2020 AHS Fall Lecture Series

CARLA SANTOS: It's my pleasure to introduce to you, my dear colleague, Liza Berdychevsky. Dr. Berdychevsky is an associate professor in the Department of Recreation Sport and Tourism at the University of Illinois here in Urbana-Champaign. She graduated from the University of Florida with a PhD in health and human performance. Dr. Berdychevsky's research really revolves at the nexus of sexual health and well-being in tourism and leisure contexts, and she really adopts a gender sensitive and life course-grounded approach, specifically some of the work that she's done investigates sexual behavior, risk taking, positive sexuality, and sexual health education amongst younger and older adults in various tourism and leisure context, and she's really a globally recognized for her work, so we're very excited that she was willing to be the inaugural speaker for our department.

Her research contributes to really a deeper understanding of the issues associated with sexual health in tourism and in leisure context, and then it really does offer directions for health education programs and also prevention and intervention methods. And she publishes in our leading academic journals in leisure and health and sexuality and is recognized for that area, including having co-edited a variety of special issues on innovation and impact of sex as leisure in research and practice. Her research, like I said, has garnered our department by association really global and regional attention in a variety of news outlets, scientific, medical, news websites, and popular magazines, and so please, I'm going to hand it over to Liza and let her begin her talk today. Thank you, Liza.

LIZA BERDYCHEVSKY: Thank you very much, Carla, for this generous introduction. So just a second. I'm sharing the screen. So dear friends and colleagues of the College of Applied Health Sciences, thank you very much for joining us today for discussing positive sexuality and sexual health in later life. My name is Liza Berdychevsky, as Carla has generously introduced me.

I'm an associate professor in the Department of Recreation Sport and Tourism in the College of Applied Health Sciences, and I'm happy to present to you one of my research lines on sexuality in later life. This research line is informed by an understanding that sex can be leisure and sex can be played and that we don't stop playing because we grow old, but we grow old when we stop playing. This research line is also informed by the positive sexuality framework following the key principles of positive sexuality.

In this context, positive refers to strengths, well-being, and happiness. Sexuality is viewed as a natural and healthy aspect of human life, and sexual health and well-being are essential throughout the life course. According to this framework, knowledge of human sexuality is essential for making responsible choices, which emphasizes the importance of sexual health education throughout the lifespan. Moreover, open, honest, and respectful communication is key, and the emphasis is on the practice of safe and mutually consensual sexual activity.

Finally, this framework promotes appreciation of diversity, with an understanding that individual sexuality is unique, multifaceted, and socially and culturally constructed. And lastly, this framework offers solid foundations for the understanding of sex as leisure. Sex can be construed and performed in different ways and with various motivations, including procreational, relational, and recreational reasons.

With recreational and relational motives, sex is typically a self-contained pleasurable activities. Hence, sex is a form of leisure when it is freely chosen, pleasurable, and performed for its own sake. It may also be considered as recreation when it facilitates rejuvenation. In the literature, sex and sexual lifestyles have been explored as a form of casual leisure, serious leisure, and a form of shared flow.

And now more specifically about sex among older adults. The studies of sex in a later life have demonstrated that many older adults are sexually active, and that people continue to feel sexy and are able to express their sexuality beyond their reproductive years. Although some studies suggest that age does negatively affect sexual desire, it is not considered to be a critical factor until the age of 70 and over, and many older adults tend to maintain levels of sexual activity that they have established earlier in life.

Moreover, it was found that even the very old, age 85 plus, enjoy intimacy and achieve both familiar and new forms of pleasure and sensuality. Many studies have documented the importance and various physical and psychological health benefits of sexuality and intimate relationships in later life and some have shown that sex is often associated with a sense of vitality as well as feeling young and healthy. At the physiological level, sex is beneficial for the immune system, it improves bladder control, it lowers blood pressure, it counts as exercise, it lowers the risk of heart attack, lessens pains, may decrease the chances of prostate cancer, improve sleep, and eases stress.

Moreover, sexual activity fosters emotional intimacy and physical pleasure. It also challenges societal ageist stereotypes, it enables reestablishment of one's sexual identity, and it helps increase bodily awareness and engender comfort with an aging body. Research has also shown that subjective sexual well-being contributes to happiness in later life. Unfortunately, however, many older adults cannot enjoy the benefits of sex because of ageist stereotypes that fuel the tendency of neglecting elderly sexuality while portraying it as unimportant or even inappropriate.

