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Egbewale B, Adebimpe W. Sexual Behaviours among the Elderly Population in Osun State, Southwestern Nigeria. Elderly Health Journal. 2020; 6 (1) :16-23
URL: http://ehj.ssu.ac.ir/article-1-180-en.html
Department of Community Medicine, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Nigeria , lekanadebimpe@gmail.com
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Sexual Behaviours among the Elderly Population in Osun State, Southwestern Nigeria
 
Bolaji E Egbewale 1, Wasiu O Adebimpe *2
1.Department of Community Medicine, College of Health Sciences, Ladoke Akintola University of Technology, Osogbo, Nigeria
2. Department of Community Medicine, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Nigeria

 
Article history
Received 5 Nov 2019
Accepted 5 Apr 2020

 
A B S T R A C T

Introduction: The population of the elderly and older persons worldwide has increased over time as demographic transition thickens. In Nigeria, whereas, most interventional efforts are geared towards prioritizing and protecting youth sexuality, very little or no attention is being given to the sexuality of the elderly. The objective of this study therefore was to determine sexual behaviors among the elderly population in Osogbo, southwestern Nigeria.
 
Methods: This was a community based descriptive cross-sectional study carried out in 2016 among 491 eligible elderly respondents drawn from a simple random sample of five clusters. Research instrument was interviewer administered semi-structured and pretested questionnaire. Bivariate analysis using chi-square test was used to examine association between categorical variables at 5% level of significance. Responses were analyzed using the SPSS software version 21.0.
 
Results: Mean age in years of respondents was 66.9 ±7.3 SD, 106 (21.6%) were males, 78 (15.9%) have had sex within the last 12 months, 25.9% had high sexual risk behavior while 45 (9.2%) described themselves as still sexually active. Major predictors of having sexual intercourse within the past 12 months and self-reported of being sexually active include; living with spouse, having low educational status, currently taking alcohol, having a regular source of income and being a male, p < 0.05 in each case.
 
Conclusion: The elderly age group is still sexually active to varying levels, thus stressing the importance of prioritizing elderly sexual health as part of a holistic and comprehensive geriatric care programmes.
 

Keywords: Sexual Behavior, Aged, Predictors, Nigeria


Copyright © 2020 Elderly Health Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cite.

 
Introduction
 
    The population of the elderly and older persons worldwide has increased over time as demographic transition thickens, thus making issues affecting this significant proportion of the human population to becoming increasingly more important. They face several medical and social problems that necessitate the attention of stakeholders in geriatric care. In a study, about 57% of above 60 years population were described as sexually active (1) in a bid to become socially relevant and maintain relationship amidst several other factors mediating social roles in their environment. Research has also suggested that many older people enjoy an active sex life contrary to some beliefs, probably exposing to common sexuality related problems (2).
    Current knowledge may have suggested that sexual functioning and frequency declines with age (2, 3). As reasons for reduced sexual interest, some of the multiple interacting etiologies include general physical health, psychological causes, and sexual dysfunction which often interact to bring about poor sexual desires; and the less importance placed on elderly sexuality compared to the younger population (4). As for the younger counterparts, high risk sexual behavior could predispose the elderly to social problems related to unstable relationships, broken homes, and sexually transmitted infections including HIV/AIDs.
    While HIV-related sexual risk behaviors have been studied extensively in younger people, limited information exists about these behaviors among older population. Generally there is serious dearth of information on elderly sexuality among Africans. Since many men and women have been reported that they could remain sexually active well into later life (5-7), then the poor availability of literature on sexuality in elderly people leaves social scientists and clinicians with the impression that older adults have either dismal or non-existent sex lives. It is thus important to ascertain social factors surrounding sexual relationships among the elderly as well as their sexual risk behaviors. This study therefore determined sexual pattern and its determinants among the elderly population in Osun State, southwestern Nigeria.
 
