Older adults are likely to experience changes in sexuality and intimacy due to age and chronic illness. Little is known about the strategies used by older adult couples to prevent, overcome, or live with these changes. The purpose of this study was to identify how aging and chronic illness affected the life-long development of sexual intimacy of a sample of married adults. The investigation used grounded theory methods to describe sexual intimacy from the perspective of the participants' lived experiences. Seventeen participants, eight couples, and one husband whose wife refused to participate were interviewed. Each participant was interviewed one time, with interviews lasting one to one-and-one-half hours. Interviews were audio-tape recorded and transcribed. Data collection and data analysis were conducted cyclically, with the findings of early interviews influencing topics discussed in future interviews. Transcripts were coded, themes identified, and interim analysis reports generated throughout the study. A framework was created to depict the findings. The core category of the framework is the maturing of sexual intimacy in the presence of aging and chronic illness. Four sub-categories of self-care and role function strategies were identified which support the development of sexual intimacy over time. These are: (1) Commitment: married for keeps; (2) Adjustment to age: what comes natural does not bother you much; (3) Sexual expression: the man's decision; and (4) Protection: we take care of each other. One couple represented an exception to the framework and was described separately. Implications of the findings include suggestions for the design of future research, the need for better training of health care providers to address sexual concerns, and educational strategies for older adult couples.
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