INTRODUCTION

Sexuality is one of the human dimensions that are least explored and addressed by Health Sciences in old age, despite the diverse evidence of care needs expressed by older adults themselves^(1,2). Sexuality in old age is conceived as the energy that drives people to seek love, human contact, tenderness and intimacy; it is expressed through feelings, movements and tactile sensations⁽³⁾. In the group of older adults, sexuality is influenced by upbringing, culture, couple relationships, negative stereotypes and body sensations experienced throughout the years^(4,5).

Nowadays, society conceives old age as a life stage where the body is diminished in all its abilities⁽⁶⁾; stereotypes such as inability and disease are constantly attributed to the aged population, thus assuming its impossibility of experiencing sexuality. The physical changes inherent to the aging process, the presence of diseases or even medication use do not mean that older adults' sexuality has come to an end; however, these situations do require adaptations to the new possibilities of an aged body and constant Nursing care⁽⁷⁾.

Among other influencing factors we can mention those related to the social environment and to the culture where these people interact; ideas such as asexuality in old age, the criticism to looking for a partner in this life stage and ageism considerably condition the experience and expression of sexuality in older adults⁽⁸⁾, who tend to repress their emotions, feelings and desires when facing the social and family judgments they are subjected to.

Older adults' sexuality is not only invisible for society; health services set aside the topic when focusing the attention on people's disease processes. In the case of Nursing, the assistance provided is seldom focused on solving needs of this nature, although care is an interpersonal practice and should be targeted at promoting people's health and growth⁽⁹⁾ and not only at disease or dependence processes.

Nurses acknowledge that it is necessary to take care of sexuality in this age group; however, they mention not feeling confident enough or having the necessary training to address this topic during the care process; therefore, the Nursing assistance provided for older adults' sexuality continues to be insufficient, sometimes nonexistent^(10,11).

For this reason, it is necessary to deepen on the topic from a comprehensive perspective that includes the beliefs, attitudes, values and behaviors that distinguish older adults from other age groups⁽¹²⁾; in other words, older adults' sexuality has to be addressed based on the way each person relates to their body and this, in turn, to the world. To this end, the Phenomenology of Perception is resorted to, a work whose premise is centered on the body as the perception instrument through which we can know ourselves, the others and the world⁽¹³⁾.

The objective is to describe the meaning of older adults' sexuality based on the influence exerted by the world and the body.

METHOD

RESULTS

Three topics emerged from the analysis of the interviews:

DISCUSSION

Older adults perceive sexuality as an important physiological need that continues to be experienced during old age and whose satisfaction is sought and valued both by men and by women, who state that this satisfaction turns out to be nice, pleasant and relaxing for their life in the present. Expressing the importance and need of experiencing sexuality is an element constantly described by researchers on the topic⁽⁷⁾, where it is stated that sexuality is seen as something positive that they want to continue experiencing in this life stage⁽⁴⁾.

The Phenomenology of Perception alludes to the human body as asexual and that, as part of its very nature, recognizes various affective states such as pleasure and pain⁽¹³⁾. Therefore, sexuality is influenced and experienced through perceptions, as sexual possibilities find support on the body experienced, understanding this body as the one in the here and now and distinguishing it from the other body dimensions: organic body (product of the ancestors); and current body (the one containing the life story marks).

Among the factors that exert an influence on the experience of older adults' sexuality, those inherent to the world experienced have been identified, where the events underwent since childhood and young age exert important impacts on the meaning attributed in the present. Repressive upbringing stands out in this sense, as well as the family/social morale and the radical stances of various religious doctrines⁽²²⁾, factors that are responsible for older adults' lack of knowledge and disinterest regarding sex education.

There is evidence about the knowledge deficit in terms of sexual topics among people aged at least 60 years old, a situation that endangers these people's health and infringes their rights⁽²³⁾. The social world in which older adults grew up instilled in their bodies the idea of sexuality as something immoral that should be concealed and repressed at all costs; however, relegating the body to the socially imposed would be a synonym to impoverishment, as what really represents corporality is the Self that has it, the body experienced that accounts for the past and is responsible for the perception of the present.

In their eagerness for educating themselves on the topic, older adults resort to communication means and to the Internet; however, despite the usefulness and benefits of digital information, there is a risk of reaching websites where information is biased, incorrect and hardly in line with the precise recommendations for this age group, hence the need for Nursing professionals to address the topic and provide due care. Adults recognize the lack of access to sex education and indicate that Internet is of great help when doubts or questions about sexuality arise; however, they state preferring to receive guidance on the topic from health professionals such as physicians and nurses⁽⁷⁾. The information experienced is understood in the sense of the needs and generalizations underlying in the social sphere as a shared way of living that generates connections, even if it may be incorrect.

In addition to the influences exerted by the world, older adults' sexuality is conditioned by factors of a physical and psychological nature. Physical difficulties and the physiological changes derived from age can condition older adults' attitudes and behaviors⁽¹⁸⁾. The physical and psychological possibilities are contained the Self's corporality and the aged body is experienced with various behavior possibilities. These behaviors will be determined by the experiences and the way in which they were perceived and, based on that, they condition the way they will be expressed by the current body⁽¹³⁾. Older adults attribute meaning to their sexuality from the bodily perceptions about the world and themselves, and it is based on these perceptions that they live, experience and express their sexuality.

