The extended life expectancy of adults in the United States has new implications for successful aging, particularly because the majority of older adults suffer from multiple chronic conditions which affect other aspects of their lives. One implicated aspect is their sexual activity. Thus, considering that chronic diseases can have harmful effects on sexual behavior and older adults today are more sexually active compared to earlier cohorts, my dissertation investigates how chronic disease burden is related to the sexual behavior and sexual satisfaction of older adults in intimate relationships. I use a three-essay approach to address this research question. The data come from Wave 1 and Wave 2 of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative, community-based sample of older Americans. In the first paper, I use the lagged dependent variable approach to examine how chronic disease burden is related to sexual frequency and functioning, with a comparison by gender. Results from OLS regression models indicate that for older men, a higher chronic disease burden is negatively associated with sexual frequency. Results from binary logistic regression models demonstrate that for older women, a higher chronic disease burden is related to a greater risk of experiencing sexual dysfunction. In my second paper, I narrow my sample to adults who have one or more chronic diseases at Wave 1 to examine marital quality as a key factor that influences sexual behaviors at Wave 2. I run OLS regression models to find that for disease-afflicted older men, both baseline and change in positive marital quality is positively related to greater sexual frequency, while baseline and change in negative marital quality is negatively associated with sexual frequency. For older women, only an increase in positive marital quality between waves and a decrease in negative marital quality between waves is associated with more frequent sex at Wave 2. In my final paper, I use dyad data from NSHAP Wave 2 and utilize actor-partner interdependence models to examine how chronic disease burden is associated with sexual frequency within older married couples, and, in turn, how it relates to husbands’ and wives’ sexual satisfaction. My analysis of couple-level NSHAP data reveals that a husband’s lower chronic disease burden is related to his greater sexual frequency which is further related to his and his wife’s increased sexual satisfaction. A husband’s lower chronic disease burden is also linked to his wife’s greater sexual frequency, and her greater sexual frequency is positively associated with her own sexual satisfaction. However, a wife’s chronic disease burden is not significantly related to her own or her husband’s sexual frequency, nor are her husband’s feelings of sexual satisfaction affected by her sexual frequency. Taken together, these studies confirm that multimorbidity in later life plays a significant role in older adults’ sexual lives. In addition to specifying how chronic disease burden can disrupt sexuality, my research demonstrates how marital quality may buffer the stress of illness to protect older adults’ sexual frequency, while also highlighting how partner effects provide a more detailed understanding of how disease is intertwined with sexuality in older marriages. My research makes a significant contribution to the underexplored area of older adults’ sexuality by identifying factors that can help maintain their sexual lives.
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