Relationships, intimacy and sexuality among old age couples one of which is faced with mild cognitive impairment

The literature on aging indicates that people aged 65 or older are at increased risk of suffering memory disorders, ranging from mild cognitive impairment to Alzheimer’s disease. In parallel, research indicates that marital relationships similarly undergo changes at this phase of life. Studies have shown that if one partner falls ill, care responsibilities often fall on the healthy spouse—with a concomitant, and marked, effect on their relationship.

This study examined the nature of marital relationships with older people when one spouse suffers from a diagnosis of mild cognitive impairment; it explored their perceptions of relationship in the light of this change, and their ways of coping with marital reality in its wake. Seven heterosexual couples, seven men and seven women all aged over 70, were interviewed individually for this study; with each couple, one spouse had been diagnosed as suffering from a mild cognitive impairment. The interviews were semi-structured, and were conducted face-to-face.

The findings of the study present a picture of "dull loss—absent presence—loss of self and lost self-parts." It is a dominant theme which allows for encapsulating the changing nature of spousal relations following a “ambiguous loss” loss such as the diagnosis of a mild cognitive impairment. While healthy spouses, from their point of view, are living in the present and are negotiating the changes that old age and the diagnosis have made to the relationship, the diagnosed spouses described experiencing themselves as living in a relationship rooted the past; some even described experienced it as directly embodied in the present. The findings that inform this theme are extensively described in the present study.

In addition, analysis of the interviews identified three major coping styles for dealing with this reality. The first coping style is "Challenging Caregiver Relationships.” In this mode, couples sought to preserve the ability and strength of each partner to match that of the their spouse by looking at the whole as exceeding the sum of its parts. This approach facilitated the creation of a synergy which allowed the couple to maintain a shared bond, despite the challenges posed by aging and the diagnosis of mild cognitive impairment.

The second coping style identified in the interviews is "Integrated Friendship with Life.”  This mode of coping presents in the form of a resource, a solid foundation of connection allowing for the preservation of a valuable friendship rooted in deep and mutual affection. The couples who described a reliance on this style of coping accumulated the resource over many years of relationship, allowing them to anchor the relationship on their shared points of reference. By finding the common points that do remain—a familiar hobby or a common activity from the past, for example—they can establish communication, and emphasize the existing and enduring over the lost or missing. In addition, mutual  affection provides both motivation and the firm foundation of the relationship which helps the couple create new pathways for communication and enjoyment; pathways which emerge from parts of the shared "unity" that may previously have been perceived as neglected, but now promote the shared mental well-being of the relationship as a whole.

A third coping style identified in the interviews can be described as a "Wake up every morning anew.” In this mode, coping with the loss of relationship bonds following the diagnosis of mild cognitive impairment creates a situation where more is hidden than is visible. The reality of the diagnosed spouse, changing unexpectedly in personality, means that he or she at times becomes a stranger to the undiagnosed spouse. The "Wake up every morning anew" mode of coping seeks to experience the options available to couples at any given moment. Through flexibility and patience in relation to the present reality, couples can focus on what is happening in the "here and now" of their relationship.

From a theoretical perspective, the current research opens a space, through which it becomes to explore the “third age” and its many meanings within the continuum that lies between health and vitality on one hand, and illness and dependence on the other. in addition, the findings of the study allow for a panoramic consideration of the perceptions, engagements, and ways of coping with the complex realities of the aging process, from the perspective of couples. From a practical viewpoint, the study promotes deeper consideration of possible interventions which may enable the successful adaptation of long-term relationships following diagnosis of cognitive impairment on the part of one spouse.