Friday Essay: Love In The Time Of Incontinence Why Young People Don't Have The Monopoly On Love, Or Even Sex

A friend with a close relative in a residential aged care home reports – in a tone of scandalised surprise – on romantic entanglements among the elderly.

In one case, a man and woman have become so inseparable that staff have been forced to move his bed into her room so the two can sleep side by side. When the woman's son made an unexpected visit, he was distressed to find his mother in her nightdress in the arms of a stranger, though eventually he had to accept it was what she wanted.

The concept of the elderly, with their age-altered bodies, demonstrating an appetite for intimacy, especially in an institutionalised setting, appears widely regarded as funny at best – and at worst, disgusting. But should we be surprised if in this difficult, final phase of their lives, elderly people yearn for human contact?

Read more: friday essay: grey-haired and radiant – reimagining ageing for women

As another friend, an experienced nurse, points out, the rooms of aged care residents are routinely lined with framed family photographs, what she calls“the people with the big hats and the scrolls”. But where, my friend demands, are these people in the lives of the lonely residents? Why do they never visit?

She describes how in her childhood in Ireland, any house you'd go to would have an old man or woman in it being cared for by the family; though she admits this may no longer be the case, since so many women have found work outside the home.

For Australians in aged care, living among strangers, removed from all that was once familiar – including the ordinary luxuries of an outing to a local cafe, or to watch the sun set over the sea – it is surely natural that they should turn to those nearest them for comfort. As the poet Pablo Neruda says:“Love is so short, forgetting is so long.”

Each February, the Day of Love rolls around, with its buckets of poor, forced roses outside florists' shops, its gaudy greetings cards, and supermarkets crammed with chocolate. Young people, of course, are mad for all the hullabaloo, with Valentine's Day themed parties, and singing telegrams delivered in the lunch breaks in high schools. But if those young people imagine they have a monopoly on love – or even on sex – the truth appears otherwise; in real life and in books.

For a moving narrative of love at the end of days, read Alice Munro's the bear came over the mountain , from her book hateship, friendship, courtship, loveship, marriage (filmed as away from her ; director Sarah Polley was Oscar nominated for her screenplay adaptation of Munro's story).

The story documents both romantic attachment in residential care, and the lengths a spouse might go to for love. Grant and Fiona have been married for almost 50 years when she starts leaving sticky notes on their kitchen drawers: Cutlery, Dishtowels, Knives. Grant is shaken by the realisation that it is not where things are kept that Fiona is struggling with, but what they are.

As Fiona's memory loss accelerates, she moves voluntarily to Meadowlake, a nursing home where she and Grant have previously visited a neighbour. The home's rules forbid visitors during the first month; Grant is told this is to help Fiona settle in. But when the month is up his wife does not recognise him, and at each visit he finds her sitting close beside her new friend, Aubrey.

Grant's eventual acceptance of Fiona's and Aubrey's relationship, his efforts, after Aubrey's wife takes him home, to have him returned to Meadowlake, is where the real love lies in this story. It is not the stuff of cellophane-wrapped roses and chocolate hearts, but the devotion that has accreted over the course of a long marriage. In Grant's case devotion may be tinged with guilt, for in the past he has been a philanderer, though he never wanted to risk losing his wife. Now that he has lost her, he throws his effort into securing the only thing that appears to make her happy.

At the end of Elizabeth Strout's Pulitzer prize-winning olive kitteridge , Olive seeks out the widowed Jack Kennison. She puts her hand on his chest and feels the thump of his heart“and her body – old, big, sagging – felt straight-out desire for his”. Olive is saddened to remember she had not loved her husband Henry in this way for a long time before he died.

Read more: elizabeth strout's lucy by the sea: a claustrophobic portrait of a terrible pandemic year

Intimate relationships have been associated with lower levels of stress and depression, with higher levels of oxytocin, a feel-good hormone, and a general lift in physical and mental wellbeing, even taking into account cognitive or physical impairment.

Intimacy, of course, does not necessarily mean sex; it can be expressed through touch, such as hugging, cuddling, or hand-holding. But in an Australian aged care setting, this may not be as straightforward as it seems in fiction. For one thing, there is a discouraging lack of privacy, including a scarcity of shared rooms, rooms with double beds and lockable doors. Then, if a resident's husband or wife is still living in the wider community, a new attachment might stir family resistance.

A recent survey of almost 3,000 Australian residential aged-care facilities conducted by researchers at La Trobe University's australian centre for evidence based aged care found that only half of facilities surveyed had written policies on sexuality, and only one third had policies on sexual behaviour.

dementia raises the question of a capacity to properly consent. Legislation is clear concerning a resident's will and medical and financial matters. But when it comes to people's sexual decisions, it is left to staff to negotiate a balance between the rights of individuals and the facility's duty of care to a group of people who are particularly vulnerable to unwanted attentions, or even sexual assault.

