Self-Care and Intimacy for Seniors With Arthritis or Limited Mobility

Your hip may have retired. The rest of you hasn't.

Arthritis affects about one in four American adults, and more than half of people over 65. Add joint replacements, back pain, a stroke or Parkinson's, and many older adults quietly decide that physical closeness, alone or with a partner, is simply over. Usually it isn't. It just needs some planning, a few cushions and a bit of honesty with your doctor.

Why it's worth the effort

Physical affection and sexual activity in later life are linked with better wellbeing and life satisfaction in several large studies, including the English Longitudinal Study of Ageing. Touch and release can ease tension and help with sleep. And if you're single or widowed, solo self-care is a normal, healthy part of life at any age (we cover that in solo self-care for single adults).

Time it around your pain

The Arthritis Foundation and occupational therapists suggest a few simple things:

• Pick your best time of day. For many people with rheumatoid arthritis, mornings are stiff. Late morning or afternoon may be easier.
• Take pain medicine about 30 to 60 minutes beforehand, if your doctor has prescribed it, so it's working when you need it.
• Warm up first. A warm bath or shower relaxes joints and muscles. A heat pack on a sore back or hip helps too.
• Go slow and stop if it hurts. Discomfort is a signal to change position, not to push through.

Positions that protect joints

You don't need anything acrobatic. The goal is to let pillows and the mattress take the weight.

• Side-lying is the most commonly recommended position for hip, knee and back pain, because no one has to hold their own weight.
• Lying on your back with pillows under the knees takes pressure off the lower back.
• A wedge pillow or firm cushion can support the hips, back or arms. Positioning cushions sold for this purpose are firmer and hold their shape better than bed pillows.
• Sitting in a sturdy armless chair works for some people with hip or knee problems.

After a hip or knee replacement

Ask your surgeon or physiotherapist when it's safe to resume activity and which movements to avoid. After many hip replacements, people are advised to avoid bending the hip past 90 degrees and crossing the legs for several weeks. Side-lying with a pillow between the knees is often suggested once you're cleared. Most people can return to sexual activity within a couple of months.

If your hands are the problem

Weak grip, stiff fingers and tremor make small objects hard to use. Options that help:

• Long or angled handles so you don't need to reach.
• Large raised buttons you can press with a knuckle.
• Hands-free designs that rest against the body or are held in place by a cushion.
• A pump-bottle lubricant rather than a fiddly cap.

Our buying guide to personal massagers for arthritis and limited grip goes into detail, and how to choose body-safe products covers materials.

Dryness, erections and medicines

• Vaginal dryness after menopause is very common and very treatable. Lubricants, vaginal moisturizers and low-dose vaginal estrogen are all options. See intimacy after menopause.
• Erection changes are common with age, diabetes and some medicines. They're worth mentioning to a doctor; see erectile dysfunction after 60.
• Medicines such as some antidepressants, blood pressure tablets and opioid painkillers can lower desire or delay orgasm. Don't stop them on your own, but ask whether there's an alternative.

Heart and lungs

If you have heart disease, the American Heart Association says sexual activity is usually reasonable if you can manage moderate exercise, such as climbing two flights of stairs briskly, without chest pain or severe breathlessness. Check with your doctor if you're unsure, and never combine erection medicines with nitrate heart medicines.

Talking to your doctor

Many doctors won't bring it up, so you may have to. You could say: "My arthritis makes intimacy painful. Is there anything that could help?" An occupational therapist or physiotherapist can be especially practical.

The bottom line

Plan for your best time, warm up, let cushions do the work, and use tools that suit your hands. Limited mobility changes how you do things, not whether you're allowed to enjoy them.

Sources: CDC (arthritis prevalence), Arthritis Foundation (sex and arthritis), American Academy of Orthopaedic Surgeons, American Heart Association (scientific statement on sexual activity and cardiovascular disease, 2012), English Longitudinal Study of Ageing, NHS. This article is general education, not medical advice.