitute a factor for prejudice and discrimination against older people, which can be referred to as ageism (Centre for Ageing Better, 2023). Age discrimination has a cultural root and influences what individuals acknowledge as acceptable for each age group within their society (Ayalon and Tesch-Römer, 2018). Moreover, a specific type of age discrimination regarding older adults as sexual beings is ‘ageist erotophobia’. This involves practices and thoughts that dismiss older people as sexual beings, discriminating against those who wish to remain sexually active (Simpson, 2021). Lastly, the least investigated social factor influencing sexual activity is gender dynamics (Træen et al, 2017a). As evidence shows, engagement in sexual activity is a gendered issue, as men and women experience and engage in this behaviour in different ways (Træen et al, 2017a; Sinković and Towler, 2019). Although, regarding older people, stereotypes and prejudice affect men’s and women’s sexuality generally, the evidence has highlighted that women report more disrespectful and judging experiences than men when expressing their sexuality (Fileborn et al, 2017).
Therefore, when researching sexual activity, there is a need to recognise the different sociocultural conditions in which men and women experience their sexual lives (Hinchliff, 2016). This is particularly important when studying sexual activity in traditional societies, such as Latin America, where a sociocultural pattern enforces different norms of accepted behaviour by men and women (Farré et al, 2010). Consequently, this research adopts a gender stratification approach. Gender stratification refers to how men and women are considered equal but are unequal in their access to resources and opportunities within society (Danaj, 2016). Regarding sexual activity, older women have unequal access to pleasure and sexual opportunities, as their sexuality has been placed in the private sphere, meaning they are assigned a passive role in relation to this topic (Farré et al, 2010). For example, evidence from the Rotterdam Study shows that engagement in sexual activity differed significantly between unpartnered older women and men (1.3 percent of unpartnered women versus 13.7 percent of unpartnered men; Freak-Poli et al, 2017). A similar pattern occurs when the older person’s partner is in poor health, with older women being more likely than older men to report they ceased to engage in sex as a consequence of their partner having poor health (Lindau et al, 2007; Træen et al, 2019). Additionally, as women live longer than men and experience widowhood at a higher rate than men, older women tend to have fewer opportunities to engage in heterosexual sexual activity, as the availability of a partner decreases with age (DeLamater, 2012).
The context for this study
This study focuses on Chile, a South American country that has experienced an advanced population transition, becoming one of the three most aged countries in the region, the other two being Uruguay and Cuba (Instituto Nacional de Estadísticas, 2018). Moreover, Chile has one of the highest life expectancies in the region, at 80.3 years – 82.8 years for women and 78.3 years for men (United Nations, 2022). Currently, the number of older people (those aged 60 and over) in the population is 3.4 million (18 percent of the total population), and this is expected to rise to 6.4 million (32 percent) by 2050 (Instituto Nacional de Estadísticas, 2018).
To better understand the country’s relationship to sexuality, it is necessary to look far into the past to see how patterns of morality have developed since colonisation. In groundbreaking work on the moral and sexual history of Chile, Figueroa (2020) notes that from colonisation to the late years of the nation, sexuality has been a subject of conflict between the different groups in society (colonisers with a male-dominant, binary and religious approach to sex versus Indigenous people with conceptualisations of sex as fluid, open and non-male focused), setting a moral double standard for disadvantaged groups, such as women. Women’s behaviour was expected to follow the coloniser’s view of sexuality, emphasising purity and marriage, with a punitive approach taken when this directive was not followed. It was accepted that men could stray from that approach to sexuality and act according to the more open Indigenous conceptualisations. This male-dominant approach to sexuality and the double standard imposed on women was mostly unchallenged during most of the country’s history (Figueroa, 2020). There were also double standards in terms of what was seen as appropriate for men and women in other areas of society, setting the tone for areas like education. Although the law on obligatory primary education was passed in 1920 and was universal, attendance patterns differed between boys and girls and the curricula segregated girls into subjects related to domestic life, while boys were exposed to more academic subjects (Egaña, 1994). However, change started during the 1960s, an era when the status quo in the country was challenged. In that decade, influenced by international movements, young people began to defy the dominant discourses regarding gender disparities and traditional family values (Figueroa, 2020). Regarding education, the 1960s was a decade of investment: the number of compulsory education years rose to eight and school curricula was unified for boys and girls, though technical and physical subjects remained as boys-only subjects for several years (Biblioteca del Congreso Nacional de Chile, 2003). The 1960s was also a prominent decade for developing a holistic approach to sexological science. However, the military dictatorship took place during 1973–90, and as a consequence the progress made previously could not be consolidated, as traditional family values, and the privatisation of the state, was strengthened by the regime (Lind and Argüello, 2009; Richardson and Birn, 2011). During the 1970s and 1980s, women’s public engagement was achieved through their domestic work, aligning their public roles to their roles as mothers and housewives. Their public roles were focused on caring for and helping the underprivileged within their local environment, meaning they could focus on their homes and families at the same time, following societal expectations (Godoy Ramos, 2013). However, since 1990, social movements have advocated for a rethinking of the traditional concepts of sex, pleasure and gender. Such movements have met with strong opposition from conservative groups and from the Roman Catholic and Evangelical Churches, which reject collective plans for sexual education and defend the traditional gender roles and the privatisation of sexual practices (Barrientos and Páez, 2006; Lind and Argüello, 2009; Richardson and Birn, 2011).
Currently, older adulthood is also a disputed territory in Chile, as research shows that in the public scenario of mass media and parliamentary debates, older people are portrayed in an ambivalent way, with imaginaries focused on wisdom and activism contrasting with those focused on frailty, ill health, victimisation and abandonment (Schmidt and Yang, 2020). However, for the general population, older people are seen as an excluded group in society and later life is viewed as a relatively negative period of life (Thumala et al, 2021).
The aim of this study
When reviewing the literature on sexual activity in later life, there appears to be an overfocus on biological–physiological aspects of sexuality and a lack of cultural diversity in research, with many studies primarily representing the experiences of older adults from high-income countries in the Global North (Heidari, 2016; Hinchliff, 2016). To address this gap, this study seeks to describe sexuality in later life in Chile. It analyses the influence of variables representing different aspects of a person’s life, considering psychological and social variables alongside biological variables, in order to describe active sex life for older men and women in Chile. Moreover, the added value of this research relates to its location, since it generates data from an under-researched place, a country in the Global South, which is generally described as lacking evidence on sexuality and particularly on later life sexuality (Dworkin et al, 2016).
The assumptions guiding this research relate to gender differences in engagement in sexual activity, assuming older women would engage in sexual activity less than older men. Because of the country’s context, older women’s sexuality may be highly influenced by attitudes and relationship status. Additionally, it is assumed that geographic location might influence engagement in sexual activity because the regions of Chile have different characteristics in terms of rurality, traditional values and education (Ministerio de Desarrollo Social y Familia, 2018). Lastly, it is assumed that relational and social variables are important influences on engagement in sexual activity.
Data and methods
Study design and participants
Secondary data analysis was conducted using data from the ‘5ta Encuesta Nacional de Calidad de Vida en la Vejez’ (5th National Survey of Quality of Life in Old Age), a nationally representative survey carried out by the Pontificia Universidad Católica de Chile and Caja Los Andes (see Pontificia Universidad Católica de Chile and Caja Los Andes, 2019).