This neglect is fueled by the myth that older adults are either asexual or do not engage in sexual risk taking. This neglect is also driven by the assumption that the consequences of older adult sexual risk taking for the society are not as dire as in the case of young adults. Such misperceptions lead to the marginalization of the sexual health needs of older adults, and unfortunately, some older adults internalize the stereotypes and retire from sexuality altogether.

Due to this age stereotypes, studies of sexuality in later life are still rather scarce. Moreover, they tend to adopt a biomedical perspective, ignoring the importance of psychological and social influences on sexuality. The fact of the matter is that very limited research attention has been given to older adults satisfaction with various physical and emotional aspects of their lives. One of the consequences of the age stereotypes is a lack of sexual health education opportunities for older adults.

Older adults are typically ignored in the contemporary sexual health education efforts, as they are not perceived as a high risk group. However, many of the older adults do partake in sexually risky behaviors and the rates of sexually transmitted infections among older adults have been rapidly rising in recent years in many industrialized countries. Moreover, many older adults born in the early to mid 20th century did not have any access to professional sexual health education earlier in their lives.

This void in sexual education is also exacerbated by the often restrained and biased communication regarding sex between older adults and health care providers. However, attending to the sexual needs of older adults is essential, because there are multiple gaps in their knowledge about sexuality and their bodies desires and needs are changing continuously as they are aging, hence, there is no question that sexual education should be offered to older adults. The question remains, however, regarding how it should be done and whether the outlook on sex as leisure and positive sexuality could be instrumental for such educational efforts.

With this in mind, I would like to present to you my research line on positive sexuality in later life that consists of several projects of this point, and I'm going to present some key ones. The first one is a collaboration with Galit Nimrod from Ben-Gurion University of the Negev in Israel, and it is called Let's Talk About Sex. So this was the starter of the conversation.

For this project, we have studied sex-related discussions in seniors' online communities. Seniors' online communities offer a platform for discussing every possible subject and expression of a wide variety of emotions. In this context, it's worthwhile noting that older adults are increasingly adopting internet, especially now in the reality of COVID-19 and also discussing sex online might be more comfortable to some, since it offers anonymity, facilitates comfortable sharing, and minimizes the risk of embarrassment. Hence, an online ethnographic approach called netnography was implemented in this study.

We have followed a full year of communication in 14 online communities. The overall database included under 700,000 posts from almost 80,000 authors to construct a relevant database manageable for an index qualitative analysis. These posts were filtered based on the sex-related keywords yielding a database with over 6,700 posts.

Our purpose was to examine first will the members use seniors online communities for the discussion of sexual topics, and second, what characterizes sex-related discussions in this communities? Well, we found that sex was discussed in the communities and the sex-related discussions played various roles in older adults lives. One of their main roles was serving as a sphere for consultation and intellectual dialogue.

These discussions were also described as an enjoyable and meaningful leisure activity, or simply fun. They often had a lighthearted, humorous tone and served as an avenue for edutainment, educational entertainment. And finally, community member to discuss their self-expression associated with posting, emphasizing a meaningful dimension of this participation, and here is one example

A poster shared, we have had a great fun, but there is a strong underlying truth to that fun. Many of us learned, and many got to express how they felt. Based on posters' testimonials, online sex-related discussions influence their offline sex lives in various ways that could be classified into either tangible impact that led to some behavioral changes or less tangible impacts associated with cognitive or emotional changes. One crucial behavioral change was starting to communicate with partners, friends, and professionals about sexual needs and concerns as a result of discussing these matters first online.

One person stated, it is thanks to this forum that I have overcome my embarrassment and started slowly asking some questions that were bothering me and my husband for a very long time. I was even too shy to ask my own family doctor, who like me is a woman about some very important sex issues that I care about. Another behavioral change was the adoption of strategies to actively seek and achieve sexual pleasure. For example, one person shared, thanks to you folks, I'm no longer frightened that it might be sinful to engage in pleasurable oral sex. I think I should start experimenting with some other means of sexual gratification, too.

Yet, it seems that most significant changes were cognitive and emotional reflected, in a greater sense of entitlement for pleasure, various sorts of reappraisal, losing inhibitions, gaining confidence, and a better understanding of both the sexual self and the others. So you see various examples on the slide of this use, and I'm going to read the last quote. To gain knowledge is empowering.