Methods
Study Area/Location
    The study was carried out in Osun State. The state is located in the south-western Nigeria and share boundaries with Kwara State in the North, in the east partly by Ekiti State and partly by Ondo State, in the south by Ogun State and in the west by Oyo State. Osun state is situated in the tropical rain forest zone and it has a Land area of approximately 14,875 sq km. According to the 2006 National Population Commission Census (8). Osun state has a population of 3,423,535 and its capital is Osogbo. The state is made up of 30 administrative areas also known as Local Government Areas LGAs. For the purpose of this study, each LGA represents a cluster.
Study design
    Community based descriptive cross sectional study.
Study population
    Elderly population in Osun State who at the time of study were 60 years and above and who gave consent to participate in the study. All eligible respondents must have resided in the selected clusters (local government areas) for at least six months before the survey and should be fit on general physical examination.
Sample size
    We calculated a minimum sample size of 382 at 80% power would be required to estimate sexual behaviour among the elderly at 95% confidence interval with a prevalence of 54% being the proportion of the elderly that reported one or more sexual intercourse within six months prior to the study (9). This value was increased to 491 for better representation and increased study power.
Sampling methods
    Five of the thirty clusters in the state were selected by simple random sampling. In each of the selected clusters, the central primary health care facility was designated as the meeting point for the medical outreach. Adequate publicity and mobilization at grass-root level was facilitated and ensured by the Health Educators, community and religious leaders in the selected clusters prior to data collection and other field events.
Research instrument
    Were essentially semi-structured interviewer-administered pretested questionnaire. This was administered alongside general physical health examination by community health physicians in the research team and should not be pale, afebrile, anicteric and no significant peripheral edema. Communications with the elderly respondents was almost entirely by the indigenous language – Yoruba. On few occasions of encountering non-indigenes, depending on the level of education, Pigeon English (some form of adulterated English language) or English language was adopted as language of communication. Overall, data collection took a period of three weeks preceded by a two day intensive training for all field workers on effective research data collection particularly from the elderly persons.
Ethical considerations
    To conduct the study was obtained from the research ethics committee of LAUTECH Teaching Hospital Osogbo. Written and verbal informed consent were obtained from each of the elderly before proceeding with data collection.
Data analysis
    Was essentially by inputting the data into the computer system and analyzing them using the SPSS software version 21.0 after data cleaning and checking for consistency of data entered through double entry and random checks. Frequency tables and a chart were used to present univariate data. Bivariate analysis was carried out using Chi-square test. Determination and scoring of sexual risk behavior was carried out by listing all variables that constitute high-risk sexual behavior. The 13 variables were managed by scoring 1 for a risk factor and zero when a risk factor was not applicable. Scores above the average of the total possible scores was categorized as high risk behavior while scores below the average of the total possible scores was categorized as low risk behavior. A binary logistic regression was used to identify predictors of sexual behavior of the elderly. Three outcome variables used to measure elderly sexual behavior were; having had sex within the past 12 months, still enjoys sex, and being currently sexually active. Statistical significance was reckoned at 5% level.
 
Results
    Table 1 shows that the mean age in years of respondents was 66.9 ± 7.3 SD, with 110 (22.4%) being in the 75 to 85 years category; 106(21.6%) were males, 202(41.1%) were living with spouses, 251(51.1%) lived in rural areas, 332(67.6%) had no formal education while 211(43.0%) claimed they have regular source of income. Table 2 shows that one hundred and fourteen (23.2%) lived in rented apartment while 315(64.2%) lived in personal apartment, 300(61.1%) lived with a person that can take care of them, 105(21.4%) have ever used alcohol drinks while 31(6.3%) were current smokers; 372(75.8%) claimed they were satisfied with their lives achievements. Table 3 shows that seventy eight (15.9%) have had sex within the last 12 months, among which 13(2.6%) had casual sex partners. Sixty-six (13.4%) described their interest in sex within the last 12 months as ‘completely lost interest’, 168(34.2%) said they have developed more interest. Only 11(2.2%) showed interest in having more children.
    Seven (1.4%) described their sexual relationship as delightful, 31(6.3%) described it as pleasurable while 16(3.3%) described it as most satisfactory. Forty two (53.8%) of the 78 that had sex 12 months before the survey said they still enjoy sexual intercourse with opposite sex while 45(9.2%) described themselves as still sexually active. Table 3 also shows that 25.9% had high sexual risk behavior while 74.1% had low sexual risk behavior. Tables 3 and 4 shows that a statistically significant association exits between having had sexual intercourse within the last 12 months and the four variables of gender, marital status, education status and having regular income (p = 0.001). Similar statistically significant association was found for being currently sexually active and still enjoying sexual intercourse with the three variables of gender, marital status and education status (p = 0.001).
    Tables 3 and 4 also shows that respondents who were old old and very old have the same odd (OR = 0.91) of having sexual intercourse as an elderly and this observation was found not to be statistically significant (OR = 0.91, 95% CI = 0.5254-1.5782, p = 0.3661). Male elderly were about nine times more likely to have had sexual intercourse as an elderly compared to female elderly and this observation was found to be statistically significant (OR = 9.91, 95% CI = 5.7147-17.1815, p = 0.001). Location, whether rural or urban is not a determinant of the odd of having sexual intercourse as an elderly and this observation was found not to be statistically significant (OR = 0.98, 95% CI = 0.5991-1.6077, p = 0.4710). In addition, men were 2.6 times more likely to be sexually active compared to women and this observation was found to be statistically significant (OR = 2.66, 95% CI = 12.0702-58.7141, p = 0.001) according to Table 3.
    Respondents with no or primary level of education were less likely to have had sexual intercourse as an elderly compared to those with secondary or tertiary level education and this observation was found to be statistically significant (OR = 0.22, 95% CI = 0.1188 - 0.3961, p = 0.001). Respondents having regular source of income were twice more likely to have sexual intercourse as an elderly within the past 12 months compared to those without regular income though this observation was also found to be statistically significant (OR = 2.11, 95% CI = 1.2682-3.5189, p = 0.0019). Male were almost ten times more likely to have had sex in the past 12 months compared to females. Likewise male were about twelve times more likely to be currently sexually active compared to females. Both observations was found to be statistically significant
    Thus, major socio-demographic predictors of having sexual intercourse within the past 12 months as an elderly and being sexually active include being a male, having low education status, currently taking alcohol, still enjoying sexual intercourse and having a regular source of income.
 
