​Little empirical information exists about sexuality among older persons, despite the progressive aging of the population.  What available information is self-reported and so subject to some bias.  The baby boomers, a generation that matured when sexual mores were starting to evolve, will likely continue in more evolved behaviors well into their old age.

​Interesting facts relating to the post-65-year-old population:

• Sexual activity is associated with greater enjoyment of life.  
• Sexuality is closely linked to health at older ages, more so for men than for women.
• Most older adults (76%) agree that sex is an important part of a romantic relationship. Men were more likely to agree (84%) than women (69%).
• The likelihood of being sexually active declines steadily with age and is lower among women than among men.
• Being in a relationship dramatically increases the likelihood of sexual frequency.  In one large study among those who were not in a relationship, only 22% of men and 4% of women reported being sexually active in the previous year.
• The prevalence of masturbation declines as a person ages and is higher among men than among women.
• Over three-quarters, (78%) of men rated their most recent sexual experience with a partner as either extremely or "quite a bit" pleasurable.  About two-thirds (68.2%) of the women in that age group rated their most recent experience with a partner that highly.
• By the time a man is in his 40’s, he has about a 40% chance of having some form of erectile dysfunction, and this increases about 10% per decade thereafter.
• Nearly one in five men (18%) and 3% of women reported they had taken medications or supplements to improve sexual function in the past two years.

For women, the increase in the proportion of widowed is a significant factor in sexual frequency decline.  Among men, both poorer physical health at older ages and a decrease in its association with occurrence are significant factors in the decline.  A change in the association between contentment and frequency is also a significant factor for men. Reverse causality may explain the joy–occurrence findings for both men and women.

​Older women are less sexually active than men of the same age and the gender gap widens as they get older.  Women are less likely than men to be in a marital or intimate relationship, and even more so with age, seemingly because men tend to die at a younger age than women.  About one in 20 women who were not in a relationship reported being sexually active in the previous year, compared with about one in five men who were not in a relationship.

​Half of both men and women reported having at least one sexual problem, and almost one-third reported having at least two sexual problems.  For women, the most common sexual problems were low libido, difficulty with lubrication, inability to orgasm, finding sex not pleasurable, and pain.  Among men, the most prevalent sexual problems were difficulty in achieving or maintaining an erection, low libido, climaxing too quickly, anxiety about performance, and inability to climax.

​‘Use it or lose it’ is a phrase more properly referred to as disuse atrophy, a medical term used to describe the loss of normal healthy tissue and worsening function after a prolonged period of lack of use.  This applies to all systems of the body and most people are best familiar with this in exercise and fitness although this also applies to genitals.  

When atrophy of penile tissue occurs the smooth muscle shrinks, creating a loss of length and girth and often poor response to erectile dysfunction drugs.  Early and aggressive treatment of impotence with oral or injection medication or possibly a vacuum erection device may improve and speed up recovery of erectile function.  

The clinical definition of erectile dysfunction is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance.  The first consistent success in the treatment of this ailment were penile implants of various engineering designs and they are still used albeit infrequently.  Pfizer hit the jackpot with the licensing of Viagra in 1998 and revolutionized sex and the elderly population, making it possible for many to have intercourse once again.  Since that time several other similar drugs have come on the market including Cialis, Levitra, and Stendra. 

A significant proportion of men with angiographically documented coronary artery disease had erectile dysfunction and that this latter condition may become evident before angina symptoms in almost 70% of cases.  This suggests erectile dysfunction is related to coronary issues.

Vaginal atrophy most often occurs during menopause because of a decrease in the hormone estrogen.  Only half of women who enter menopause suffer from vaginal discomfort or lack of lubrication. Regular stimulation of vaginal tissue helps maintain blood flow, which in turn increases lubrication and elasticity.  Women who have had a long sexual hiatus are more likely to experience vaginal dryness than women who are regularly having intercourse.  Topical estrogen application or systemic hormonal treatment is effective in managing vaginal atrophy.

​What helps keep an older couple sexually active?  Older adults with satisfying sex lives engage more frequently in open sexual communication and setting the mood for sexual activity.  An expansive sexual repertoire, as measured by the number of sexual activities used during the last sexual encounter, is also associated with greater sex frequency and sexual satisfaction.