As children, we were kept ignorant about sex. Let's not be ignorant as we mature. As a result of this study, we have found that sex-related discussions in seniors' online communities help older adults cope with various vulnerabilities, because A, they serve as a safe sphere to discuss sexual problems and concerns, B, they offer a channel for sharing difficulties, gaining knowledge, and advice, C, they provide an opportunity for communal coping. A given sexual issue becomes our problem versus mine or your problem.

Also, online discussions liberates some older adults from offline communication constraints and facilitate their communication with health care providers and significant others. Online sex-related discussions also prompt various behavioral, cognitive, and emotional sex-related changes, and they empower older adults to enjoy sex life and the many physical and psychological benefits it has to offer. Finally, these discussions help cope with aging and resisting negative social cultural views of elderly sexuality.

Nevertheless, this only discussions are not a panacea, and they should not serve as a substitute to formal sexual health education for older adults. Indeed, we have repeatedly seen various sex-related misconceptions circulated in the posts that might be detrimental to older adults' sexual health and well-being. And I will circle back to this need for sexual health education later in the presentation, because this is actually the research project that I am working on right now. OK, another project that I would like to present today was also conducted with the Galit Nimrod, and it's titled, Sexual Until We Drop, and this is actually a quote from the database.

But we are focusing on sex as leisure in later life. Focusing on the interplay between body, mind, and social context, this study aims first to provide an in-depth understanding of the complexity of sex as leisure in later life, and second, to examine whether sex is a source of joy in later life or other cause of distress. For this study, we have implemented the same methodology of netnography that I have briefly described earlier.

This figure summarizes the major components of our findings, as well as the series that we have employed to explain the findings. The first component focuses on the importance of sex as leisure and it syncs to health and well-being in later life. Contrary to ageist societal stereotypes portraying older adults as asexual, many authors post authors in these communities stressed the role of sexual expression in their lives.

Sex was also often discussed by older adults as an enjoyable, gratifying, and even stress relieving leisure activity. They also associated the increasing importance of sex with the abundance of free time in older adulthood, but particularly after retirement. Many posters emphasize that they remain sexually active, able, and interested. They associate sex with various psychological, social, and physical benefits. Also, in the context of various life transitions, including retirement, older does describe sex as a crucial adjustment and coping strategy.

And here are a couple of quotes to illustrate this. We are simply older, not dead. Sex offers a superior, personal, instant satisfaction. Sex is nourishment for the soul, and sex helps stay fit in mind and body. Older adults also discuss various psychological, physiological, and social cultural constraints to sex in later life.

Older adults describe professional dead ends, empty nest syndrome, spousal infidelity, or demise. Frustration was a mundane as sexual routine and other wake up calls. Older adults also experience frustration about social inhibitions, prudishness, ageist stereotypes, and religious taboos imprinted on sex. Many older adults were concerned by the societal lack of acceptance of sexuality in later life, which inevitably affected their sexual self-expression.

Older adults also described various sex-related special needs that only come with age, including decreased sexual desire, diminished intensity or frequency of orgasms, and sexual dysfunction. Another constraints faced by older adults is negative body image, as some older adults do not feel attractive and see it as a potential obstacle for sexual desire. Finally, older adults discuss various constraints related to safety and risks, including lack of confidence with contraception, perceived on the safety of oral anal sex in later life, and the possibility of physical traumas or even coital death.

Here are a couple of quotes to illustrate these constraints as well. One poster shared, no way I'd let anyone handle me now. I have spinal and heart problems, I'm fragile. And another poster shared, although I'm curious about sex toys, I would not be caught dead looking at one, buying one, or even worse, dead with one. Nevertheless, many older adults did not surrender to constraints and employed various cognitive and behavioral strategies to negotiate constraints to sex in later life.

Single older adults discuss the joys and pains of dating in older adulthood, which was perceived as noble and adventurous. Novelty and innovation were prominent, not only in older adults attempts to launch new relationships, but also their efforts to maintain or revive their existing sexual relationships or to diversify their masturbation practices. They discussed various adaptive and innovative strategies enabling or diversifying their sex lives and referred to others, including visiting sex shops and trying various sex aids, sex toys, and sex medications.

Lastly, older adults related their sex lives to various reprisals that they had experienced, especially those regarding a sense of mortality, limited time ahead, living life to the fullest, enjoying life for what it is, loving and being loved, and losing inhibitions, all of which enhance sexual experimentation and innovation. Here are a couple of quotes to illustrate this as well. One of the posters encouraged other older adults in the forum to experiment, try other positions, even consult a sexpert. And don't worry, it only seems kinky the first time.

