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      Declines in Sexual Activity and Function Predict Incident Health Problems in Older Adults: Prospective Findings from the English Longitudinal Study of Ageing

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          The objective of this study was to investigate cross-sectional and longitudinal associations between declines in sexual activity and function and health outcomes in a large population-based sample of older adults. Data were from 2577 men and 3195 women aged ≥ 50 years participating in the English Longitudinal Study of Ageing. Past-year changes in sexual desire, frequency of sexual activity, and ability to have an erection (men)/become sexually aroused (women) were assessed at baseline by self-completion questionnaire. Health outcomes (self-rated health, limiting long-standing illness, doctor-diagnosed diseases of the vascular system, and cancer) were self-reported at baseline (2012/2013) and 4-year follow-up (2016/2017). Data were analyzed using logistic regression, adjusted for sociodemographics, health behaviors, and depressive symptoms. Prospectively, men who reported a decline in sexual desire had higher odds of incident limiting long-standing illness (OR 1.41, 95% CI 1.04–1.91) and incident cancer (OR 1.63, 95% CI 1.06–2.50) than those who maintained their sexual desire. Men who reported a decline in the frequency of sexual activities had higher odds of deterioration in self-rated health (OR 1.47, 95% CI 1.04–2.08) and incident limiting long-standing illness (OR 1.69, 95% CI 1.20–2.37). In women, a decline in frequency of sexual activities was associated with deterioration of self-rated health (OR 1.64, 95% CI 1.07–2.51). Erectile dysfunction was longitudinally associated with poorer health outcomes including incident cancer (OR 1.73, 95% CI 1.11–2.70), coronary heart disease (OR 2.29, 95% CI 1.29–4.07), and fair/poor self-rated health (OR 1.66, 95% CI 1.19–2.32). Practitioners should be mindful that a decline in sexual activity, desire, or function in older age may be an important indicator of future adverse health outcomes.

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          The online version of this article (10.1007/s10508-019-1443-4) contains supplementary material, which is available to authorized users.

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          Most cited references 28

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          Natural killer cells: In health and disease.

          Natural killer (NK) cells constitute our bodies' frontline defense system, guarding against tumors and launching attacks against infections. The activities of NK cells are regulated by the interaction of various receptors expressed on their surfaces with cell surface ligands. While the role of NK cells in controlling tumor activity is relatively clear, the fact that they are also linked to various other disease conditions is now being highlighted. Here, we present an overview of the role of NK cells during normal body state as well as under diseased state. We discuss the possible utilization of these powerful cells as immunotherapeutic agents in combating diseases such as asthma, autoimmune diseases, and HIV-AIDS. This review also outlines current challenges in NK cell therapy.
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            Sexual expression in later life: a review and synthesis.

             J DeLamater (2011)
            In the past decade, researchers have begun to study the sexual functioning of typical older persons. This review summarizes literature on the sexuality of men and women over age 50 as researched by social and health scientists. Research on the relationship of biological factors (changes accompanying aging), health (physical, mental, and medication use), psychological factors (attitudes, information about sex), relationship factors (status, satisfaction), and sexual functioning (desire, dysfunctions, treatment) to sexual behavior is reviewed. The review suggests that (a) men and women remain sexually active into their 70s and 80s, (b) aging-related physical changes do not necessarily lead to decline in sexual functioning, and (c) good physical and mental health, positive attitudes toward sex in later life, and access to a healthy partner are associated with continued sexual activity. In turn, regular sexual expression is associated with good physical and mental health. Progress in understanding later life sexuality requires development of comprehensive theoretical models, a broad focus on intimacy, attention to measures and samples, and research on couples. Progress in understanding is especially important, given the aging of populations.
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              Sexual Health and Well-being Among Older Men and Women in England: Findings from the English Longitudinal Study of Ageing

              We describe levels of sexual activity, problems with sexual functioning, and concerns about sexual health among older adults in the English Longitudinal Study of Ageing (ELSA), and associations with age, health, and partnership factors. Specifically, a total of 6,201 core ELSA participants (56 % women) aged 50 to >90 completed a comprehensive Sexual Relationships and Activities questionnaire (SRA-Q) included in ELSA Wave 6 (2012/13). The prevalence of reporting any sexual activity in the last year declined with age, with women less likely than men at all ages to report being sexually active. Poorer health was associated with lower levels of sexual activity and a higher prevalence of problems with sexual functioning, particularly among men. Difficulties most frequently reported by sexually active women related to becoming sexually aroused (32 %) and achieving orgasm (27 %), while for men it was erectile function (39 %). Sexual health concerns most commonly reported by women related to their level of sexual desire (11 %) and frequency of sexual activities (8 %). Among men it was level of sexual desire (15 %) and erectile difficulties (14 %). While the likelihood of reporting sexual health concerns tended to decrease with age in women, the opposite was seen in men. Poor sexual functioning and disagreements with a partner about initiating and/or feeling obligated to have sex were associated with greater concerns about and dissatisfaction with overall sex life. Levels of sexual activity decline with increasing age, although a sizable minority of men and women remain sexually active until the eighth and ninth decades of life. Problems with sexual functioning were relatively common, but overall levels of sexual health concerns were much lower. Sexually active men reported higher levels of concern with their sexual health and sexual dissatisfaction than women at all ages. Older peoples' sexual health should be managed, not just in the context of their age, gender, and general health, but also within their existing sexual relationship.

                Author and article information

                Arch Sex Behav
                Arch Sex Behav
                Archives of Sexual Behavior
                Springer US (New York )
                20 August 2019
                20 August 2019
                : 49
                : 3
                : 929-940
                [1 ]GRID grid.83440.3b, ISNI 0000000121901201, Department of Behavioural Science and Health, , University College London, ; 1-19 Torrington Place, London, WC1E 6BT UK
                [2 ]Department of Epidemiology, Center for Public Health, Vienna, Austria
                [3 ]GRID grid.5841.8, ISNI 0000 0004 1937 0247, Research and Development Unit, Parc Sanitari Sant Joan de Déu, , Universitat de Barcelona, ; Fundació Sant Joan de Déu, Barcelona, Spain
                [4 ]GRID grid.469673.9, Instituto de Salud Carlos III, , Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, ; Madrid, Spain
                [5 ]GRID grid.37640.36, ISNI 0000 0000 9439 0839, Physiotherapy Department, , South London and Maudsley NHS Foundation Trust, ; Denmark Hill, London, UK
                [6 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, , King’s College London, ; De Crespigny Park, London, UK
                [7 ]GRID grid.5115.0, ISNI 0000 0001 2299 5510, Faculty of Health, Social Care and Education, , Anglia Ruskin University, ; Chelmsford, UK
                [8 ]GRID grid.5326.2, ISNI 0000 0001 1940 4177, Consiglio Nazionale delle Ricerche Area della Ricerca di Padova, Neuroscience Institut, ; Padua, Italy
                [9 ]GRID grid.5115.0, ISNI 0000 0001 2299 5510, The Cambridge Centre for Sport and Exercise Sciences, , Anglia Ruskin University, ; Cambridge, UK
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: FundRef, Cancer Research UK;
                Award ID: C1417/A22962
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                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                Sexual medicine

                sexual function, sexual activity, erectile dysfunction, older adults, health outcomes


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