​‘Nootropics’ refers to any natural or synthetic substance that may have a positive impact on mental skills.  Nootropics fall into three general categories: dietary supplements, synthetic compounds, and prescription drugs.  Peddlers promote nootropics to stave off dementias and increase cognitive abilities including both memory and intelligence.  But it is far easier to make lifestyle betterments to achieve proven results.

A Romanian psychologist and chemist, Corneliu Giurgea, derived the word ‘nootropic’ in 1972 from the Greek words ‘nous’ or mind and ‘trepein’ meaning to bend or turn.  Nootropics, also referred to as smart drugs or cognitive enhancers, are drugs, supplements, or other substances that improve cognitive function, particularly executive functions, memory, creativity, or motivation.

The use of cognition-enhancing drugs by healthy individuals in the absence of a medical indication is one of the most contested subjects among medical professionals, including the ethics of their use, and concerns over side effects by ungoverned and misinformed consumers.

​Some of the endemic problems in assessing the efficacy of these compounds are the small number of participants in studies and the scarcity of large randomized, double-blind, placebo-controlled clinical trials.  Many of the studies focus on improving memory in elderly populations so the results are not pertinent to a general population. 

​Professional associations define intelligence as ‘the ability to derive information, learn from experience, adapt to the environment, understand, and correctly utilize thought and reason.’  Those same organizations define memory as ‘the ability to retain information or a representation of experience, based on the mental processes of learning or encoding, retention across some interval of time, and retrieval or reactivation of the memory.’  There are standardized tests to measure both memory and intelligence and these provide a basis for empirical measurement.

​Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds are on the way their off-label use will increase.  The supplement industry is well-tooled to generate a new spin on simple compounds advertising amazing results with little supporting evidence.

Trailing is a selected list of commonly used nootropics:

• Humans consume caffeine in various carriers such as tea, coffee, soft drinks, and capsules but oddly few studies corroborate the common cultural idea that it speeds reaction time, short-term memory, and learning.
• Piracetam refers to a group of synthetic nootropics with many animal studies but almost no human studies.  These synthetic compounds are available over the counter in the United States, but in many other countries they require a prescription.
• Physicians prescribe stimulant medications such as Adderall for the treatment of ADHD, but students and competitive gamers also use them to enhance performance.
• Another prescription used as a nootropic is modafinil (Provigil).  The United States Food and Drug Administration approved it to treat narcolepsy and sleep apnea, but some studies suggest that it may help with learning and memory in healthy people.
• L-theanine is an amino acid found primarily in green and black tea, some mushrooms, but one can obtain it in pill form.  There is some evidence it might be effective in managing anxiety disorders.
• CDP-choline may help memory, at least in people who have vascular dementia, and physicians prescribe it in Europe for such conditions.
• Creatine helps build muscle mass, but studies have also found that it may improve reasoning skills and short-term memory in healthy people
• A traditional Indian (ayurvedic) herb, Bacopa monnieri, also known as brahmi, assists with some neuropsychiatric diseases.
• Flavonoids are various compounds found naturally in many fruits, vegetables, wine, tea, and chocolate.  Evidence in support of the neuroprotective effects of flavonoids has increased significantly in recent years.
• Vitamin K plays a role in brain cell survival and cognitive performance.
• Ginkgo biloba and rhodiola rosea may have some positive effect on short-term working memory.

​For the consumer, the effects of these compounds are highly subjective and dependent to some degree on placebo effects.  The huge supplement industry in the United States loves these circumstances because they result in sales of elements or compounds to treat maladies that might not exist with results that are impossible to measure.  

Around half of the adult population in the United States consumes vitamin supplements and the global nootropics market size will reach about $4.9 billion by 2025.  Nootropics manufacturers target high-income professional overachievers seeking to gain an edge at work and feature innovative packaging, product placement, and promotion.

As seen in the chart above, provided by Grandview Research, the bulk of nootropics sales were for the following purposes:

• Memory enhancement.
• Mood and depression.
• Attention and focus.
• Longevity and anti-aging.

