Sexuality

 

Sexual activity is associated with health (Laumann EO, 2005).

Illness may considerably interfere with sexual health (Schover LR, 2000).

 

A massive and growing market for drugs and devices to treat sexual problems targets older adults.

Driven in part by the availability of drugs to treat erectile dysfunction, the demand for medical attention and services relating to sexual health is increasing.

 

Most women and men maintain sexual and intimate relationships and desire throughout their lives (Nicolosi A, 2004 A).

Physiologic changes can affect the sexual response of men and women and may inhibit or enhance sexual function as people age (Rosen RC, 2005).

Age and poor health are negatively associated with many aspects of sexuality (Camacho ME, 2005).

 

Sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer (Isselbacher KJ, 1994).

Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal (Nicolosi A, 2004 B).

Patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician–patient communication about sexuality is poor (Gott M, 2004).

 

 

Intimacy

 

It is suggested that intimacy consists of 5 distinct components (Moss BF, 1993) :

• commitment,

• mutuality (interde­pendence),

• emotional intimacy (includes caring, positive regard),

• cognitive intimacy (includes thinking about the other; shared values), and

• physical intimacy (ranging from closeness to intercourse)

 

Intimacy is a process which develops and fluctuates over time. Intimacy is an unstable state, it cannot be "achieved," it must be worked on to be maintained (Olson DH, 1975).

 

The Personal Assessment of Intimacy in Relationships (PAIR) questionnaire is a validated tool for the measurement of the 5 components of intimacy.

 

 

Intimacy and privacy

 

Viewed from the perspective of privacy, inti­macy cannot be forced upon a person even if all the signs indicate that he or she is craving human contact.

Rooted in the ethical principle of respect for person, privacy is a personal right (Mattiasson AC, 1999).

Caregiving (e.g., assistance with activities of daily living) straddles the space between privacy and personhood. It is a kind of intimacy that cannot be avoided because it is frequently a hands-on activity and task related.

However, caregivers should not assume that a person likes or wants to be touched. Non-task-related “affective” touching, such as simply stroking a person’s cheek or holding his or her hand may be viewed as assaultive, erotic, comforting, or presumptuous, de­pending on a person’s cultural background, relationship with the one touching, and personal comfort zone.

Appropriate and sensitive questioning, especially following cues of distress, is essential to assess intimacy related desire, fears and /or distress.

 

 

Relationship between Sexuality and Intimacy

 

The relationship between intimacy and adequacy of sexual functioning may be particularly important in older individuals, since older people have a higher likelihood of experiencing difficulties with sexual functioning (Hyde JS, 1990).

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An older adult’s expression of sexuality may be restrained by functional limitations, normal aging changes, chronic health conditions such as cardiac disease, arthritis, diabetes, depression, incontinence, as well as environmental issues that exist in institutional living or limit contact with others.

Treatments for chronic diseases may impair sexual function or reduce sexual desire.

The attending GP and other health professionals have a pivotal role to open the discussion on sexuality with the older adult.

Further assessment of normal aging changes, disability, chronic health issues, medications, and environmental factors contributes to appropriate education, interventions for sexual issues, and referral to interprofessional specialists as needed. 

 

The PLISSIT model offers a framework to assess sexuality of adults (Annon, 1976). The model enables the interviewer to initiate and further the discussion of sexuality with older adults. There are suggested questions to guide the discussion of sexuality.

 

Defensiveness in Response to Measures of Relationship Satisfaction

 

Social desirability can be thought of as a tendency to respond to items in such a way that one appears in a favourable light (Jemail JA, 1982).

In test situations, people often respond in a way that will create a favourable impression, regardless of how they actually think, act, or behave. Cosequently, items which are considered socially desirable are endorsed, and those which are considered socially undesirable are denied (Carstenson LL, 1983).

The possibility of socially desirable, or defensive responding must be taken into account when utilising tools such as PAIR and PLISSIT model (Patton GR, 1979).

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Overcoming Barriers to Sexuality and Intimacy in Residential Care

 

Staff misconceptions and negative attitudes about sexuality and aging may pose a barrier to sexual fulfillment for long-term care residents.

It is important to examine staff attitudes to sexuality and intimacy, to ensure that optimum responses and actions are taken in response to residents sexuality and intimacy needs.

Staff education about sexuality and intimacy of older adults encompasses recognition of cues, desires, and interest in sexual activity and inti­macy. It also must address the use of and access to pornographic material, assisting expression of sexuality through masturbation, and discussion and debunking of stereotypes (e.g., the “dirty old man”).

 

In long-term care settings, supporting sexual health of older adults begins with an assessment of sexual history on admission. This includes ob­taining information about the person’s sleeping habits (e.g., without sleepwear), sexual orienta­tion, current sexual activity (e.g., masturbation), and interests (Kamel HK, 2003).

It is useful to know the resident’s atti­tude toward sexual humor and entertainment, such as explicit magazines or movies. How does the resident meet his or her need for sexual expression and intimacy?

 

All residents should be offered a level of pri­vacy commensurate with their individual needs.

Ways to promote privacy might include hanging a “do not disturb” sign during conjugal visits and arranging something for the roommate to do during this personal private time. For some residents, the opportunity to pet or stroke an an­imal may provide the sense of touch they are missing.

Gay and lesbian older adults may need support to maintain their relationship (if their partner lives in community) or starting one in the assisted liv­ing residence (Blando JA, 2001).

 

Sex education and counseling might be indicated for those residents who ex­press an interest in pursuing or resuming sexual activity.

Residents’ families might also benefit from sex education or counseling, keeping in mind, however, that the resident’s privacy rights are paramount.

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The Sexuality Assessment Tool (SexAT) for residential aged care facilities provides a gap analysis style and scoring system to assist with policy development aimed at supporting and optimising the expression of sexuality of residents, both with and without dementia.

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The Golombok-Rust Inventory of Sexual Satisfaction is a pay per use tool.

The 28 item questionnaire designed to measure specific areas of sexual functioning is available as GRISS-M for males, and GRISS-F for females. It includes questions pertaining to specific sexual dysfunctions (i.e., erectile disorder, anorgasmia) as well as subscales measuring sexual satisfaction and communication.