It must be acknowledged that in Australia an estimated 50 sexual assaults occur every week in residential aged care, and that the elderly also experience such assaults in their own homes; victims are invariably female. Police and care providers can be unwilling to take action, believing that dementia makes the victim's evidence unreliable – and, mistakenly, that people with dementia will not remember, nor be traumatised.

The ready to listen project, launched in 2021 by the Older Persons Advocacy Network, aims to address the rights of people in aged care to be heard, to be believed, and (following open disclosure of assault) to have their cases followed up by police. It is also concerned with establishing a charter of sexual rights for older people, including their right to a consenting, romantic relationship, and clarifying the all-important question of consent.

But the possibility of non-consensual contact exacerbates the difficulty of forming genuine attachments, and family disapproval may be enough to cause staff to intervene. Even without this, the lack of guidance, or the ageist prejudices of staff members, may mean intimate friendships within an aged care setting will be firmly discouraged.

Children, especially adult children, can complicate mature love, and are often unscrupulous in thwarting it. Because aside from what they perceive as age-appropriate behaviour, late-life attachments can, of course, have consequences for an offspring's anticipated inheritance.

In Kent Haruf's our souls at night , Addie Moore and Louis Waters, neighbours for years, both live alone; their houses empty of family, their evenings solitary. Then Addie visits Louis with the astonishing proposal that he sleep over with her at night: for the company, for the quiet conversations after lights out. Louis agrees, and they fall into a companionable routine. The town soon notices this new intimacy, but at 70, Addie does not care what anyone thinks, and nor does Louis.

Alerted by a friend to her father's behaviour, Louis's daughter Holly tells him,“It just seems embarrassing”. But Addie's son Gene is incensed.“Because he's after your money too, isn't he?” he says.“If you married him he'd get half of everything wouldn't he? I couldn't stop him.”

Addie's six-year-old grandson Jamie is sent to stay with her when Gene separates from his wife. Frightened at night, Jamie ends up sleeping in Addie's bed, making her arrangement with Louis impossible. But gradually the three of them bond, and when Louis gives Jamie a dog, Bonny, Bonny is allowed to sleep on Jamie's bed. When the three of them go camping, they share the same tent.

Gene comes and takes Jamie and Bonny away, and afterwards Addie and Louis decide they will do what the town believes they've been doing all along.

Addie says,“This old body. I'm an old woman now.” Louis says,“Well, old woman Moore. You've won me completely. You're just right. You're how you're supposed to look.”

When their lovemaking is not a success, Louis says,“I've got the old man's complaint.” Addie says,“It's just the first time. We have all the time ahead of us [...] Let's try again another night.” But Addie's son returns.“I want this to stop,” he says.“You're not even ashamed of yourselves.”

Gene bans Addie from speaking on the phone to her grandson. When she does get through to Jamie, he tells her that if he talks to her“they'll take Bonny away”. Addie must have contact with the boy; she cannot afford to wait until Jamie is 16. She tells Louis they must remain separate.

When Addie falls in the street, Gene has her transferred from the town of Holt, where she and Louis live, to Denver. Louis goes to the hospital, where Gene tells him,“You're not wanted here.”

When Addie is discharged, she will move into assisted living in another town. Gene's disgust, while partly motivated by financial need, is also an expression of a common distaste for age-altered bodies. To Gene, this is all the justification he needs to use his small son as a weapon.

Read more: today's aged care falls well short of how we'd like to be treated – but there is another way

Addie Moore is not the first elderly woman to discover that the last great love of her life is settled on a grandchild. The unconditional love can flow both ways, to their mutual joy, if it is not pinched out by parents with a loveless attitude towards the older generation. In her surrealist novel the hearing trumpet , Leonora Carrington delivers this dehumanising impulse with devastating economy as a woman speaks to her husband about his aged mother, Marian.

“Remember, Galahad,” added Muriel,“those old people do not have feelings like you or I. She would be so much happier in an institution.” Unfortunately for Marian, her adult grandson is not the loving kind. “She ought to be dead,” Robert said.“At that age people are better off dead.”

Even when offspring are not primarily focused on their inheritance, a lifetime's accumulation of feelings and resentments can be in play. In anything is possible , also by Elizabeth Strout, the story Mississippi Mary tells of a 78-year-old woman living in Italy, married to a man so much younger than her that at first the locals assumed she was his mother.

When her youngest daughter visits, Mary thinks she will not understand“what it had been like to be so famished. Almost fifty years of being parched”. At their 50th wedding anniversary party her husband had not asked her to dance. Later, when Mary was 69, her daughters had given her a trip to Italy as a birthday gift, and it was there that she had wandered off and become lost, and was found by Paolo.