With the number of people over the age of 60 expected to double between 2000 and 2050, the projected incidence of dementia and related health care costs is also set to rise significantly.  Interest in staving off the horror of dementia appears to be another driver of sales of nootropics.

Some cognition-enhancing drugs produce their beneficial effects on learning and memory by increasing the availability of glucose for uptake and utilization into the brain.  The hypothesis further suggests that many cognition-enhancing drugs act through a peripheral mechanism rather than directly on the brain.

​A more informed approach would be to examine lifestyle changes that show similar or better empirical support for increasing intelligence and memory skills.  Another large question is whether the qualities inherent in a pill are translatable into true nutrition from a healthy diet.  

While the limited empirical data points to minor positive effects from the use of nootropics on intelligence and memory, simple lifestyle changes are proven to provide an immediate positive impact.  The easiest, fastest, most effective, and the least expensive fix is to implement these before employing special measures such as consuming nootropics, some of which uncertain in terms of long-term health effects.

​Lifestyle changes can provide immediate improvements to intelligence and memory:

• Meditation was associated with better executive functioning and working memory.
• Adequate sleep is correlated with intelligence.
• Exercise is also correlated with memory and intelligence.
• A good diet is associated with mitigating dementias.

​The United States in its American exceptionalism extension of empire has been engaging in nation building since the end of the Civil War with very little evidence of success.  Such endeavor is generational and requires substantial effort, intent, and resources.  About 156 years have passed since the Confederate States of America surrendered and United States forces occupied the South, and the ghost of Jim Crow still rides at night, but there are few signs the South will join the community of progressive nations.

A May 2003 publication by the Carnegie Foundation, in a seminal work produced in the shadows of the United States interventions in Iraq and Afghanistan, defined three criteria required to be present in a United States nation building effort:

• The goal of the United States intervention was a regime change or the survival of a regime that would otherwise collapse.
• The deployment of large numbers of United States ground troops.
• The use of American military and civilian personnel in the political administration.

​The report concluded that of the sixteen such efforts to that date (2003) since 1900, the United States helped sustain democracy in only four cases ten years after the departure of United States forces.  Two of these followed the total defeat and surrender of Japan and Germany after World War II, and two were the tiny countries Grenada and Panama.

The complete military devastation of Germany and separation into two distinct occupied states made that a unique outlier but the result was successful regardless, although the United States military has remained in Germany since.  Japan’s capitulation was certified by the Emperor, literally a God in the state religion, and the country still has a military occupation by United States forces.

Oddly the referenced Carnegie report neglected to include South Korea, which turned into a very successful democracy, albeit with continuous United States presence.  

​After World War II, Soviet troops occupied areas north of the 38th parallel, which became North Korea, with United States troops in the south, in what became South Korea.  

The governance of South Korea oscillated between republican efforts punctuated by repressive military juntas until Kim Young Sam, who was an opponent of a previous military regime, became the first freely-elected civilian president in 1993, 48 years after the initiation of the nation building effort.

​Nation building is a problematic undertaking, and it is a generational process with many starts and stops.  Whether nation building is moral and ethical is questionable and far beyond the scope of this examination.

An examination of the American South from a nation building lens is illuminating as it fits the three Carnegie criteria:

• After the secession of the Southern states in April 1861, the United States intended to remove Jefferson Davis as the President of the Confederate States of America.
• The United States committed an immense number of troops to the conflict
• The United States forces overran the Confederate military and occupied the Southern states for the next 12 years with both military and civilian political administration.

Reconstruction was an attempt to eradicate the odor of slavery and rebuild a society around democratic ideals and free labor. 

The primary legal portions of Reconstruction remade the United States Constitution through three amendments:

• The Thirteenth Amendment outlawed slavery.
• The Fourteenth Amendment granted citizenship to former slaves and provided them equal protection under federal law.

• The Fifteenth Amendment granted former slaves the right to vote.