This is a repeated cross-sectional survey which started in 2007 and is carried out every three years. The fifth survey took place in 2019. The sample selection is random and probabilistic; it is executed in all 16 regions of the country, and each city with a population higher than 30,000 inhabitants and a population similar to the region’s population is included. Participants are 60 years and over, and data collection consists of face-to-face interviews in participants’ homes. All participants are cognitively screened before completing the survey so that people with a cognitive impairment can be identified (Borson et al, 2000).
For the 2019 survey, 2,234 older people were selected to participate, and of these, 102 individuals were excluded due to cognitive impairment. Therefore, the sample for the 2019 survey consisted of 2,132 participants.1
Measures
Several variables were selected from the fifth National Survey of Quality of Life in Old Age to evaluate their influence on sexual activity. For the selected variables, analysis was carried out on responses from the entire sample (2,132 participants); no exclusion criteria were applied. However, some of the variables analysed had a level of non-response, and this is noted for each variable.
The analysis included sociodemographic variables: age; sex; marital status; education level; and geographic location. Age, sex and marital status are noted in existing literature as significant factors for determining engagement in sexual activity among older people (DeLamater, 2012; Lee et al, 2016a). Three age groups were created for the analysis: 60–69; 70–79; and 80 and over. Although age and sex represent biological aspects and marital status represents a social aspect, these variables were grouped as sociodemographic characteristics in the hierarchical regression analysis, as they are very well-known influences on sexual activity in later life, and the intention was to better evaluate the influence of other variables in the Chilean population.
Education and geographical location are both important factors. Education is a well established measure of socioeconomic status (Office for National Statistics, 2017). Regarding sexuality, people who are highly educated are more inclined to grant higher importance to sexuality (Træen et al, 2017b). Lastly, the geographic location of participants was selected to explore if engagement in sexual activity differs in the various regions of the country; this is especially relevant considering that an essential feature of Chile is that its territory is narrow and long, its length covering over 4,300 kilometres (Moreno et al, 2016).
The following survey question measures active sex life: Do you have an active sex life? This question does not frame the behaviour within a space of time or specify the sexual behaviours to be included. This variable has dichotomised response categories (yes/no). Missing data for 117 observations were removed in the hierarchical analysis.
The variables selected to test biological influences on sexual activity were: self-perceived health; and the presence of five chronic conditions – depression, hypertension, diabetes, arthritis and heart condition and/or stroke (Lindau et al, 2007; DeLamater, 2012; Lee et al, 2016a; Jackson et al, 2019). Self-perceived health was ranked on a five-point Likert scale, and for the chronic conditions, questions asked about the presence of each of the conditions in the past year. In the survey, depression is included in a list of chronic illnesses, as this condition often needs medical treatment. In the analysis here, it was grouped with the other illnesses. In the literature, being in poor health and having one of these illnesses correlates negatively with the value assigned to sexuality and the frequency and satisfaction of engagement in sexual activity (Lindau et al, 2007; DeLamater, 2012).
Another variable used in the analysis was the health of the survey participant’s partner. All participants, regardless of their civil status, were asked if they had a partner. People without a partner were included in the original question on sexual activity and so were included in the analysis. The survey does not offer those who do not have a partner the option to skip the question on partner health; rather, in the question on partner health, there is a response to indicate the absence of a partner. The partner health question asks for the participant’s perception of their partner’s health (for those who have a partner), and the responses are plotted on a five-point Likert scale (very bad, bad, regular, good and excellent), with a separate value entered for those who do not have a partner. Missing data for 715 observations were excluded from the analysis.
The psychological variables selected for analysis were life satisfaction and attitude towards sexuality (Lindau et al, 2007; DeLamater, 2012). The survey used the Satisfaction With Life Scale (Diener et al, 1985). The scale consists of five items rated on a five-point Likert scale, ranging from strongly agree to strongly disagree. The general score goes from 5 to 25, with higher scores indicating higher satisfaction with life. For analysis, categories were created with the scores representing the following satisfaction levels: very satisfied, satisfied, neutral, dissatisfied and very dissatisfied. Attitudes towards sexuality in old age were also used in the analysis. The variable aims to measure changes in importance given to sexual activity over time. The responses were: (1) as important when one was younger; (2) important but not as much as when one was younger; and (3) not important. As the question focuses on changes over the life course and does not provide a simple important/non-important response, the values were not grouped for analysis. Missing data, representing 9.7 percent of responses, were excluded from the analysis.
A decision was made to group the life satisfaction variable with the health condition variables because life satisfaction is a component of subjective well-being (Diener et al, 1985). This variable and the selected biological variables seem to reflect a broader concept, general health (DeLamater, 2012), and were grouped together in the logistic regression analysis.
A variable measuring perceived discrimination was used to test the influence of the social environment on engaging in sex activity (Syme and Cohn, 2020). This is the only variable in the survey that explores discrimination, and it situates discrimination in five social environments: the healthcare system; social connections; public services; private networks; and mass media. The variable measures the presence of discrimination and its frequency (responses are: Yes, frequently; Yes, sometimes; and No, never). Categories were merged in each question to create a dichotomous variable (based on a yes/no response). For this study, the measure was perceived discrimination, regardless of how long a person experienced it.
Ethical approval for the research was granted by the University of Southampton.
Data analysis
Analysis was conducted using SPSS version 26.
Descriptive statistics were produced, and bivariate analysis using chi-square correlations was carried out to understand the relationship between active sex life and each independent variable. Then, multiple hierarchical logistic regressions were carried out to examine associations between the variables (calculated via odds ratios – ORs). This part of the analysis was carried out using a gender stratification approach, as sexual activity is experienced differently by men and women. Thus, three models were created to assess the impact of independent variables on the dependent variable (active sex life) for the total sample and for each sex: model A represents the analysis for the total sample; model B represents analysis for men only; and model C represents analysis for women only (see Table 3). An initial model was created to test the impact on the dependent variable using cumulative groups of independent variables to analyse and explore associations between the dependent variable and independent variables within thematic areas. The first group was sociodemographic characteristics (gender, age and marital status), the second group was socioeconomic characteristics (education level and geographic location), the third was general health (self-perceived health, physical and mental health conditions, partner health and life satisfaction), the fourth was perception of treatment by society, and the fifth was attitude towards sexuality. The hierarchical approach was used to evaluate the relative importance of each group of variables (Field, 2018).
Results
Table 1 summarises the distribution of the sample for each of the variables.
