An integrated model to understand elder sexuality in urban China

Abstract

Despite the fact that China’s population is rapidly aging, the sexual behaviors of adults aged 60 or above are severely understudied. The present research is an attempt to advance understanding of sexual behaviors among older Chinese. It explores the subjective sexual experiences of older adults and examines the prevalence, characteristics and correlates of sexual behaviors of community dwelling older adults in an urban Chinese setting.

The present research utilized a sequential mixed-method research design that comprises two separate studies. Study one is a qualitative exploration of subjective sexual experience and socio-cultural circumstances related to elder sexuality. 42 semi-structured in-depth interviews were individually conducted with older Chinese residing in Chengdu and Tianjin. Study Two involves scale translation. Three measures: Chinese Senior Adult Sexuality Scale (SASS), Dyadic Sexual Regulation Scale (DSRS) and the Gender Norm Attitude Scale (GNAS) were translated and adapted for use. In particular, forward and backward translation, consultation with internal and external expert panel, and pilot testing were employed. Results indicated that all adapted scales exhibited acceptable internal consistency with Cronbach’s alphas ranging from .59 to .93. A representative sample of 688 older adults aged 60 or above randomly selected from six downtown districts in Tianjin to test an integrated model on sexual behaviors of older Chinese.

In Study One, participants reported experience in other sexual behaviors such as orgasm and the use of lubricants and other products. The influence of socio-cultural contexts on participants’ attitudes and sexual expression is evident.

The goal of Study Two is to establish the prevalence of various sexual behaviors and to identify important factors relevant to the sexual behaviors using quantitative approach. Through a comprehensive review of the continuity theory, the sexual script theory, the theory of planned behavior and the bio-psycho-social perspective, the author proposes an integrated model of engagement of sexual behaviors involving demographic characteristics, as well as biological, psychological, and social factors. Of the 688 surveyed participants, 50% of older men and forty percent of older women reported engaging in at least one type of sexual behavior in study two. Sexual intercourse (44%) and caressing(43%)were the two most prevalent among the six designated types of sexual behaviors. The results show that level of sexual interest is a salient predictor of overall engagement in sexual behaviors(intercourse, sexual touch, oral sex, orgasm, use of sexual objects and initiation of sex) (ORs ranged from 2.05 to 3.36, p < .001). Other factors such as good physical health, high level of knowledge in elder sexuality, positive attitude towards elder sexuality and having a romantic partner were all found to be positively and independently associated with engagement in various sexual behaviors; while the opposite is true with respect to age and the presence of illness.

This research is among the first empirical endeavors to investigate six types of sexual behaviors in older Chinese. The study results provide preliminary support for an integrated bio-psycho-social model in explaining sexual behavior in older Chinese. Recommendations for research, policy, and practice are also discussed.