​The United States Congress took additional aggressive legal action in the nation building effort.  The First Reconstruction Act in 1867 divided the South into five districts, each governed by the United States military.  Congress also specified states would have to enfranchise former slaves before formal readmission to the United States.  The Second Reconstruction Act put the military in charge of Southern voter registration. 

The natural outcome of the right to vote was representative democracy.  A dozen African American men, many of whom had been born into slavery, were elected to the United States Congress, including the first African American Senator, Hiram Rhodes Revels of Mississippi.

​Unfortunately for the entire United States Reconstruction ended in 1877.  The Compromise of 1877 resolved the disputed 1876 presidential election between Democratic candidate Samuel Tilden and Republican candidate Rutherford B. Hayes.   Democrats agreed that Rutherford B. Hayes would become president in exchange for the withdrawal of federal troops from the South and the granting of ‘home rule’ in the South.

​‘Home rule’ in this sense became the resurrection of white supremacy with all its convoluted immorality.  ‘Jim Crow’, a colloquial term of unknown provenance, referred to a type of laws and regulations enforcing a race-based social order run by European Americans.  Southern segregation gained ground in 1896 when the United States Supreme Court declared in Plessy v. Ferguson that facilities for African Americans and Caucasian Americans could be ‘separate but equal.’

The Civil Rights era formed the platform of an American Renaissance.  The Civil Rights Act of 1964 was labor law legislation that outlawed discrimination based on race, color, religion, sex, or national origin, and ended unequal application of voter registration requirements and racial segregation in schools, at the workplace, and in public accommodations.  The Voting Rights Act of 1965 outlawed the discriminatory voting practices adopted in many southern states after the Civil War, including literacy tests as a prerequisite to voting.  President Lyndon Johnson urged the approval of the Fair Housing Act of 1968 which occurred one week after the assassination of Martin Luther King, Jr.  Its primary prohibition made it unlawful to refuse to sell, rent to, or negotiate with any person because of that person's inclusion in a protected class.

As outlined in a previous investigation the repression of voting rights, gerrymandering, functional segregation of education, housing, and outright racism have caused the South to trail the United States in income per capita.  Economic growth and representative democracy are correlated.  South Africa's growth performance strengthened substantially since the end of apartheid in 1994.

Like South Korea, the South is taking its time in becoming truly representative but there are signs of cracks.  Of the 11 former Confederate states, two, Virginia and Georgia, went Blue in the presidential election this year, and Georgia elected two Democratic senators, one African American and one Jewish.  Some analysts insist Texas could join Blue states as soon as 2024 due to demographic changes.

Recent corporate objections to Republican-led voting restrictions including Major League Baseball pulling the All-Star game from Atlanta due to Georgia’s attempts to limit the ability of people to vote will act to mitigate voting rights suppression.  The Business Round Table, a group of CEOs of major corporations, has publicly stated their opposition to voter suppression legislation.

However, corporations can’t whitewash their support for politicians who support voting rights suppression legislation due to open-book reporting on campaign contributions.  Corporations donated $50 Million to supporters of voter suppression bills since 2015 and $22 Million in the 2020 election cycle.

​The path forward for the South is embracing multiculturalism and human rights, otherwise, it faces continuing erosion of its economic status and cultural prestige.  

​Americans seem to love quick fixes.  Fitness boot camps and drastic diets where immediate results cost a few bucks and some personal sacrifice and result in short-term good outcomes generate lots of revenue but few long-term health improvements.  Recidivism to previous self-destructive measures renders these short-term gains defunct and the subscriber ends where they were or worse.  

,Fitness boot camps come from cultural icons related to the military.  The United States empire is nothing if not militaristic, with the defense budget of the United States exceeding that of the next 10 countries combined, as discussed in a previous investigation.  The United States 13-week bootcamp for new enlistees allegedly reforms their bodies and minds into proper soldiers ready to fight for freedom.   Stripes, an iconic 1981 comedy where a ragtag group of ne’er-do-wells performed heroic acts in a Cold War conflict is an iconic example of this philosophy.

The concept extreme efforts can result in great outcomes permeated into society particularly with crash diets and fitness programs intended to turn overfed bodies into glistening Hollywood-ready stars and social media influencers.  Corporate workouts, each a bit niftier than the last, and each promising a beautiful body bring millions of Americans with their cash in a quest for youthful vigor and attractiveness.

