Quelles représentations de l’amour et de la sexualité chez des sujets en EHPAD malgré le veuvage ? Étude clinique exploratoire

Abstract

Context

The sexuality of elderly people is often surrounded by negative perceptions and prejudices, even among professionals. For children and friends, it can be associated with lechery and an adolescent crisis. When it involves two adults in a home for the dependent elderly, sexual behavior may be controlled or even restricted. However, sexual desire persists despite aging and associated bodily changes. Based on sociological and psychodynamic literature on love and sexuality, this study explores the subjective experiences of widowed elderly people living in nursing homes. Sociologists stress the high expectations towards the couple and the partner as a means of personal fulfillment for all adults. Sexuality is an essential component of the couple, and disturbances in one's love life can manifest themselves in various ways, reflecting individual approaches to love and sexuality. The renunciation of sexuality often leads to the breakup of the couple, and the romantic bond can weaken if the sexual relationship becomes cold and distant. Psychodynamic readings also focus on the experience of mourning. When a deeply invested partner dies, a balance is broken, requiring a painful adjustment process known as mourning. Many elderly people experience social relegation and severe isolation, which is exacerbated when the spouse dies. Some bereaved individuals may engage in new libidinal bonds, while others avoid such romantic interactions, with the deceased spouse occupying all their psychological sphere. Re-engagement in life and the world through projects and activities can accelerate the mourning process.

Objective

This qualitative study aims to understand the subjective experiences of love and sexuality in widowed elderly people and to identify possible connections between these two modalities. This understanding can lead to reflections on the specific support for the elderly, the complex psychology of the aging subject, and potential training needs for caregivers.

Method

This clinical study is based on a qualitative approach. Two interviews, the first non-directive and the second semi-directive, were conducted with nursing home residents. All participants were volunteers selected after a pre-selection based on known data from a residential establishment for dependent elderly people (widowhood, absence of neurodegenerative pathology). They scored above the 5th percentile on the Mini-Mental State Examination (MMSE) of the reference sample (age and sociocultural level), allowing them to understand the various questions of the two interviews. We analyzed both the subjective experiences of the subjects and the way they narrated their stories. Indeed, discourse and discursive strategies bear the trace of psychological functions (such as repression, denial and avoidance).

Results/Discussion

During our interviews, we observed a slight reluctance on the part of the participants when it came to discussing sexuality. They either did not feel concerned or they felt social pressure and internal constraint to no longer think about it. However, they were able to freely discuss the representation of the couple and share fragments of their past and present lives during our meetings. The psychological bond with the loved and deceased person persists. Subjects emphasized the notion of trust and commitment to the other in their testimonies. They did not fall into idealizing the loved one and highlighted the quality of the bond with their life companion. All four of the participants had each made their lives with their deceased partner and had had children with them.

Conclusion

The results of this study encourage caregivers not to view the elderly solely through the lens of somatic pain and sensory deficits but to pay attention to and value their psychological life, both past and present. Reflecting on one's inner life knows no age restrictions, provided one is ready to listen and offer a space for traversing one's history. This research sheds light on the future of emotional and romantic investments, as well as marital and family dynamics in old age and the approach of death. We conclude that aging calls for the creation of new bonds with oneself and with others, far from the idea of a shrinking psychological life modeled on somatic disorders.