 
Table 1. Personal data of respondents (n = 491)
Variable   Frequency %
Age (in years)
 
60-74 (young old) 369 75.2
75-85 (old old) 110 224
> 85 (very old) 12 24
Gender
106 21.6
Female 385 78.4
Marital status
 
Living with spouse 202 41.1
Not living with spouse 289 58.9
Religion
296 60.3
Christians 195 39.7
Residence
 
Rural 251 51.1
Urban 240 48.9
Highest education level
 
None (nil formal) 332 67.6
98 20.0
Secondary 34 6.9
Tertiary 27 5.5
Clusters
 
Ede North 96 19.6
Obokun 78 15.9
Olorunda 85 17.3
Orolu 90 18.3
Ejigbo 142 28.9
Having regular source of income Yes 211 43.0
No 280 57.0
 
Table 2. Social history of respondents (n=491)
Variable (Yes option only)   Frequency %
Present residential status
 
Rented apartment 114 23.2
Personal apartment 315 64.2
Resident with child/relatives etc 59 12.0
Others 3 0.6
Living with a person that takes care of him   300 61.1
Satisfied with present residential arrangement   292 59.5
Considers self to be lonely   63 12.8
Ever used alcohol drinks   105 21.4
Currently taking alcohol   31 6.3
Ever smoked   92 18.7
Current smoking   4 0.8
Takes kolanut   165 33.6
Have any source of worry   196 39.9
Satisfied with one’s life   372 75.8
 
Table 3. Sexual history of respondents (n = 491)
Variables   Frequency %
Had sex within the last 12 months (n = 491)
78 15.9
No/no response 413 84.1
If yes, have had casual sex partners (n = 78)   13 2.6
Interest in sex within last 12 months (n = 243) Less interest/    
Completely lost interest 66 13.4
More interested 168 34.2
Others 12 4.9
No of biological children (n = 374) 1-4 115 23.4
5 259 52.7
Any concern about menopause or andropause (n = 491) Not concerned at all 145 29.5
Sometimes concerned 346 70.5
Still desire to have more children (n = 491)
11 2.2
346 70.5
No response/not sure 134 27.3
Sexual relationships with (n = 76) Female 59 77.6
Male 17 22.4
Have casual sexual partner (n = 491) Yes 13 2.6
No 478 97.4
Still enjoying sexual intercourse with opposite sex  Yes 42 53.8
No 36 46.2
Physical pleasurability of relationship (n = 64) Delightful 7 1.4
31 6.3
Most satisfactory 16 3.3
Mixed 10 2.0
Sexual risk status High risk 364 74.1
Low risk 127 25.9
Believes he/she is currently sexually active(n = 491) Yes 45 9.2
No  446 90.8
 
 
 
 
Table 4. Association between outcomes variables and some personal data of respondents
  Bivariate analysis Binary logistic regression
Variables Have had sex in the past 12 months Statistics OR 95% CI p-value
Yes No χ2-value p-value   Lower Upper  
Age
Young old
Old old/Very old*
 
56(18.5)
22(20.0)
 
246(81.5)
88(80.0)
 
2.244
 
0.326
 
0.91
 
0.5254
 
1.5782
 
0.366
Gender
Male
Female*
 
50(49.5)
28(9.0)
 