​Squeezing into a Speedo with 20 extra pounds of COVID weight seems unappealing enough to compel a quick fix at the gym and the fitness providers are happy to provide lots of promises. 

While the rationales offered by fitness snake oil salespeople are indisputable – exercise burns calories and muscles burn more calories than fat – the details get a lot sketchy in a hurry.  Purveyors of fitness programs in many ways are like real estate developers; they  provide pretty pictures, waving of hands, and extravagant promises.  Whether it be High-Intensity Interval Training (HIIT), kick-boxing, kettlebells, fitness bands, progressive resistance bodybuilding, marathon training programs, yoga, or weight training hanging upside-down, sellers of these programs promise results, and fast, but with a price.

Studies indicate about 50% of exercise program enrollees drop out in the first six months.  There does not appear to be an authoritative study about the whys of that attrition rate so any further discussion would be conjecture or parroting from fitness websites.  Traditional low-cost gyms tend toward a model of over-subscription counting on most users showing up rarely, with the best example being Planet Fitness with membership costs at $10 a month.  Many people commit to joining a gym and then become that gym’s best customer by not showing up.

Diet programs in common use include meat-only, low-carbohydrate, intermittent fasting, juice cleanses, packaged foods with determined calorie values, uncooked foods only, low-fat, high-fat, and the like.  All feature some ‘scientific’ rationale and provide evidence of efficacy, albeit in many cases anecdotal or otherwise questionable.  Most of these diets work in the short-term as the regimes tend to proscribe consumption of calorie-rich industrial foods. 

While the diets seem to work short-term, long-term analysis confirms these diets are not only ineffective they might contribute to even worse weight gains so the subject becomes even fatter and confirmed in their inadequacy. 

Americans spend $33 billion annually for weight-loss products and services and about 45 million of them go on a diet regime each year.  There are about 3,500 calories in one pound of body fat so reduction of weight becomes a simple equation of lowering caloric intake or conversely increasing exercise.  While exercise can help, running a 26.2-mile marathon burns 2,500 calories, which sounds like a lot of burn, but forgoing 12 Snickers bars is about the same number of calories.

​Authoritative studies indicate dietary and other lifestyle behaviors may affect the success of the eat less and exercise more mantra for preventing long-term weight gain.  Weight gains over time were strongly associated with eating industrial foods including, in order, potato chips, potatoes, sugar-sweetened beverages, unprocessed red meats, and processed meats, and was inversely associated with the intake of vegetables, whole grains, fruits, nuts, and yogurt, once again, in order.  The best advice is to simply avoid industrial foods full of calories with little nutrition.  Long-term mindfulness practice could erode overnutrition without obsession and result in a more satisfactory outcome.

Western medicine has made huge advances in treating acute conditions such as cancer, diabetes, stroke, and heart disease but chronic conditions such as obesity, depression, drug addiction, and pain management are resistant to pharmaceutical or surgical intervention.  The cultural lens of immediate benefit through sporadic interventions has clouded the truth that good outcomes with the management of these chronic conditions require ongoing diligence and behavioral changes.

While it seems boot camp concepts about health and fitness are erroneous, and regardless compliance with the recommended program erodes very quickly, the power of habits to corrode existing structures remains available for use.  Habits make up a vast share of our daily lives and once molded, they become such second nature that breaking or changing them can be intolerable.  Weight management and fitness almost entirely are supported by large numbers of good habits.

Studies about developing habits opine:

• Any new habit begins with conscious thought and goals.
• Cues trigger habit action.
• One is more likely to form habits in a stable environment. 
• One must perform the habit many times for it to take.
• Rewards are helpful to ingrain the habit into one’s daily milieu.
• One of the finest openings to promote new habits is during a major life change, such as moving to a new physical setting, taking a different job, or recuperating from a major illness.
• If one associates a new habit with an existing routine action, habit formation will be more effective than trying to replace a habit with a new one.
• Making any desired behavior easy to do rather than requiring a great deal of effort or expense.