Dissertations and Theses

Date of Degree


Document Type


Degree Name

Doctor of Public Health (DPH)


Community Health and Social Sciences


William Gallo

Committee Members

Sandra E. Echeverria

Betty Wolder Levin

Michele Greene

Subject Categories

Public Health


Older Adults, Sexuality, Sexual Expression, Social Connectedness, Community-Dwelling


Sexuality is a central aspect of human identity for all people, including older persons. Sexual expression continues across the lifespan, despite the cultural fallacy of the sexlessness of older adults. Older adults live active sexual lives which involve relationships, social roles, and an array of sexuality-related needs.

This dissertation examines the relationship between sexual expression and social connectedness, in older community-dwelling adults. Research on sexuality in this community predominately focuses on genital sexual expression, has not explored the non-genital dimension of sexual expression, and little is known about the role of social relationships that can play in supporting sexual expression. The present study addresses these critical needs by investigating the intersections of older age, holistic sexual expression, and social connectedness to better inform further investigation and to guide the development of interventions ­­- all aiming to help support sexually healthier and happier lives of older adults.

The study uses data from the 2005 National Social Life, Health, and Aging Project (NSHAP), a nationally representative, longitudinal population-based survey of 3,005 adults (aged 57-85). It is a unique dataset that captures both sexuality questions and social connections amongst older adults. My study sample is comprised of community-dwelling older adults. Using ten sexuality-related measures, the study used Exploratory Factor Analysis to develop summary factors to measure older adult sexual expression. To assess if social connectedness and social non-isolation, composite variables previously developed by Cornwell and Waite (2009) from the same NSHAP dataset, are associated with sexual expression, these social connectedness variables were tested as predictors of sexual expression. The study population was then stratified by age and gender to evaluate their interaction on the relationship between social connectedness and sexual expression variables.

To evaluate non-genital sexual expression, this study also established an “intimacy” factor, variables that were considered “above-the-waist” or more holistic in addition to a genitally focused “sensuality” factor. This study’s focus, which incorporates non-genital expression to the investigation of sexual expression, provides an important missing component to this public health issue: a lens that includes the whole person, for their whole lives.

This investigation’s findings build upon previous research and demonstrated that (1) sexual expression in older adults includes genital and non-genital domains, (2) is distinct from sexual expression in younger people, and (3) is under-explored. Results indicated that both a non-genitally focused intimacy domain and a genitally-focused sensuality domain exist. While the sensuality domain may dominate sexual expression in younger adults, the present study contributes evidence that the pendulum may swing in older adulthood with the intimacy domain driving their sexual expression. The study’s main finding was that the social variable (social non-isolation) is related to the intimacy dimension of sexual expression, and merits further study.

Notably intimacy is positively and significantly associated with social non-isolation (beta = .23; p < .001), whereas social connectedness’s estimated coefficient remains small, negative, and statistically nonsignificant (beta = -.04; p > .05). The association between intimacy and social non-isolation and social connectedness found that males (compared to female) and married subjects (compared to single) had significantly higher intimacy values, while Blacks (compared to Whites) had significantly lower intimacy values. Self-reported mental health was positively correlated with intimacy values., In addition to the connection between mental health and non-isolation, this study established a link between a person’s perception of their mental health and their intimacy score. No relationship was shown to exist between social non-isolation and sensuality nor social connectedness and sensuality.

Based on these findings, it is recommended that interventions incorporate a focus on the intimacy and social connectedness dimensions of sexual expression in older adult programming. Service agencies and providers should train staff using a holistic approach to older adult sexuality; and incorporate sexual expression and social connectedness into their client resources, referrals, and services. As the present study’s sample was predominantly white, married, and heterosexual, future research should investigate a more diverse population of older adults. New studies should include populations characterized by more racial diversity, individuals with diverse gender and sexual orientations, and those who are partnered/not partnered, but not married. Without advancing the knowledge of older adult sexual expression and its interaction with social connectedness, an entire dimension of sexuality, and its implications on the public’s health may be lost.

Included in

Public Health Commons


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