Another one shared, we can have a satisfying sex life without the presence of hard penis. Overall, our findings offer a model for treating the complex dynamics of sex as leisure in later life. While some older adults do not receive sex as important and report losing interest in it for a while or for good, others do see sex as essential for their health and well-being and desire to maintain it.

It is also essential to consider the mutual interdependence between the perceived importance of sex and the bias psychosocial constraints to sex in later life. For instance, perceived importance of sex might serve as a motivation to face and negotiate constraints, but the perception of constraints can also be a trigger for losing interest in sex. Some older adults negotiate constraints to sex in order to maintain the patterns of sexual activity established earlier in life. They long for continuity to an active in their sex lives and some even seek innovation.

Other older adults negotiate constrains, yet are unable to maintain the importance of sexual activity established earlier in life. Among them, some surrender to the constraints and retire from sex, either temporarily or permanently. Nevertheless, others negotiate this constraints through various strategies, such as selection of sexual activities, optimisation of their quality, compensation for the lost abilities with sex aids and altered sexual practices, social emotional selectivity, and innovation through behavioral, cognitive, and emotional strategies.

And of course, all of these processes should be considered in the context of the various interdependent factors, such as individual circumstances, perceptions of sexuality over the life course, social cultural views of sexuality, and persons social and demographic characteristics. The next step for us was to circle back to the importance of sexual health education in later life, and among many purposes to also explore the potential usefulness of incorporating the concept of sex as leisure and positive sexuality in that education.

My collaborators for this project are Iulia Fratila, who is also my PhD student, and she is with us today. She will talk later. Galit Nimrod and Wendy Rogers from the Kinesiology and Community Health department in our college. And this study was generously funded by the Center on Health, Aging, and Disability Pilot Grant, Center for Social and Behavioral Science Pilot Grant, and collaborations in Health, Aging, Research, and Technology Pilot Grant.

This study investigated three research questions. First, what are the perceptions of sex as leisure in later life? What are the benefits of sex as leisure, of viewing sex as leisure, and what do participants think about the possibility of including the notion of sex as leisure in sexual health reeducation for older adults? For this study, we have conducted 73 in-depth interviews, lasting from one hour 2 over three hours each, we have interviewed 26 experts from all over the country working specifically with older adults.

The levels of experience varied from 5 to over 40 years, and they came from various sex-related professions, including sex educator, sex coaches, sexologists, sexual therapy, sex activists, sex counselors, and sex shop owners, and they had various levels of education. In addition, we have also interviewed 53 older adults, ranging in age from 60 to 85 years old and coming from various social demographic backgrounds. So let's start with the use of sex as leisure.

Many sexual health experts believe that sex should be considered as leisure, saying, yes, what else would it be? They shared that practicing outercourse, as opposed to intercourse, is important in later life and that outercourse is a pinnacle of leisurely sex. The views among older adults were equivocal.

A few did not see sex of leisure, but viewed it as a means for procreation, and they retired from sex. To use their words, as God intended, because they didn't want anymore children. Other older adults had sex lives, but did not necessarily view sex as leisure. Nevertheless, there was a substantial group, a majority of older adults in this study, who remained sexually active, whether it's couples sex or masturbation, and they viewed sex as leisure.

Older adults shared that sex is leisure in later life when or because it is a fun, exciting, and playful activity. It's important to know that boring sex was not viewed as leisure. Within this realm, older adults often brought up sex toys and sex aids and other innovative strategies. They also viewed sex as leisure because it is pleasurable and satisfying activity, it is recreational and rejuvenating activity, it counts as exercise. They also viewed sex as leisure because it is a chosen rather than obligatory activity, because it leads to relaxation and enjoyment, they construed it as guiltless pleasure.

They also viewed sex as leisure because it became more meaningful for some in later life. They said that they felt entitled and compelled to be selfish because it's about me now. They also construed sex as leisure because it held them to clear their minds, and it was a mentally engaging experience. Many shared that the main sexual organ in later life is between your ears, and it's not about the instincts or urges anymore. Sex in a later life is cerebral rather than carnal.

They also qualify as sex as leisure for its ability to offer a full absorption in the experience that flow like presence in the moment. And finally, it was qualified as leisure because sex offered a sense of escape from the world. That ability to put the world on hold and enjoy the self and/or each other. Here are a couple of examples for these tendencies.