Characteristics of participants
| Men | Women | Total | ||||
|---|---|---|---|---|---|---|
| % | N | % | N | % | N | |
| Sex | 33.3 | 711 | 66.7 | 1,421 | 100.0 | 2,132 |
| Age (years) | ||||||
| 60–69 | 41.4 | 294 | 40.9 | 581 | 41.0 | 875 |
| 70–79 | 35.3 | 251 | 38.2 | 543 | 37.2 | 794 |
| 80 and over | 23.3 | 166 | 20.9 | 297 | 21.7 | 463 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Marital status | ||||||
| Single | 7.6 | 54 | 14.5 | 205 | 12.2 | 259 |
| Married/has a partner | 64.8 | 458 | 38.0 | 536 | 46.9 | 994 |
| Divorced/separated | 11.0 | 78 | 11.6 | 164 | 11.4 | 242 |
| Widowed | 16.5 | 117 | 35.9 | 506 | 29.4 | 623 |
| Missing | 0.01% | 4 | 0.7% | 10 | 0.6% | 14 |
| Total | 100.0% | 711 | 100.0% | 1,421 | 100.0% | 2,132 |
| Education level | ||||||
| No education | 5.4 | 38 | 5.8 | 83 | 5.7 | 121 |
| Primary education | 38.4 | 273 | 46.0 | 653 | 43.4 | 926 |
| Secondary education | 33.6 | 239 | 31.3 | 445 | 32.1 | 684 |
| College/apprenticeship | 13.2 | 94 | 9.7 | 138 | 10.9 | 232 |
| Higher education | 9.4 | 67 | 7.2 | 102 | 7.9 | 169 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Geographic location | ||||||
| Northern regions | 12.1 | 86 | 12.7 | 181 | 12.5 | 267 |
| Central regions | 38.0 | 270 | 37.6 | 534 | 37.7 | 804 |
| Southern regions | 10.8 | 77 | 10.6 | 151 | 10.7 | 228 |
| Metropolitan region | 39.1 | 278 | 39.1 | 555 | 39.1 | 833 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Self-perceived health | ||||||
| Excellent/very good | 12.0 | 85 | 9.7 | 138 | 10.5 | 223 |
| Good | 40.8 | 290 | 33.2 | 472 | 35.7 | 762 |
| Regular/bad | 46.8 | 333 | 56.6 | 804 | 53.3 | 1,137 |
| Missing | 0.4 | 3 | 0.5 | 7 | 0.5 | 10 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Partner’s health | ||||||
| Excellent/very good | 9.8 | 70 | 6.0 | 85 | 7.3 | 155 |
| Good | 24.9 | 177 | 14.5 | 206 | 18.0 | 383 |
| Regular/bad | 33.1 | 235 | 22.4 | 318 | 25.9 | 553 |
| Do not have a partner | 12.1 | 86 | 16.8 | 240 | 15.3 | 326 |
| Missing | 20.1 | 143 | 40.3 | 572 | 33.5 | 715 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Active sex life | ||||||
| Yes | 41.7 | 297 | 18.8 | 267 | 26.5 | 564 |
| No | 51.1 | 363 | 76.6 | 1,088 | 68.0 | 1451 |
| Missing | 7.2 | 51 | 4.6 | 66 | 5.5 | 117 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Do you think that sex life in old age is… | ||||||
| as important as when one was younger? | 26.3 | 187 | 13.1 | 186 | 17.5 | 373 |
| important, but not as much as when one was younger? | 41.2 | 293 | 27.5 | 391 | 32.1 | 684 |
| not important? | 25.6 | 182 | 48.3 | 687 | 40.8 | 869 |
| Missing | 6.9 | 49 | 11.1 | 157 | 9.7 | 206 |
| Total | 100.0 | 711 | 100.0 | 1,421 | 100.0 | 2,132 |
| Self-reported chronic conditions (participants who reported having the condition) | ||||||
| Hypertension/high blood pressure | 59.8 | 425 | 64.0 | 909 | 62.6 | 1,334 |
| Diabetes/high blood sugar | 28.6 | 203 | 33.4 | 475 | 31.8 | 678 |
| Arthritis | 13.9 | 99 | 35.8 | 509 | 28.5 | 608 |
| Heart condition/stroke | 9.7 | 69 | 10.7 | 152 | 10.4 | 221 |
| Depression | 13.1 | 91 | 23.7 | 329 | 19.7 | 420 |
| Have you ever felt mistreated because of your age… (participants who answered yes) | ||||||
| when visiting a general practitioner, local health clinic or hospital? | 36.0 | 256 | 31.8 | 452 | 33.2 | 708 |
| by people in your neighbourhood? | 17.7 | 126 | 15.2 | 216 | 16.0 | 342 |
| by public services or city council? | 26.3 | 187 | 23.2 | 330 | 24.2 | 517 |
| by your family? | 13.4 | 95 | 12.2 | 174 | 13.9 | 296 |
| by mass media, TV, newspapers or advertisements showing a negative image of older people? | 36.8 | 262 | 31.0 | 441 | 33.0 | 703 |
Source: Author analysis from the fifth National Survey of Quality of Life in Old Age (carried out in Chile in 2019).
All participants were aged 60 and over. The table shows that 66.7 percent of respondents in the sample were women and 33.3 percent were men. Of the three age groups established for analysis, the youngest group, those aged 60–69, was the largest (41.0 percent of the sample), followed by the 70–79 age group (37.2 percent) and the 80 and over group (21.7 percent). In terms of marital status, the most common category was being married or in a relationship (reported by 46.6 percent of the sample), followed by being widowed (29.2 percent). For education level, most participants reported having primary education (43.4 percent) and this was followed by secondary education (32.1 percent) and college training or apprenticeships (10.9 percent); the highest and lowest education levels, having higher education and no formal education, had the lowest representation in the sample (7.9 percent and 5.7 percent, respectively).
Relationship between active sex life and biological, psychological and social variables among older Chilean people
Associations between active sex life and each of the independent variables were calculated using chi-square analysis (Table 2).
Bivariate analysis of active sex life and independent variables
| Independent variable | X2 a |
|---|---|
| Age | X2 (4) = 217.193*** |
| Sex | X2 (2) = 145.456*** |
| Marital status | X2 (6) = 374.820*** |
| Education level | X2 (8) = 81.244*** |
| Geographic location | X2 (6) = 11.370 |
| Self-perceived health | X2 (4) = 72.449*** |
| Partner’s health | X2 (6) = 219.411*** |
| Satisfaction With Life Scale | X2 (8) = 52.420*** |
| Hypertension | X2 (2) = 49.110*** |
| Diabetes | X2 (2) = 14.114*** |
| Arthritis | X2 (2) = 33.345*** |
| Heart condition/stroke | X2 (2) = 3.205 |
| Depression | X2 (2) = 10.245** |
| Treatment by general practitioner/hospital | X2 (2) = 1.170 |
| Treatment in neighbourhood | X2 (2) = 0.413 |
| Treatment by public services or city council | X2 (2) = 0.918 |
| Treatment by family | X2 (2) = 4.493 |
| Treatment in mass media | X2 (2) = 1.782 |
| Attitude towards sexuality | X2 (4) = 522.585*** |
Notes: a Degrees of freedom are shown in brackets. Significance levels: *p ≤ .05; ** p ≤ .01; *** p ≤ .001.
Source: Author’s analysis of the fifth National Survey of Quality of Life in Old Age (carried out in Chile in 2019).
As seen in the table, active sex life had a statistically significant association with age, sex, marital status, education level, self-perceived health, partner health, life satisfaction, four of the five chronic health conditions (hypertension, diabetes, arthritis and depression) and attitudes towards sexuality in old age.
