Introduction <p>This systematic review aims to identify and evaluate existing evidence on the effectiveness of psychological and therapeutic interventions for supporting intimacy, including emotional and physical affection, in adults aged 65 and older.</p> Methods <p>Following PRISMA guidelines, a systematic search was conducted across relevant electronic databases and cross-referencing for studies published up to September 2025. Screening and selection were performed independently by at least two researchers using strict inclusion and exclusion criteria. Ethical approval was not required. The review was pre-registered on PROSPERO, and rigorous procedures were employed throughout the search, screening, and data extraction processes.</p> Results <p>From 14,501 screened records, six studies met inclusion criteria. Five of these used a randomised controlled trial (RCT) design to evaluate a range of interventions addressing intimacy in the context of health-related challenges (prostate cancer, epilepsy) and in community-based settings. One study investigated the impact of a sexual well-being promotion programme in the community with a non-randomised longitudinal design. Risk of bias was moderate across most studies, with no selected study rated as low risk. Although the interventions indicated some positive and promising effects, they predominantly targeted a narrow segment of the older adult population, mainly within the context of chronic illness.</p> Conclusions <p>The limited scope of existing studies reveals a significant research gap on intimacy in later life, highlighting the urgent need for specifically tailored, evidence-based interventions that support sexual health and well-being in older adults, and for inclusive approaches that reflect the diverse needs of this growing population.</p> Policy Implications <p>The review points to need for policies around ageing that recognise intimacy and relationship well-being as vital to healthy ageing.</p>