Autumn shared, sex is still leisure because you do it to relax. You do it because it's fun. You do it because you're finally alone. The kids are gone, let's have fun.

Francis also shared, I read that a 20-minute session is equal to a four mile jog, and if given a choice, I'd rather have sex than run four miles. And Marigold shared, sex became leisure as we grew older. When we are older, we feel freer, and my husband was selfish when he was young, but he realized that women are supposed to enjoy it too, and you become familiar with each other's needs, and that makes sex leisure, too.

OK, so sex experts and many older adults did view sex as leisure, but what are the benefits of such outlook on sex? Both sexual health indicators and older adults who view sex as leisure pointed the benefits of such outlook and concluded that it helps to prioritize sex and to enjoy sex. Indeed, older adults viewing sex as leisure seem to be more satisfied and had a more playful attitude toward sex in their lives, they were more eager to adopt and experiment with sex to maintain and reinvent their sex lives.

This also meant more resilience not to retire from sex. They also seemed to have a broader, flexible, and more creative definition of sex, including various forms of outercourse. They appeared to have a more humorous outlook on sex and the self and tended not to take sex too seriously. This is helpful in coping with various performance anxieties and other stressful factors such as negative body image.

They also had fewer inhibitions and concerns about normalcy or having sex urges in later life and naturalness and legitimacy of their sexual practices. Viewing sex as leisure also seem to be associated with an understanding that sex in later life is a choice, and it helps resist ageist stereotypes, portraying older adults as asexual. It is also quite possible that there is a relationship between viewing sex as leisure and the quality of sex, because when older adults were asked to define what good sex means to them, after stating the standard responses like climax, orgasm, ejaculation, most continued with describing the exact same qualities that they have used to explain why sex is leisure.

As Adam shared, cigarettes, weed, booze have been out of my life for years. This is all I got left. Sex is one of the few things I kept to enjoy life. Considering those benefits, would it make sense, then, to include the view of sex as leisure and the positive outlook on sexuality in sexual health education for older adults? Most sex experts and many older adults believed that it would indeed be beneficial.

Framing sex as leisure in sexual health education for older adults was described as potentially instrumental to help connect sex to quality of life and explain health benefits to help learn to use sex as leisure as a part of self care to help remove the shame and guilt from having non-procreational sex, to help frame sex as a form of adult play, and expand people's mindset about sex. For instance, broaden their definition of what sex can be in later life, gain a better understanding of the variations in sexual expression in later life. In other words, we all play differently.

This outlook including it in sexual health education could also help alter socially conditioned responses and inhibitions to sex. It could also help normalize and legitimize sex for older adults, give that permission that many older adults seem to need. It would also help to emphasize that sex is a choice and facilitate sexual expression, and it could help teach that sex can be a process, rather than a goal-oriented sprint, and this would take away the goal of performance because leisure is intrinsic and sex as leisure is intrinsic.

It could also help develop a more lighthearted attitude toward sex and aging, improve people's communication about sex, and actual communication was a huge constraint for most older adults in our sample. And finally, including this outlook in sexual health education would help combat loneliness and isolation, which is a huge problem for older adults, particularly nowadays under COVID-19 reality.

Here are a couple of quotes to illustrate these ideas. Mitchell, sexologist, shared, "Embracing sex as an important leisure and recreational activity is one of the most vitalizing and healthiest thing that older adults can do. By changing the focus to leisure, you can do a better job of helping them see quality of life." Or Pamela, sex coach, shared, "Better the outlook of leisure than the outlook of performance. I talk about performance anxiety. The outlook that sex is pleasure that we share takes the performance anxiety out of it."

Melanie, sex educator, also shared, "Framing sex as leisure can definitely take away shame from having sex for non-procreational purposes. Seeing sex as a way to have fun and enjoy yourselves takes away the shame." And finally, Mitchell, sexologist, shared, "Framing sex as leisure is one of the most important perspectives, because this is where we could really get into teaching the health benefits of sex. I mean, sex doesn't just feel good, but it is good for you."

So the next step from here is, how do we put this knowledge to work? In light of the importance of sex in later life and various vulnerabilities in later life, there exists a critical need for educational efforts using innovative methods to specifically address the sexual health needs of older adults. So this and our team is working on developing individualized sexual health communications for older adults that can seamlessly be delivered to large populations using tailored, internet-based, health education.