Mary's first husband had been in a long-term affair. Their daughter Angelina judges it“pathetic [...] painful, of course, but pathetic”. Her father“really was a mean snake of a man” Angelina admits, but then the selfishness of the hurt child kicks in:

Angelina accuses her mother of having taken from her the ability to care for her in her old age, and to be with her when she dies. Mary is a little stricken by this, because she suspects death is not far away. But“she did not dread her death [...] she was almost ready for it, not really but getting there”. Mary admits that

In her essay, sexy old women , Krissy Kneen has just finished writing a novel that would go on to be shortlisted for the Stella Prize, an uncertain grace , in which the main character, Liv, reaches 130 years of age and is still very much a sexual being. Kneen writes:

In the work of writers such as gabriel garcia marquez , philip roth , Yasunari Kawabata, Michel Houellebecq, peter carey , and vladimir nabokov , Kneen easily finds literary examples of sexual old men. But it is harder to find a model for a sexual older woman, and in the few examples she does find – in praise of the stepmother , by Mario Vargas Llosa, and the graduate by Charles Webb (the basis for the 1967 film starring Dustin Hoffman) – the women are portrayed as“dangerous, manipulating, clever enough to cause a man's downfall”.

Kneen recalls watching the screening of a documentary, nitrate kisses , in which a sex scene involving two very old women draws a shocked response from the young audience. Describing the scene as“caring and quite frankly, beautiful” Kneen, though at the time still young herself, hopes that as an old woman she will still be“equally sexually bold”.

Septuagenarian American novelist and poet may sarton famously developed the optimistic concept of“ripening towards death in a fruitful way”. But ripeness as it relates to the elderly, especially elderly women, can be a fraught topic. Some pro-ageing advocates insist that an essential element of a woman ageing well is glamour, but glamour is a construct; in our times it is often measured by the subject's perceived sexual appeal, as demonstrated by the clichéd poses and facial expressions of those modelling“glamour” in magazines, or on screens.

The pro-ageing movement on Instagram is divided between older women who still lay claim to the glamorous props of their youth – skin-baring garments, high heels, extravagant quantities of makeup – and those who are evolving towards a kind of beauty that does not rely on overt sexuality, but focuses instead on being comfortable in one's own skin. Neither approach is right or wrong, but of the two ways of going forward, the“less is more” philosophy of the natural agers somehow seems more universally doable.

The roots of the word“glamour” can be traced to the Scottish word gramarye, meaning“magic, enchantment, spell”, including the lovely phrase“to cast the glamour”. Gramarye may be from an Ancient Greek word for the weight unit of ingredients used in magic potions. Or it is an alteration of the English word“grammar”, in its medieval sense of“scholarship” and especially“occult learning”?

In John Jamieson's 1825 etymological dictionary of the scottish language , glamer, glamour, is

This definition draws glamour closer to the Old Norse words glámr,“moon”, or“name of a ghost”, and glámsýni,“illusion” – which makes of glamour a deception, a beauty trick.

Jamieson's dictionary contains many old words that women might use to describe themselves in ways that stand outside the conventions formed around youthful beauty.

For those of us anticipating our own extreme old age, when we will be more frooch (“frail, brittle”) than now, let us hope we shall still be able to summon the odd moment of gleit (“to glitter”), and that our eyes, our hair, will be touched at times with their old glister (“lustre”).

And looking back over the fiction I've drawn on for this essay, I see the writers were both forsy (“powerful”) and formois (“beautiful”).

The royal commission into aged care quality and safety was announced by the Morrison government in 2018, following a string of disturbing incidents – including South Australia's oakden aged care scandal , where the facility was closed after evidence came to light of neglect and abuse. Among the findings of the Royal Commission were that“sub-standard care and abuse pervades the Australian aged care system”. In its final report, it pronounced this“a source of national shame”.

Reforms suggested by the Royal Commission in any overhaul of Australia's aged care system include the right of autonomy, the right to the presumption of legal capacity, and in particular the right of elders in residential aged care to make decisions about their care and the quality of their lives, and the right to social participation.

The recommendations state that older people should be supported to exercise choice about their own lives and make decisions to the fullest extent possible, including being able to take risks and be involved in the planning and delivery of their care. They also state that older people are entitled to receive support that acknowledges the aged care setting is their home, and enables them to live in security, safety and comfort, with their privacy respected.

For those of us who are not yet quite ready to access these late-life services, let us hope the Albanese government follows through on the Royal Commission's recommendations, which state that people should be treated as individuals. And that the relationships older people have with significant others in their lives should be acknowledged, respected, and fostered.

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