Regarding the general health variables selected for analysis, a high significance level (p ≤ .001) was found for the relationship with hypertension, diabetes and arthritis. These findings suggest that having an active sex life is more likely for people who do not have an illness compared to those who do. Although the significance level for depression was lower (p ≤ .01), this finding still suggests that living with depression is less likely to be associated with an active sex life. Moreover, the associations between the dependent variable and self-perceived health and partner health were both strong (p ≤ .001). These findings suggest that the chances of having an active sex life increase when health perception (for both personal health and partner health) is more positive.
Findings for life satisfaction show that people who reported a higher degree of satisfaction (very satisfied and satisfied) on the Satisfaction With Life Scale were more likely to have an active sex life compared to those who reported lower satisfaction (significant at p ≤ .001). For attitudes towards sexuality, the association with high significance level (p ≤ .001) suggests that older people who grant the same importance to sexuality in later life as in previous stages of life have a higher chance of being sexually active in old age than those who see sexuality as less important in later life.
For geographic location of participants, having a heart condition/stroke and the five variables for treatment by society, the association with having an active sex life was not statistically significant.
Gender-stratified analysis predicting active sex life
Table 3 presents the results of three logistic regression models predicting active sex life in later life. The results are shown in ORs, which indicate the odds of having an active sex life when different groups of variables were introduced; these groups were related to: sociodemographic characteristics; general health; treatment by society; and attitudes towards sexuality. Although the analysis was run in blocks of variables, Table 3 reports on the final models: model A cover the total sample, and models B and C cover a men only and women only, respectively.
Odds ratios of models predicting active sex life
| Model A: total sample(OR) | Model B: men only(OR) | Model C: women only(OR) | ||
|---|---|---|---|---|
| Sociodemographic characteristics | ||||
| Model (X2) | 285.595*** | 82.024*** | 184.262*** | |
| Cox and Snell R square | 0.220 | 0.160 | 0.238 | |
| Nagelkerke R square | 0.297 | 0.213 | 0.329 | |
| Hosmer–Lemeshow test | 5.105 | 0.696 | 1.174 | |
| Sex | ||||
| Men | Reference | |||
| Women | 0.472*** | |||
| Age (years) | ||||
| 60–69 | Reference | |||
| 70–79 | 0.291*** | 0.409*** | 0.217*** | |
| 80 and over | 0.113*** | 0.130*** | 0.115*** | |
| Marital status | ||||
| Single | Reference | |||
| Married/has a partner | 2.856*** | 2.084 | 3.514*** | |
| Divorced/separated | 0.586 | 0.913 | 0.325* | |
| Widowed | 0.564 | 0.593 | 0.534 | |
| Socioeconomic characteristics | ||||
| Model (X2) | 18.735** | 19.018** | 11.684 | |
| Cox and Snell R square | 0.233 | 0.193 | 0.251 | |
| Nagelkerke R square | 0.314 | 0.257 | 0.347 | |
| Hosmer–Lemeshow test | 5.246 | 6.203 | 5.741 | |
| Education level | ||||
| No education | Reference | |||
| Primary education | 1.299 | 0.586 | 3.282* | |
| Secondary education | 1.732 | 0.891 | 3.970* | |
| College/apprenticeships | 1.898 | 0.698 | 5.798** | |
| Higher education | 2.621* | 1.841 | 4.415* | |
| Geographic location | ||||
| Metropolitan region | Reference | |||
| Northern regions | 1.367 | 1.869 | 1.111 | |
| Central regions | 1.033 | 1.214 | 0.925 | |
| Southern regions | 0.694 | 0.597 | 0.869 | |
| General health | ||||
| Model (X2) | 95.335*** | 63.736*** | 51.269*** | |
| Cox and Snell R square | 0.294 | 0.295 | 0.306 | |
| Nagelkerke R square | 0.396 | 0.393 | 0.422 | |
| Hosmer–Lemeshow test | 10.143 | 5.204 | 10.624 | |
| Self-perceived health | ||||
| Excellent/very good | Reference | |||
| Good | 0.696 | 0.618 | 0.889 | |
| Regular/bad | 0.620 | 0.494 | 0.817 | |
| Partner’s health | ||||
| Excellent/very good | Reference | |||
| Good | 0.757 | 0.562 | 0.760 | |
| Regular/bad | 0.475** | 0.472 | 0.376** | |
| Do not have a partner | 0.098*** | 0.056*** | 0.088*** | |
| Satisfaction With Life Scale | ||||
| Very satisfied | Reference | |||
| Satisfied | 0.771 | 0.981 | 0.633 | |
| Neutral | 0.687 | 0.749 | 0.603 | |
| Dissatisfied | 0.453** | 0.360* | 0.500 | |
| Very dissatisfied | 0.487 | 0.213* | 0.629 | |
| Self-reported chronic conditions | ||||
| Hypertension | ||||
| No | Reference | |||
| Yes | 0.757 | 0.732 | 0.726 | |
| Diabetes | ||||
| No | Reference | |||
| Yes | 0.810 | 0.689 | 0.848 | |
| Arthritis | ||||
| No | Reference | |||
| Yes | 0.901 | 1.200 | 0.840 | |
| Heart condition/stroke | ||||
| No | Reference | |||
| Yes | 1.199 | 1.682 | 1.047 | |
| Depression | ||||
| No | Reference | |||
| Yes | 1.119 | 1.532 | 0.994 | |
| Treatment by society | ||||
| Model (X2) | 4.178 | 6.591 | 1.979 | |
| Cox and Snell R square | 0.296 | 0.304 | 0.308 | |
| Nagelkerke R square | 0.399 | 0.406 | 0.425 | |
| Hosmer–Lemeshow test | 5.021 | 7.063 | 6.556 | |
| Have you ever felt treated unfairly because of your age… | ||||
| when visiting a general practitioner, local health clinic or hospital? | ||||
| No | Reference | |||
| Yes | 1.023 | 0.826 | 1.233 | |
| in your neighbourhood? | ||||
| No | Reference | |||
| Yes | 0.744 | 0.708 | 0.811 | |
| by public services or city council? | ||||
| No | Reference | |||
| Yes | 1.379 | 2.194* | 0.950 | |
| by your family? | ||||
| No | Reference | |||
| Yes | 1.174 | 1.158 | 1.432 | |
| by mass media, TV, newspapers or advertisements showing a negative image of older people? | ||||
| No | Reference | |||
| Yes | 0.888 | 0.634 | 0.995 | |
| Attitudes towards sexuality | ||||
| Model (X2) | 245.222*** | 80.787*** | 160.537*** | |
| Cox and Snell R square | 0.431 | 0.414 | 0.454 | |
| Nagelkerke R square | 0.582 | 0.552 | 0.627 | |
| Hosmer–Lemeshow test | 13.053 | 9.263 | 4.718 | |
| Do you think that sex life in old age is…? | ||||
| as important as when one was younger | 29.997*** | 24.103*** | 48.493*** | |
| important, but not as much as when one was younger | 11.216*** | 11.442*** | 11.411*** | |
| not important | Reference | |||
Notes: All analyses were carried out with 95% confidence interval. Significance levels: * p ≤ .05; ** p ≤ .01; *** p ≤ .001.