Using the same methodology and sample that I have just described, our research purpose is threefold. First, to establish older adults' sexual health needs that should inform sexual health education. Second, to develop the content vignettes of preliminary tailored sexual health education messages for older adults, and third, to investigate older adults a willingness to adopt technology use, technology tools to receive innovative, internet-based, sexual health messages tailored to their needs.

This research is still unfolding, but here are some preliminary results. In terms of the content that older adults would like to see covered in sexual health education tailored to their needs, following are some major foresight. First, they would like to learn more about change in aging body and how it affects sexual expression, desire, and available possibilities. They would also like to learn more about specific health conditions and medications that affect sex, they would also like to learn more about communication strategies about sex with a partner and health care providers.

They would also like to learn more about the benefits of sex in later life in a very broad, holistic way, physiological, psychological, and interpersonal and social benefits. They would also like to learn more about various means for increasing performance and satisfaction. This would include this would include information on sex aids, sex toys, sex meds, various adjustments and expansions of sexual repertoire, masturbation, kink, BDSM, and the list goes on.

They also wanted to learn more about protection methods such as dental dams, condoms, and their correct use. They also wanted to learn more about sexually transmitted infections and how they might remain similar or become different in later life. They would also like to receive that motivational booster regarding the normalcy of sexual desire in later life and get that permission to have sexual urges without feeling abnormal.

They also wanted to learn more about body image issues, about resuming dating, about consent and sexual abuse issues, particularly in the scenario where it is one of the partners has any cognitive decline, such as Alzheimer or dementia, and they wanted to learn more about LGBTQ+ matters. Not only LGBTQ members wanted to learn more about their own sexuality, but heterosexual older adults themselves also wanted to learn more because they felt that they were left in the dark for their entire lives and now they have an opportunity to learn more.

We also asked both sex experts and older adults about the possibility of delivering sexual health education online, and there was support, but they have, of course, identified both advantages and disadvantages of delivering mode. So among the advantages, they talked about accessibility and easiness if sexual health education is delivered through the internet. They also talked about privacy and convenience that they can access it at any time at their own pace and without anybody having to know.

They also appreciated the anonymity associated with it. They appreciated that it will likely spare a lot of embarrassment. They also appreciated the sense of agency. That they would have control over the information they receive and when they receive it and how they receive it. They also appreciated the possibility that internet can be used to deliver targeted or even tailored content to their needs.

They also appreciated the breadth of the reach, regardless of the geographical proximity, and they also felt that internet is associated with novelty. That what's on the internet has to be state of the art up to date, whether that's true or not, that's a different story. But they also noted that there are several disadvantages or things to figure out that we need to consider.

Many older adults might not have access to computer. Also, what's on the internet might be perceived as lacking credibility, and to be fair, there's a lot of junk floating on the internet, especially when it comes to sex. Many people were also concerned about security talking in particular about viruses and hackers. Some were concerned about digital literacy or illiteracy.

Some were concerned that sexual health related content might be reflected in their browsing history or that they might have annoying commercials that follow after that. Some were concerned that online delivery mode will not have the personal touch, the contact that they would need to relate well to the material. And of course, we would need to figure out how to deliver this content to people with hearing and visual disabilities.

Considering this advantages and disadvantages, most of which could, of course, be figured out, an application for delivering tailored sexual health education to older adults can help address older adults' sexual health needs. Previous research shows that individually tailored sexual health communications can be seamlessly delivered to large populations achieving mass customization, and this can be done using relatively low cost, tailored, internet-based health education that enables valid self-assessment through online questionnaire and then personalized feedback as well. Furthermore, research shows that tailored house communications focus on the individual needs, eliminate redundant information, and are more likely to be remembered and perceived as relevant than non-tailored communications.

This is important because sexual health education needs over let's say 65-year-old lesbian female unlikely to be very different from such needs of an 85-year-old heterosexual male. Therefore, sexual health messages tailored to the individual needs sexual histories, health conditions, sexual orientation, and cultural and social demographic backgrounds of older adults and delivered anonymously via the internet, are likely to offer an innovative option to address older adults sexual health needs and vulnerabilities. So this, and we need to develop at least three components, and we need to test them subsequently as well.

First, we need to develop an online self-assessment questionnaire for profiling users based on their sex-related needs. Second, we need to develop a flexible content library with the messages reflecting older adults preferences and needs that we have identified in this study. These messages can be used as a jigsaw puzzle and bundled up in various ways to accommodate older adults' individual needs.