51(50.5)
283(91.0)
 
81.486
 
0.001**
 
9.90
 
5.7147
 
17.1815
 
0.001**
Marital status
Live with spouse
Not with spouse*
 
52(30.4)
26(10.8)
 
119(69.6)
215(89.2)
 
25.091
 
0.001**
 
3.61
 
2.1454
 
6.0860
 
0.001**
Residence
Rural
Urban*
 
37(18.8)
41(19.1)
 
160(81.2)
174(80.9)
 
0.006
 
0.941
 
0.98
 
0.5991
 
1.6077
 
0.470
Having regular source of income
Yes
No
 
 
50(24.6)
28(13.4)
 
 
153(75.4)
181(86.6)
 
 
8.467
 
 
0.004**
 
 
2.11
 
 
1.2682
 
 
3.5189
 
 
0.001**
Still enjoys sexual intercourse
Yes
No
 
 
42(35.6)
36(13.0)
 
 
76(64.4)
241(87.0)
 
 
2.666
 
 
0.001**
 
 
3.69
 
 
2.2117
 
 
6.1884
 
 
0.001**
Consider Self to  be lonely
Yes
No
 
 
8(17.0)
70(19,2)
 
 
39(83.0)
295(80.8)
 
 
0.126
 
 
0.722
 
 
0.86
 
 
0.3868
 
 
1.9318
 
 
0.374
 
Variables Currently sexually active Statistics OR 95% CI p-value
Yes No χ2 value p-value   Lower Upper  
Age
Young old
Old old/Very old*
 
33(13.4)
12(14.5)
 
213(86.6)
71(85.5)
 
0.084
 
0.959
 
0.91
 
0.4492
 
1.8705
 
0.399
Gender
Male
Female*
 
35(51.5)
10(3.8)
 
33(48.5)
251(96.2)
 
103.691
 
0.001**
 
26.62
 
12.0702
 
58.7141
 
0.001**
Marital status
Living with spouse
Not with spouse*
 
34(26.2)
11(5.5)
 
96(73.8)
188(94.5)
 
28.334
 
0.001**
 
6.05
 
2.9376
 
12.4724
 
0.001**
Residence
Rural
Urban*
 
21(12.0)
24(15.6)
 
154(88.0)
130(84.4)
 
0.891
 
0.345
 
0.73
 
0.3932
 
1.3875
 
0.175
                 
*Reference category                              **Statistical Significant
Table 5. Association between sexual behaviour outcomes variables and some personal data of respondents
  Bivariate analysis Binary logistic regression
Variables Have had sex in the past 12 months Statistics OR 95% CI p-value
Yes No χ2 value p-value   Lower Upper  
Education level
None/primary
Secondary/tertiary*
 
53(14.9)
25(44.6)
 
303(85.1)
31(55.4)
 
35.136
 
0.001**
 
0.21
 
0.1188
 
0.3961
 
0.001**
Have regular  income
Yes
No*
 
50(24.6)
28(13.4)
 
153(75.4)
181(86.6)
 
8.467
 
0.004**
 
2.1
 
1.2826
 
3.5981
 
0.002**
Sexual risk
High
Low*
 
13(17.3)
89(28.0)
 
62(82.7)
230(72.0)
 
3.941
 
0.139
 
0.54
 
0.2840
 
1.0338
 
0.028**
Currently takes  alcohol 15(48.4)
45(19.7)
16(51.6)
184(80.3)
12.702 0.001** 3.83 1.7640 8.3304 0.001**
 
 
Variables Currently sexually active Statistics OR 95% CI p-value
Yes No χ2 value p-value   Lower Upper  
Education level
None/primary
Secondary/tertiary*
 
32(11.3)
13(27.7)
 
250(88.7)
34(72.3)
23.478 0.001** 0.33 0.1601 0.6999 0.003**
Have regular  income
Yes
No*
 
32(19.5)
13(7.9)
 
132(80.5)
152(92.1)
 
9.428
 
0.002**
 
2.85
 
1.4281
 
5.6259
 
0.001**
Consider Self to be lonely 5(17.2)
40(13.3)
24(82.8)
260(86.7)
0.342 0.559 1.35 0.4886 3.7532 0.275
Currently takes alcohol
Yes
No
 
10(45.5)
23(12.5)
 
12(54.5)
161(45.5)
15.863 0.001** 5.83 2.2647 15.0252 0.001**
*Reference category                              **Statistical Significant
 