Source: Author’s analysis of the fifth National Survey of Quality of Life in Old Age (carried out in Chile in 2019).
The first group of variables introduced to test the dependent variable were those relating to sociodemographic characteristics: sex, age and marital status. Gender differences can be seen for all these variables; in model A, results show that women were 53 percent less likely to have an active sex life than men (OR = 0.472, p ≤ .001). Age was a statistically significant predictor variable for active sex life: for both sexes, the likelihood of having an active sex life was reduced by ageing. For marital status, in the general model, people who reported being married or in a relationship were 2.8 times as likely to have an active sex life than single people (OR = 2.856, p ≤ .001). However, this effect was different in models B and C. In the men’s model, none of the categories of this variable were statistically significant, meaning that their marital status did not relate to being sexually active. In the women’s model, being married/having a partner and being divorced/separated showed statistically significant results, meaning women with those relationship statuses had higher odds than single women of having an active sex life.
The second group introduced social variables: education level and geographic location. Regarding education level, in model A, having higher education was the only category with a statistically significant result, and participants with higher education were 2.6 times more likely than those with no formal education to be sexually active (OR = 2.621, p ≤ .05). Gender differences were present in models B and C: for women, all the education levels were statistically significant, while for men, none of the education levels were significant.
The third group introduced in the regression models covered general health. The same variables from the bivariate analysis were included in these models, but as a block. Although in the bivariate analysis, self-perception of health and four of the five chronic illnesses had a statistically significant association with the dependent variable, the regression showed that these variables did not have a predictive value for the dependent variable. Instead, partner health and life satisfaction were shown to be statistically significant in the general model, but the variables behaved differently depending on gender. In model C, women who reported their partner’s health to be regular/bad had a 63 percent lower chance of being sexually active (OR = 0.376, p ≤ .01). In the men’s model, there were no statistically significant results for rating of partner health. Regarding life satisfaction, men feeling dissatisfied or very dissatisfied with their life showed statistical significance, and those men were 64 percent and 79 percent less likely to be sexually active compared to those who felt very satisfied. For women, this variable showed no results with statistical significance.
Fourthly, the social variables on treatment by society were introduced, testing ageism. These variables did not have a statistical significance with the dependent variable.
Lastly, attitudes towards sexuality were introduced. For all the models, this variable had a strong significance level. For the general model, people reporting that sex in old age is as important as when one was younger were 29.9 times more likely to have an active sex life than those reporting that it is not important (OR = 29.997, p ≤ .001). Although the values indicated a strong association, they did not express causality, as other factors could contribute to the associations.
Discussion
This study aimed to investigate sexual activity among older adults in Chile, examining how variables that go beyond the biological can influence sexual activity for both sexes. The findings suggest that psychological and social variables were a better predictor of sexual engagement than biological and health variables for this study’s population, offering insights into gender differences regarding each variable’s influence.
Consistent with previous studies (Lindau et al, 2007; Lee et al, 2016a), age and gender were associated with having an active sex life and had a predictive value in the three regression models. However, gender was particularly relevant because of differences in this study regarding other independent variables, such as marital status. Although the association between marital status and sexual activity is known (DeLamater, 2012), this study points out that for older men in Chile, marital/relationship status did not have a predictive value for sexual activity, meaning that it was not a relevant factor prompting this behaviour. For women, however, marital/relationship status, particularly being married, was strongly correlated to sexual activity. Following gender stratification theory (Danaj, 2016), it is possible to see gender inequalities in opportunities for sexual engagement and to note the hierarchical division of social practices for older men and women. Some cultural practices, like the different social scripts against which men and women are held accountable and the male-centred view regarding sexuality (Laumann et al, 2006; Graf and Patrick, 2014), not only place women as less sexually active but position them as dependent on men and especially dependent on the status of being in a formal relationship, leaving older women at greater risk of ageism and sexism.
The location of participants was not a relevant influence on older adults’ sexual activity, contrary to assumptions. Differences among Chilean regions seem insignificant in terms of influencing intimate behaviour like sexual activity. Despite regional disparities, factors influencing sexual behaviour, such as gender dynamics, education, age and self-perceived health, appear similar across the country.
On the personal biological influences analysed in the general health block of variables, results showed no predictive value on active sex life, which is a surprising finding because this does not coincide with findings from other studies (Lindau et al, 2007; Lee et al, 2016a). However, several considerations could serve as an explanation. The first is the methodological approach of this study, sequential hierarchical analysis. This study used a different approach to analysis compared to previous studies; it seems that when groups of variables are added hierarchically, results differ from those of earlier studies; however, when these variables were analysed independently in a linear regression to see if they predict the dependent variable, the results were statistically significant. Additionally, the measure used for active sex life was non-specific regarding sex behaviours and time frame, leaving the participants to answer within their own frame of reference. This situation might explain why results differ from previous studies, as previous literature frames the behaviour in a set period and explicitly defines the types of behaviour which constitute a sexually active life. Lastly, the measures for health conditions used in this study differ slightly from those used by Lee and colleagues, who measured diagnosis and medication taken to control health conditions. Medical treatment was not considered in this study, possibly leading to less severe conditions being reported in some cases.
Regarding the social influences on active sex life, perceived discrimination and education level were analysed. Perceived discrimination, in all social contexts considered, was not associated with the dependent variable and did not have a predictive value for the dependent variable. These findings can be interpreted according to the activation of sub-stereotypes of ageing, which include images of old age that are multiple and heterogeneous. From this perspective, to understand stereotypes on ageing, the content and context must be taken into account. Voss et al (2018) note that context information impacts people by highlighting the most prominent stereotype, activating a more robust response to those domains in which the context applies. In the case of the variables analysed, none explicitly referred to sexuality.
Consistent with previous literature (Jackson et al, 2019; Fischer et al, 2021), life satisfaction and partner health had predictive value for having an active sex life in later life. However, gender differences were found, as partner health was not a significant variable for men’s active sex life, while it was for women’s. Life satisfaction predicted active sex life for men, but was not significant for women.
The psychological and social variables analysed – attitudes towards sexuality and education level – showed relevant associations. Older people who granted the same level of importance to sexuality throughout the life course were more likely to have an active sex life in all three regression models.
Additionally, regarding education level, this study presents a relevant finding that mainly relates to gender differences. In the general model, higher education was the only statistically significant category, suggesting that a higher socioeconomic level is correlated with a better perception of sexuality and engagement, and this result is consistent with previous findings (Træen et al, 2017a). For older men in this study, education level had no predictive value for having an active sex life, as none of the levels of education predicted sexual activity. For older women, however, all levels of education correlated with sexual activity, showing higher odds of having an active sex life compared to women with no formal education. As the literature points out, older women have encountered disadvantages regarding access to services, economic resources and education, which have accumulated throughout their lives. This situation restricts women’s socialisation by segregating them into private spheres of society (Fernández-Mayoralas et al, 2018). Besides, particularly in male-dominant cultures like those of Latin America, women’s sexuality has been ruled by traditional expectations focused on marriage and reproduction and a sociocultural pattern of punishment for those who deviate from this norm, thereby limiting women’s autonomy and access to information by developing an understanding of sexuality based on guilt and fear (Farré et al, 2010). Men, on the other hand, experience their sexuality as a path full of possibilities, highlighting that throughout their lives, they have the chance to explore and experiment, regardless of their social circumstances (Mazzucchelli and Arevalo, 2019). It seems, however, that social circumstances such as access to education are pivotal for older Chilean women regarding the possibility of sexual activity and the decision to be sexually active. Therefore, for older women who have explored the public sphere by acquiring education – at least some levels of education – the sociocultural constraints on their sexuality are less prominent. Formal education, then, constitutes a possibility to challenge the male-dominant pattern by receiving information and skills to achieve autonomy and independence (Mazzucchelli, 2019). As Stahl et al (2019) note in their study on sexual pleasure, for older women, the paths to being in control of their sexuality relate mainly to acquiring information which allows them to have a critical view towards traditional gendered values and to question how they have experienced sexuality previously.
