Sexuality in Older Individuals: Addressing the Elephant in the Room
by Sarah N. Mourra, MD; May 01, 2014;


We are delighted to present this Q&A with Sarah Mourra, MD, chair and presenter for the American Psychiatric Association Annual Meeting in a symposium titled “Goldmine or Minefield: Navigating the Spectrum of Sexual Feelings and Conduct in Elderly Adults.” Dr Mourra’s presentation will particularly cover erotic transference in elderly adults. The symposium will include numerous additional issues, which include sexuality in growing older (Kirsten Wilkins, MD), ethics of sexual consent in senescence (Louis Trevisan MD), and management of improper sexual actions in dementia (Rajesh Tampi, MD).

Sarah N. Mourra, MD

Q: The title of your symposium appears rather provocative. Why did you select this topic?

A: Sexual interest and longings within the therapeutic connection are frequently thought to be more taboo than other types of transference, and are rarely talked about in terms of perspective and management, despite sometimes being the elephant in the room. This issue is made more difficult by issues of aging, loss, and medical comorbidity that come up in seniors populations. I hope my audience will see erotic transference in older patients as an opportunity to fully grasp the inner lifestyles of our patients in a more thorough manner.

Q: What facets of this topic do you plan to cover?

A: I intend to explore the multitude of reasons that sexual transference may arise in the medical experience, obstacles to spotting it, and techniques for managing and conceptualizing it in terms of complex psychodynamics and difficulties such as organic mental illness. It will also cover relevant issues of ageism and social factors that have an effect on the approach of clinicians to sexual feelings and tendencies in the aging population.

Q: How is this subject matter relevant to psychiatrists who consider themselves “medication supervision only” clinicians?

A: Erotic transference can take place even when the mental health specialist is not performing weekly psychotherapy. Dr. David Mintz of the Austin Riggs Institute often describes how even the administration of a medication can be packed with psychodynamic meaning. Moreover, these issues may arise around additional associates of a therapy team, such as caregivers, and psychiatrists will need to be able to help out in understanding, processing, and controlling these characteristics within a group context as well.

Q: Why should general adult psychiatrists be knowledgeable with regards to this topic within geriatric psychiatry?

A: We estimate that the number of adults age 65 and older in the US will increase to more than 72 million by 2030, with 14% to 20% of the elderly population predicted to carry mental wellness or substance use diagnoses, such as depressive disorders and dementia- associated behavioral and psychiatric indications. As suggested in the Institute of Medicine report, “The Mental Health and Substance Use Workforce for Elderly Adults: In Whose Hands,” the rate of special suppliers entering the workforce is dwarfed by the rate at which this population is growing.

Increasingly, mental health care for older adults will fall to non-geriatric psychiatrists and other providers who may be unaccustomed to the unique requirements of this population. I believe that for this rationale, recognition, supervision, and understanding of the extensive range of sexual feelings in elderly adults is a crucial element to providing humane and competent treatment.


Dr Mourra is Bureau of Health Professions Fellow in Geriatric Psychiatry at Geffen School of Medicine at UCLA, Department of Psychiatry and Biobehavioral Sciences. She additionally keeps a private practice in Los Angeles, California. She reports no conflicts of interest with regards to the subject matter of this document.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

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