Aged people perceive their body as with diminished physical possibilities, arguing the following: presence of diseases, physical limitations and permanent medication use. The testimonies indicate that these events have significantly modified their sexual expressions, which had to be adjusted to their new physical possibilities, whether due to difficulty or impossibility to indulge in genital sexual relations. The body changes related to erection, vaginal lubrication, penetration and ejaculation have been widely documented⁽²⁴⁾ and are recognized as physical and psychological elements that influence the expression of sexuality since, in addition to requiring adjustments in genital sexual relations, they exert a strong impact on older adults' self-esteem.

In this same sense, subtle sexual expressions are affected to a lesser extent by physical issues; however, the psychological impact caused by physical deterioration on older adults modifies everyday behaviors and even causes distancing from the partner. Older adults continue finding sexual satisfaction in subtle expressions such as kisses, caresses, hugs and words⁽²⁵⁾, placing love as a central element and relegating penetration as dispensable⁽²⁶⁾. Although the body possibilities are reduced over time, this should be no impediment for the expression of older adults' sexuality, as it is closely linked to any thinking and active being, as well as each person's intersubjectivity and history, so that the sexual should never be limited to the genital.

Another of the influencing factors related to the older adults' world is the social opinion about sexuality in old age along with the negative experiences they have undergone; in this sense, the stereotypes and preconceptions existing in the social collective towards aged people's sexual expressions regain strength. These elements make older adults feel ashamed of their sexual needs and prefer to repress all aspects related to sexuality. The social and family preconceptions and stereotypes towards older adults' sexuality and their aging process represent a difficulty that precludes their free and full sexual expressions⁽⁴⁾. People learn to live with these social preconceptions, labels and taboos by lowering their quality of life, as they must conceal their needs and feelings for the fear of negative criticism⁽²⁷⁾. This is why the impact exerted by the world in again considered, in the sense of projecting diverse shared knowledge that can even generate normalizations around the image of old age. Over time, it would be expected that this stereotyped image of asexual older adults would disappear or change; however, the reality indicates that it is found in a large part of society to the present day⁽²⁸⁾. All efforts to modify this perception should be based on showing the importance of experiencing sexuality in old age through education and sensitization targeted at normalizing the approach to this topic⁽⁴⁾, favoring adequate and healthy sexual practices in older adults.

The sexuality experiences underwent by older adults are determined by their corporality and by their relationship with the world and with others, so that it not only presents itself as a body possibility that is adjusted to bodily and social changes but as an intentionality of the Self, “with sexuality which, however, has long been seen as a bodily function, we now face an intentionality, not peripheral automatism…” p. 174 (free translation)⁽¹³⁾.

The results of the current study represent solid grounds to provide Nursing care for older adults' sexuality, to explore the meaning attributed by this age group to the experiences undergone around their sexuality enabling identifying opportunity areas and care needs by Nursing professionals, such as absence of sex education, the desire to normalize sexuality in old age and emotional support, which are aspects inherent to the profession that should be met. Knowing about the influences exerted by the world and the older adults' experienced body provides nurses with tools to develop care interventions that address all of a person's dimensions and, thus, achieve truly holistic care.

As study limitations we can mention the possibility that the data collection modality with digital tools may have excluded older adults that are not familiar with the technologies or that cannot access to them. In this same sense, the sample was limited to participants from a single public institution devoted to caring for older adults; therefore, it is considered convenient to explore the topic in other institutional environments and even in community ones, in order to know the phenomenon of sexuality in old age more in depth.

According to what has been presented, there is a clear need for sensitization towards older adults' sexual health needs, which should be initiated with education on the topic in order to promote its open approach; in addition, Nursing professionals need to address this theme while providing care to older adults. Education should not only be focused on people aged at least 60 years old but be started since the approaches with the family and society in general; it is only in this way that it will be possible to fight against the preconceptions and stereotypes about sexuality derived from age⁽²⁹⁾. Nursing professionals need to carry out sex education and sensitization strategies targeted at normalizing older adults' sexuality, in order to promote adequate and healthy sexual practices in this life stage⁽⁵⁾.

CONCLUSION

The meaning of sexuality from the influence exerted by older adults' body and the world is constructed based on the world experienced as per the events underwent during other life stages, as well as on the current body possibilities, which condition the perception and expression of sexuality. Older adults recognize the negative influences of their own body in experiencing sexuality and seek strategies to counteract them; however, the influences exerted by the world (such as the stereotypes and preconceptions about sexuality) represent an important challenge, not only for older adults but for health professionals and society in general.

Older adults' sexuality is influenced by the context where they interact and by the experiences underwent in this aspect. Diseases and physical limitations affect older adults' sexuality and hinder its expression; in this same sense, the stereotypes and preconceptions about sexuality existing in society and in the family condition sexual expression and force older adults themselves to repress their sexuality.