From this study’s findings, the gender differences regarding life satisfaction, partner health, attitudes towards sexuality and education level encourage further research, as they pose questions about the emphasis that older Chilean women place on their sexual activity and whether older women are allowed to place importance on this matter. As qualitative research has shown, traditional gender roles and the different sexual scripts against which the genders are assessed influence sexual life until old age by positioning sexual activity in line with reproduction for women, and when the reproductive period ends, women grant sexuality a secondary importance and focus on their roles as carers (Mazzucchelli and Arevalo, 2019; Fischer et al, 2021), as if sexuality in line with pleasure was not expected for older women, not even by women themselves.
Conclusion
This study shows the particularities of the Chilean context regarding sexual activity in later life. The most significant finding of this research relates to the importance of using a gender perspective when exploring sexuality in later life and how the variables that show more variability between the genders are those that refer to psychological or social influences on sexual activity. The findings show that when studying engagement in sexual activity by older people, it is relevant to assess and understand factors holistically, as in this study psychological and social variables were more pertinent in predicting active sex life and these variables behaved differently when accounting for gender. This exposes the need to understand sexuality in later life in the context of the gender perspective, as the differences in sexual behaviour are primarily embedded in social–contextual factors, rather than in the capacity for sexual encounters (Laan et al, 2021). By including a gender perspective, our understanding of the phenomena and the provision of guidance can be tailored to men and women.
Another critical conclusion for this research is that several findings are consistent with previous research from the Global North. It seems that some factors, such as age, gender, marital status, partner health and attitudes towards sexuality, are essential predictors of sexual activity for various general populations (Lindau et al, 2007; Lee et al, 2016a; Freak-Poli et al, 2017). However, the reasons each factor is a predictor may vary from place to place. The most significant findings of this research are those that show the particularities of the Chilean context. The underpinnings of these results might come from a complex combination of several factors, from the country’s traditional values (Barrientos and Páez, 2006) to the different sexual social scripts, roles and expectations for men and women in society (Farré et al, 2010) to how the nation’s historical attitudes towards sexuality shape older adults’ sexual expression over their life course (Farré et al, 2010) or the value that the country gives to sexuality as a general topic (Giami and Russo, 2013). As evidence of gender inequality is found in other non-Western societies (Sinković and Towler, 2019; Ricoy-Cano et al, 2020), these results may reflect the broader Latin American region due to shared history, values and representations of sexuality and older adults in the subcontinent. Therefore, due to the lack of research representing the Global South in general and Latin America in particular (Dworkin et al, 2016), this study’s additional contribution is to shed light on the influences of ageing and sexuality in an under-researched location.
Strengths and limitations
This study’s strengths lie in its gendered approach and multidimensional focus, examining variables across various aspects of life. Additionally, to the author’s knowledge, it marks the first exploration of older persons’ sexual activity in Chile, a country in the Global South, so it addresses a significant gap in research on sexuality (Dworkin et al, 2016). This study has limitations regarding the dataset and methodology used. First, the cross-sectional survey analysed lacks detailed questions on sexuality, which limits understanding of practices, desires and satisfaction related to sexual activity. Second, the other study variables are limited to those in the original survey, which means some potential factors influencing sexual activity are excluded, such as sexual trajectory, lifestyle factors, disabilities, living arrangements and relationship satisfaction. Third, the methodological decision to use hierarchical regression analysis may have led to the finding that certain variables are less relevant for predicting sexual activity. Lastly, the relationships found may be bidirectional, as good health facilitates sexual engagement and vice versa (Gianotten et al, 2021).
Note
Survey results can be accessed at: https://encuestacalidaddevidaenlavejez.uc.cl/ediciones-anteriores/.
Funding
The author received no financial support for the research, authorship and/or publication of this article.
Research ethics statement
The study was performed in accordance with ethical standards and received ethical approval from the University of Southampton’s ethics committee.
Data availability statement
Data and materials cannot be provided because they belong to the Pontificia Universidad Católica de Chile and Caja Los Andes.
Acknowledgements
The author would like to thank Pontificia Universidad Católica de Chile for sharing the dataset. Portions of this manuscript appear in the author’s unpublished master’s thesis.
Conflict of interest
The author declares that there is no conflict of interest. The author alone is responsible for the content of the article. This research analysed data from the fifth National Survey of Quality of life in Old Age, carried out in Chile in 2019 by Pontificia Universidad Católica de Chile and Caja Los Andes. All the results of this study are the full responsibility of the author and do not compromise any of the institutions named here.
References
Aboderin, I. (2014) Sexual and reproductive health and rights of older men and women: addressing a policy blind spot, Reproductive Health Matters, 22(44): 185–90. doi: 10.1016/S0968-8080(14)44814-6
Allen, M.S. and Desille, A.E. (2017) Health-related lifestyle factors and sexual functioning and behavior in older adults, International Journal of Sexual Health, 29(3): 273–7. doi: 10.1080/19317611.2017.1307301
Ayalon, L. and Tesch-Römer, C. (2018) Introduction to the section: ageism—concept and origins, in L. Ayalon and C. Tesch-Römer (eds) Contemporary Perspectives on Ageism, Switzerland: Springer Open, pp 1–10.
Barrientos, J. and Páez, D. (2006) Psychosocial variables of sexual satisfaction in Chile, Journal of Sex & Marital Therapy, 32(5): 351–68. doi: 10.1080/00926230600834695
Biblioteca del Congreso Nacional de Chile (2003) Ley 19876: Reforma Constitucional que establece la obligatoriedady gratuidad de la Educacion Media, www.bcn.cl/leychile/navegar?idNorma=210495.
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000) The mini‐cog: a cognitive ‘vital signs’ measure for dementia screening in multi‐lingual elderly, International Journal of Geriatric Psychiatry, 15(11): 1021–7. doi: 10.1002/1099-1166(200011)15:11<1021::AID-GPS234>3.0.CO;2-6
Centre for Ageing Better (2023) Ageism: what’s the harm? Exploring the damaging impact of ageism on individuals and society, https://ageing-better.org.uk/sites/default/files/2023-02/Ageism-harms.pdf.