Finally, and this is the crux of it all. We need to develop an algorithm for creating personalized message bundles based on profiling. Namely, this flexible algorithm would use the results of need-based profiling to tap into the content library and prioritize and pick the message components that are likely to be most relevant to that particular individual. Then this individually tailored package wouldn't be delivered back to the user.

We have presented this possibility to our participants and asked if they would use it to educate themselves on sexual matters. Many, although not all, many older adults were enthusiastic about this idea and said that they would give it a try, and they discussed various strengths of such application. The strengths revolved around relevance, flexibility, convenience. They also felt that this approach would make them feel important. This was tailored exclusively just for me with my needs in mind.

Many felt that it would be a good start. It would empower them to explore further then and many were mesmerized by the novelty of it. They considered it as a game. They said that sexual education in itself might become playful due to this arrangement. Nevertheless, older adults and sex experts also pointed to various issues that would need to be figured out for a successful launch of the application.

To summarize a long list of issues that really need to figure out, they revolved around promotion. How would we find the user, how would we promote for the user. The credibility, again, a lot of what is floating on the internet is less than credible, to put it gently. There are also some concerns about assessment questionnaires. Several people shared that they might not necessarily feel comfortable sharing sex-related private information via internet.

Some were concerned that they might not be sufficiently digitally literate to navigate the application and they would need some extra guidelines and training. Some were concerned about the delivery of the message, namely would it send it back as an attachment or mail or email? How would it look like? And then last but not least, some older adults wanted to have a direct access to the content library, not necessarily instead of the tailored bundled package, but in addition to it.

So they wanted to have a possibility to tap into it and to explore on their own. To develop and tap the application, we're now heading into the next project phase study with a large-scale survey and proceed into the randomized controlled trial. Sexual health education for older adults is crucially important. However, to combat ageist stereotypes and to contribute to older adults health and well being, we need to educate people across the lifespan, including younger adults.

Understanding young adults attitudes might contribute to the interventions aiming to decrease social stigma regarding later life sexuality. With this understanding in mind, Iulia Fratila, my PhD student, Jessica Escutia-Calderon, my undergraduate student mentee through the Start college program, and I, have decided to study young adults' attitudes towards later life sexuality. Now, we address three research questions. How much do young adults know about older adult sexuality and how do they feel about it? Do young adults' knowledge and views of later life sexuality vary by gender? And third, do young adults' views of later life sexuality vary based on their general attitudes toward sexuality and views of sex as leisure?

We have used a survey methodology and collected data using face to face and online strategies, and we have survey 284 young adults with the mean age of 21 and 1/2 year old, among whom 158 were women and 117 were men, and nine participants self-identified as other. Our results have shown that young adults have moderate levels of knowledge in later life sexuality, and hold relatively open ended attitudes toward later life sexuality. Interestingly, though, high levels of knowledge were unrelated to holding more permissive attitudes.

Also, no differences by gender were found in young adults knowledge and attitudes toward later life sexuality. However, general liberal attitudes towards sexuality and viewing sex as leisure predicted having more accepting, permissive attitudes toward later life sexuality. General attitudes towards sexuality and viewing sex as leisure explained 56% of variability in young adults attitude toward later life sexuality, and this is substantial in any regression model.

So this study suggests that social psychological factors rather than cognitive and demographic factors drive the acceptance of later life sexuality among young adults. Results confirm that increased knowledge does not combat ageist views. Conversely, it is the open minded use of sex and considering sex as leisure that can help reduce ageist stereotypes.

Lastly, I would like to mention a study that I am currently rolling out on the impacts of COVID-19 and sex life in older adulthood. I'm working on a pilot of this project with Brooklyn Clough, Brianna Silveira, and Jesse Li, who are the undergraduate student mentees through the Spark and Start college programs, and we are focusing on three following research questions. First, what are the impacts of COVID-19 and related mitigation measures on the quality, quantity, diversity, and meanings of sex in later life? Second, what cognitive and behavioral strategies that older adults employ to negotiate the impacts of COVID-19 and related mitigation measures on their sex lives? And third, to what extent, if any, has COVID-19 and related mitigation measures affected older adults views of sex as leisure?

To conclude, this research line that is ever evolving and will probably be with me until I retire myself offers various contributions to knowledge and practice. It provides empirical investigations of older adults sexual health needs and implications for sexual health and well-being, it focuses on the marginalized sexual health needs of older adults, it triangulates the perspectives of older adults, younger adults, and sexual health experts. As for the practice, this research line offers improved understanding of older adults sexual health needs and views, and it provides practical recommendations for holistic sexual health education programs for older adults, which are virtually non-existent.

