Sexual Activity, Sexual Well-Being, and Associated Factors Among Older Adults: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to synthesize quantitative evidence on sexuality-related outcomes, including sexual activity, behavior, function, and well-being, among older adults and to examine differences according to gender and social context. Conducted in accordance with the PRISMA 2020 guidelines, the review included quantitative observational studies. Random-effects meta-analyses were performed, heterogeneity was assessed using the I² statistic, and leave-one-out sensitivity analyses evaluated the robustness of the pooled estimates. Twelve studies met the inclusion criteria. Older men had significantly higher sexual behavior-related scores than older women (SMD = -0.39, 95% CI -0.65 to -0.14; p = 0.002), while older adults living with someone had higher sexual behavior-related scores than those living alone (SMD = 0.93, 95% CI 0.50-1.36; p < 0.001). No significant difference was found in sexual function-related scores between sexually active and sexually passive older adults (SMD = -0.07, 95% CI -3.05 to 2.90; p = 0.96), although substantial heterogeneity warrants cautious interpretation. Overall, sexuality-related outcomes in older adults appear to differ according to gender and social context, but the observed associations should be interpreted cautiously because of considerable between-study heterogeneity.