Aging does affect the number of people who engage in sexual activity, and the percentage of sexually active adults does decline with each decade (Doskoch, 2011), as shown in ■ Table 13.3.

What factors contribute to remaining sexually active in later years? Research has consistently revealed a close correlation between the level of a person’s sexual activity in early adulthood and his or her sexual activity in later years (Kinsey et al., 1948; Kinsey et al., 1953; Leiblum & Bachmann, 1988). Lifelong consistent sexual activity may reflect an overall higher sex drive and positive attitudes toward sexuality, since both are signifi­cant influences on sexual desire and response (DeLamater & Sill, 2005).

Typically the most crucial factor influencing sexual activity in older adulthood is health. Poor health and illness have a greater effect on sexual functioning than does age itself. In long-term relationships, the poor health and loss of sexual interest by one person limits the partner’s sexual expression as well (Fisher, 2010). Besides contributing to gen­eral and sexual health, regular physical exercise, a healthy diet and weight, and light or no alcohol use help maintain sexual desire and response (Harvard Health Publications, 2006).

Older adults often find new techniques for maintaining or enhancing their enjoyment of sex despite progressive physiological changes. Oral sex, viewing sexually explicit materials, fantasy, manual stimulation, and use of a vibrator are some of the variations older cou­ples may integrate into their sexual experiences. Openness to experi­menting with and developing new sexual strategies with a supportive

partner is instrumental in continuing sexual satisfaction (Trudel et al., 2008). When genital contact becomes less frequent, interest and pleasure in and frequency of nongenital activi­ties, such as kissing, caressing, and embracing, may remain stable or increase (Kellett, 2000). In fact, a study of 1,000 couples (in the United States, Brazil, Germany, Japan, and Spain) who had been together an average of 25 years found that cuddling and caressing are impor­tant for long-term relationship satisfaction. Contrary to gender stereotypes, tenderness was rated as more important to men than to women (Heiman et al., 2011).