Overall, this research line offers valuable insights for knowledge, practice, and advocacy concerning later life sexuality. Thank you very much for your time and attention today. Your questions and comments are most welcome, and my contact information appears below. And Iulia Fratila, one of the students who are involved in this research line is also here, and I know that she would like to share her experience as well.

IULIA FRATILA: Hello, how is everyone doing? I hope you're all doing well. Thank you, Liza, for introducing me and such a nice presentation. I have written a few notes here that I just wanted to talk about, so my experience with this line of research. I was a research assistant for Liza for two years, and so this revolved around this research line. And I, overall, I just want to say I learned how you can become a part of a dialogue so you start to understand what's in the field, what exists, what's the gap, and how this research answers that gap specifically with sexuality in older adulthood.

And so being a part of this experience was nice because I've had qualitative data analysis experience, I've gained quantitative data collection experience, but by working in the Start program, I was able to understand what it's like to be in an advising role, and specifically advising undergraduate students with research, which is an interesting place to be as I'm getting advised about research, so that was really cool, and what I've learned is really-- this is what I want to say is I've just really learned how research becomes applicable, because this is, I think, something that Liza's done well even throughout this presentation to show where an idea started with the beginning studies and how it's evolved and it's become this very applicable, innovative, educational program.

And so also, as my involvement progress through this research line and being a co-advisor for the Start program with undergraduate students, I've had opportunities to present this research. So most recently, just now in November, I presented at the Gerontological Society of American Annual Scientific Meeting. Sorry. I didn't want to mess it up.

So that was just now recently, and we had received a nice comment on the presentation. People said, this is an interesting topic. Thank you for sharing, and it was nice to be a part of such a big association. Of course, with COVID, it's online, but still a nice experience.

And then also at the undergraduate research symposium that's hosted here at the University of Illinois, I presented their two years in a row with the undergraduate students that were part of the Start program and then also at the Academy of Leisure Sciences Annual Teaching and Research Conference. So that's about it.

I just want to finish with one comment. I looked through my emails, and after my two year tenure, I guess, as Liza's research assistant with this project, I emailed her and I just said, honestly, I really, it sounds cheesy, but from doing this project and being on this work, it's made me be excited and have a larger appreciation for aging in the life course, because at the end of the day, I learned to do research and I learned a lot of things about aging in the life course, and it was just really a great experience, so I want to thank you all for listening and thank you, Lisa, for having me speak here.

LIZA BERDYCHEVSKY: Thank you for contributing. OK, and thank you so much for your questions that starts coming in. So I'll be happy to address them. So the first question is, do you find support or evidence that higher levels of sexual house as an older adult correlate to higher levels of medical health? Well, the study's methodology does not allow us to make causal claims.

In other words, this is not an experimental design to make that inference. However, based on the in-depth interviews with both older adults and sex experts who work with thousands of older adults throughout their careers, many argue that this is indeed the case. That people who remain sexually active are able to maintain their health, both physically and psychologically, in various capacities.

Many talked about the use it or lose it approach. So I guess there is some truth to it. OK, and another-- thank you so much. Thank you. We have a legend joining us today, Jack Kelly. I'm very, very excited to see you here. Thank you so much for your praise.

OK, here is another question. Just curious, since you received your PhD at the University of Florida, did you have the opportunity to do any research at the Villages in Central Florida? It is a thriving retirement community in the state. That's a wonderful question. I wish.

I have to admit that this research line was launched upon my joining at University of Illinois. So when I was studying at the University of Florida, I was not yet studying this matters. Related matters, I was actually studying sexual health and sexual risk taking among young tourists, so there is the overarching running theme of sexual health, positive sexuality, health and well-being across all of my projects, but at that time when I was in Florida, I was not yet studying sexuality in later life.

If I did, I would probably be living in those retirement communities with them and studying them by all means. That's a wonderful idea. Maybe one day when I retire myself. Danielle, are there any other questions that I might be missing out on?

DANIELLE SARA RUNYON: I do not see anything else, so I think we're ready to wrap up.

CARLA SANTOS: So thank you again-- thank you again, Liza, for doing this. We really do appreciate it. This was very interesting. It actually helped several of us in the college, too, because it really does give greater context to the work, right? So thank you