 
Discussion
    Quite a contrast to most reproductive health sexuality and fertility research focusing on the adolescents and young adults, this study assessed the issue of sexuality among the various categories of the elderly in order to determine their sexual pattern and behavior. Only few and far less than one fifth of our respondents have had sexual intercourse within the last 12 months with about two thirds reporting less interest in sex. This finding which could probably be due to the ageing process and reducing quantity of the testosterone hormone among the elderly that is in disagreement with another study (2) that reported a prevalence of sexual activity among three quarter of the elderly respondents studied. A higher sexual activity figure was also reported by Lindau et al. (10), but most of these studies actually included pre-elderly age group in their research respondents, and such would make the potential of their figures to be higher if truly sexual activity reduces with age. Reduced sexual attraction, cultural and societal expectations, poverty and loss of strength among other mental and physical disorders could have been responsible for reducing sexual activities among the elderly. This explanation for reduced sexual activity has been supported by another similar study (3).
 
    In our study, about one third said they still enjoy sexual intercourse, while less than one tenth described themselves as sexually active coupled with about one third claiming they still have interest in sex. This pattern of sexual activity among the elderly is low when compared to yet another study (1) that reported about 57% being active. Though these comparative studies have used 60 years as their cut off age, this reference study reported that others had become completely abstinent at some time in their lives. Statistical analysis of this reference study also revealed significant gender, health and educational status based differences in the sample in support of our findings where gender and education status were major predictors of elderly having sexual intercourse. The female gender most especially the widowed are traditionally or culturally expected to remain single and pre-occupy themselves with the care of children and grandchildren, the same may not hold for the elderly male who probably believes that he is still socially relevant in the society, who wants care from younger women most especially those with regular income which is one of the major predictors from our study.
    In our study, some elderly described their sexual relationship as delightful, some described it as pleasurable, some as most satisfactory while about one third said they still enjoy sexual intercourse with opposite sex. This supports findings from another study (9) in which about two third indicated that sexual intercourse or activity is appropriate, a little more than half reported having sexual desire, a little less than half considered sex very important in their lives, a little more than half  reported one or more instances of sexual intercourse. This shows the dire importance of sex to life most especially among the elderly men, despite the fact that menopause and andropause may have taken place or commenced as the case may be. The issue of satisfaction was also supported by another study (11).
    In our study, men were 2.6 times more likely to be sexually active compared to women and this observation was found to be statistically significant. This supports another study (12), who reported that women were less likely than men to be sexually active in the previous 6 months (54.3% vs 62.0%). However the non-significant odd of being sexually active or having sexual intercourse within the past 12 months negates findings from some other studies (3, 11, 13). This may not be unconnected with the inclusion of younger age in some of these studies while trying to do age correlation, and also the time limit set for sexual activity which is just a period of the past 12 months in our study. As a matter of limitation to this study, issues of sexuality are private matter to individuals and there was a possibility of dis-inhibition to volunteering information at first. This we overcome by telling them the rationale for the study and assuring them that data collected are confidential and for research purpose only. As a consequence, the elderly age sub-groups are still sexually active to varying levels with a belief that life must continue. They could face several sexuality interest related challenges and consequences in addition to their physical health limitations. This study also showcased the need to prioritize elderly sexual health care.
 
Conclusion
    The elderly age sub-groups are still sexually active to varying levels most especially the male and those with regular income. With a belief that life must continue in the presence or absence of a climacteric and andropause period, the elderly could face several sexuality interest related challenges and consequences in addition to their physical health limitations. Stakeholders in elderly care and reproductive health have to prioritize elderly sexual health in the same way they do for the younger generation as part of a holistic and comprehensive geriatric care for the teaming and increasing population of the elderly in Osun state and Nigeria as a country.
 
Study limitations
    In this environment, matters relating to sexual intercourse are usually regarded as private and should not be expressly shared in public. This led to some level of dis-inhibition to volunteer sexuality information among some of our respondents. Initial counseling and assurance of confidentiality of data collected resolved this issue
 
Funding
    The study was supported by the TETFund Institutional-based grant of Ladoke Akintola University of Technology, PV No: 00011220.
 
Conflict of interest
    None to declare, between authors and concerned institutions.
 
Acknowledgements
    Authors wish to thank the community leaders in the locations where data collection took place. We sincerely appreciate all our elderly respondents who gave consent to participating in this study.
 
Authors’ contributions
    BE owned the concept of this research. He worked on data collection, analysis and write up. WO worked on data management, writing and review of the manuscript.
 
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Type of Study: Research | Subject: General
Received: 2019/11/5 | Accepted: 2020/04/5 | Published: 2020/06/27

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