Danaj, E. (2016) Gender stratification, in Encyclopedia of Family Studies, Chichester: Wiley. doi: 10.1002/9781119085621.wbefs261
DeLamater, J. (2012) Sexual expression in later life: a review and synthesis, The Journal of Sex Research, 49(2–3): 125–41. doi: 10.1080/00224499.2011.603168
DeLamater, J. and Koepsel, E. (2015) Relationships and sexual expression in later life: a biopsychosocial perspective, Sexual and Relationship Therapy, 30(1): 37–59. doi: 10.1080/14681994.2014.939506
Diener, E., Emmons, R., Larsen, R. and Griffin, S. (1985) The Satisfaction With Life Scale, Journal of Personality Assessment, 49(1): 71–5. doi: 10.1207/s15327752jpa4901_13
Dworkin, S.L., Lerum, K. and Zakaras, J.M. (2016) Sexuality in the Global South: 50 years of published research in the Journal of Sex Research—inclusions, omissions, and future possibilities, The Journal of Sex Research, 53(9): 1059–64. doi: 10.1080/00224499.2015.1106433
Egaña, L. (1994) La Ley de Instrucción Primaria Obligatoria: un debate político, Revista Latinoamericana de Estudios Educativos, XXVI(4): 9–39.
Estill, A., Mock, S.E., Schryer, E. and Eibach, R.P. (2018) The effects of subjective age and aging attitudes on mid- to late-life sexuality, The Journal of Sex Research, 55(2): 146–51. doi: 10.1080/00224499.2017.1293603
Farré, A.F., Salas, B.L. and Giménez, A.R. (2010) Secretos y silencios en torno a la sexualidad de las mujeres mayores, Debate Feminista, 42: 35–51.
Fernández-Mayoralas, G., Schettini, R., Sánchez-Román, M., Rojo-Pérez, F., Agulló, M.S. and João Forjaz, M. (2018) El papel del género en el buen envejecer. Una revisión sistemática desde la perspectiva científica, Revista Prisma Social, 21: 149–76, https://revistaprismasocial.es/article/view/2422.
Field, A. (2018) Discovering Statistics Using IBM SPSS Statistics, 5th edn, London: Sage.
Figueroa, E. (2020) Sexualidad e historia en Chile: un ensayo sobre el conflicto y el control, RELIES: Revista del Laboratorio Iberoamericano para el Estudio Sociohistórico de las Sexualidades, 2: 89–114.
Fileborn, B., Hinchliff, S., Lyons, A., Heywood, W., Minichiello, V., Brown, G. and Crameri, P. (2017) The importance of sex and the meaning of sex and sexual pleasure for men aged 60 and older who engage in heterosexual relationships: findings from a qualitative interview study, Archives of Sexual Behavior, 46(7): 2097–110. doi: 10.1007/s10508-016-0918-9
Fischer, N., Træen, B. and Hald, G.M. (2021) Predicting partnered sexual activity among older adults in four European countries: the role of attitudes, health, and relationship factors, Sexual and Relationship Therapy, 36(1): 3–21. doi: 10.1080/14681994.2018.1468560
Flyckt, R. and Kingsberg, S.A. (2011) Sexuality and ageing, in I. Stuart-Hamilton (ed) An Introduction to Gerontology, Cambridge: Cambridge University Press, pp 283–316.
Freak-Poli, R., Kirkman, M., De Castro Lima, G., Direk, N., Franco, O. and Tiemeier, H. (2017) Sexual activity and physical tenderness in older adults: cross-sectional prevalence and associated characteristics, The Journal of Sexual Medicine, 14(7): 918–27. doi: 10.1016/j.jsxm.2017.05.010
Galinsky, A.M. and Waite, L.J. (2014) Sexual activity and psychological health as mediators of the relationship between physical health and marital quality, The Journals of Gerontology: Series B, 69(3): 482–92. doi: 10.1093/geronb/gbt165
Gianotten, W.L., Alley, J.C. and Diamond, L.M. (2021) The health benefits of sexual expression, International Journal of Sexual Health, 33(4): 478–93. doi: 10.1080/19317611.2021.1966564
Giami, A. and Russo, J. (2013) The diversity of sexologies in Latin America: emergence, development, and diversification, International Journal of Sexual Health, 25(1): 1–12.
Godoy Ramos, C. (2013) El estado chileno y las mujeres en el siglo XX. De los temas de la mujer al discurso de la igualdad de géneros, Diálogos Revista Electrónica de Historia, 14(1): 97–123.
Graf, A.S. and Patrick, J.H. (2014) The influence of sexual attitudes on mid-to late-life sexual well-being: age, not gender, as a salient factor, International Journal of Aging and Human Development, 79(1): 55–79. doi: 10.2190/AG.79.1.c
Heidari, S. (2016) Sexuality and older people: a neglected issue, Reproductive Health Matters, 24(48): 1–5. doi: 10.1016/j.rhm.2016.11.011
Hinchliff, S. (2016) Sexual health and older adults: suggestions for social science research, Reproductive Health Matters, 24(48): 52–4. doi: 10.1016/j.rhm.2016.10.001
Instituto Nacional de Estadísticas (2018) Síntesis de Resultados: CENSO 2017, Santiago de Chile: Instituto Nacional de Estadísticas, www.censo2017.cl/descargas/home/sintesis-de-resultados-censo2017.pdf.
Jackson, S.E., Firth, J., Veronese, N., Stubbs, B., Koyanagi, A., Yang, L. and Smith, L. (2019) Decline in sexuality and wellbeing in older adults: a population-based study, Journal of Affective Disorders, 245: 912–17. doi: 10.1016/j.jad.2018.11.091
Laan, E.T.M., Klein, V., Werner, M.A., Lunsen, R.H.W. and Janssen, E. (2021) In pursuit of pleasure: a biopsychosocial perspective on sexual pleasure and gender, International Journal of Sexual Health, 33(4): 516–36. doi: 10.1080/19317611.2021.1965689
Laumann, E., Paik, A., Glasser, D., Kang, J., Wang, T., Levinson, B. and Gingell, C. (2006) A cross-national study of subjective sexual well-being among older women and men: findings from the Global Study of Sexual Attitudes and Behaviors, Archives of Sexual Behavior, 35(2): 145–61. doi: 10.1007/s10508-005-9005-3
Lee, D.M., Nazroo, J., O’Connor, D.B., Blake, M. and Pendleton, N. (2016a) Sexual health and well-being among older men and women in England: findings from the English Longitudinal Study of Ageing, Archives of Sexual Behavior, 45(1): 133–44. doi: 10.1007/s10508-014-0465-1
Lee, D.M., Vanhoutte, B., Nazroo, J. and Pendleton, N. (2016b) Sexual health and positive subjective well-being in partnered older men and women, The Journals of Gerontology: Series B, 71(4): 698–710. doi: 10.1093/geronb/gbw018
Lind, A. and Argüello, S. (2009) Ciudadanías y sexualidades en América Latina, Íconos – Revista de Ciencias Sociales, 35: 13–18.
Lindau, S.T., Schumm, L.P., Laumann, E.O., Levinson, W., O’Muircheartaigh, C.A. and Waite, L.J. (2007) A study of sexuality and health among older adults in the United States, The New England Journal of Medicine, 357(8): 762–74. doi: 10.1056/NEJMoa067423
Mazzucchelli, N. and Arévalo, A. (2019) Personas mayores y sexualidad. relatos y experiencias del taller ‘con la sexualidad nunca se baja el telón’, Valparaíso, Revista Pensamiento y Accion Interdisciplinaria, 5(1): 8–28. doi: 10.29035/pai.5.1.8
Ministerio de Desarrollo Social y Familia (2018) Encuesta de Caracterización Socioeconómica Nacional (CASEN) 2017, http://observatorio.ministeriodesarrollosocial.gob.cl/encuesta-casen-2017.
Moreno, X., Sánchez, H., Huerta, M., Albala, C. and Márquez, C. (2016) Social representations of older adults among Chilean elders of three cities with different historical and sociodemographic background, Journal of Cross-Cultural Gerontology, 31(2): 115–28. doi: 10.1007/s10823-016-9288-y
Office for National Statistics (2017) Graduates in the UK labour market: 2017, www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/articles/graduatesintheuklabourmarket/2017#graduate-and-non-graduate-earnings.
Pontificia Universidad Católica de Chile and Caja Los Andes (2019) Chile y sus mayores. 5ta Encuesta de Calidad de Vida en la Vejez, https://ww2.cajalosandes.cl/cs/groups/public/documents/document/cmvz/ltiw/~edisp/chile-mayores-20202.pdf.
Richardson, E. and Birn, A.E. (2011) Sexual and reproductive health and rights in Latin America: an analysis of trends, commitments and achievements, Reproductive Health Matters, 19(38): 183–96. doi: 10.1016/S0968-8080(11)38597-7
Ricoy-Cano, A.J., Obrero-Gaitán, E., Caravaca-Sánchez, F. and Fuente-Robles, Y.M.D.L. (2020) Factors conditioning sexual behavior in older adults: a systematic review of qualitative studies, Journal of Clinical Medicine, 9(6): 1716. doi: 10.3390/jcm9061716
Schmidt, C.M. and Yang, K. (2020) Controlling active ageing: a study of social imaginaries of older people in Chile, Ageing & Society, 40(7): 1428–54. doi: 10.1017/S0144686X18001733
Simpson, P. (2021) ‘At YOUR age???!!!’: the constraints of ageist erotophobia on older people’s sexual and intimate relationships, in P. Simpson, P. Reynolds and T. Hafford-Letchfield (eds) Desexualisation in Later Life: The Limits of Sex and Intimacy, Bristol: Policy Press, pp 35–52.
Sinković, M. and Towler, L. (2019) Sexual aging: a systematic review of qualitative research on the sexuality and sexual health of older adults, Qualitative Health Research, 29(9): 1239–54. doi: 10.1177/1049732318819834
Slack, P. and Aziz, V.M. (2020) Sexuality and sexual dysfunctions in older people: a forgotten problem, BJPsych Advances, 26(3): 173–82. doi: 10.1192/bja.2019.80
Sladden, T., Philpott, A., Braeken, D., Castellanos-Usigli, A., Yadav, V., Christie, E. and Mofokeng, T. (2021) Sexual health and wellbeing through the life course: ensuring sexual health, rights and pleasure for all, International Journal of Sexual Health, 33(4): 565–71. doi: 10.1080/19317611.2021.1991071
Soysal, P. and Smith, L. (2022) Sexual activity and successful aging, European Geriatric Medicine, 13(6): 1235–8. doi: 10.1007/s41999-022-00694-6
Stahl, K.A.M., Gale, J., Lewis, D.C. and Kleiber, D. (2019) Pathways to pleasure: older adult women’s reflections on being sexual beings, Journal of Women & Aging, 31(1): 30–48. doi: 10.1080/08952841.2017.1409305
Syme, M.L. and Cohn, T.J. (2020) Aging sexual stereotypes and sexual expression in mid- and later life examining the stereotype matching effect, Aging & Mental Health. doi: 10.1080/13607863.2020.1758909
Syme, M.L., Graf, A., Cohn, T.J. and Cornelison, L. (2022) Sexuality in later life, in G.J.G. Asmundson (ed) Comprehensive Clinical Psychology, 2nd edn, Oxford: Elsevier, pp 73–88.
Thumala, D.T., Arnold-Cathalifaud, M., Herrera, F.H. and Torres, C.M. (2021) Sexta Encuesta Nacional Inclusión y Exclusión Social de las Personas Mayores: Cómo Observa la Población el Envejecimiento en Chile, Santiago: Ediciones Servicio Nacional del Adulto Mayor.
Træen, B., Carvalheira, A., Kvalem, I.L., Štulhofer, A., Janssen, E., Graham, C.A. and Enzlin, P. (2017a) Sexuality in older adults (65+)—an overview of the recent literature, part 2: body image and sexual satisfaction, International Journal of Sexual Health, 29(1): 11–21. doi: 10.1080/19317611.2016.1227012
Træen, B., Hald, G.M., Graham, C.A., Enzlin, P., Janssen, E., Kvalem, I.L. and Štulhofer, A. (2017b) Sexuality in older adults (65+)—an overview of the literature, part 1: sexual function and its difficulties, International Journal of Sexual Health, 29(1): 1–10. doi: 10.1080/19317611.2016.1224286
Træen, B., Štulhofer, A., Janssen, E., Carvalheira, A.A., Hald, G.M., Lange, T. and Graham, C. (2019) Sexual activity and sexual satisfaction among older adults in four European countries, Archives of Sexual Behavior, 48(3): 815–29. doi: 10.1007/s10508-018-1256-x
Træen, B., Štulhofer, A., Jurin, T. and Hald, G. (2018) Seventy-five years old and still going strong: stability and change in sexual interest and sexual enjoyment in elderly men and women across Europe, International Journal of Sexual Health, 30(4): 323–36. doi: 10.1080/19317611.2018.1472704
United Nations (2022) World population prospects 2022, https://population.un.org/wpp/.
Vasconcelos, P., Paúl, C., Serruya, S., Ponce de León, R. and Nobre, P. (2022) A systematic review of sexual health and subjective well-being in older age groups, Revista Panamericana Salud Publica, 46(e179). doi: 10.26633/RPSP.2022.179
Voss, P., Bodner, E. and Rothermund, K. (2018) Ageism: the relationship between age stereotypes and age discrimination, in L. Ayalon and C. Tesch-Römer (eds) Contemporary Perspectives on Ageism, Switzerland: Springer Open, pp 11–32.
Woods, S.B. (2019) Biopsychosocial theories, in B.H. Fiese, M. Celano, K. Deater-Deckard, E.N. Jouriles and M.A. Whisman (eds) APA Handbook of Contemporary Family Psychology: Foundations, Methods, and Contemporary Issues across the Lifespan, Washington, DC: American Psychological Association, pp 75–92.
World Health Organization (2010) Developing Sexual Health Programmes: A Framework for Action, Geneva: World Health Organization, https://iris.who.int/bitstream/handle/10665/70501/WHO_RHR_HRP_10.22_eng.pdf?sequence=1&isAllowed=y.
Zhang, Y. and Liu, H. (2019) A national longitudinal study of partnered sex, relationship quality, and mental health among older adults, The Journals of Gerontology: Series B, 75(8): 1772–82. doi: 10.1093/geronb/gbz074
