Dr CATHERINE COOK discusses intimacy, sexuality and sexual health in retirement and aged care.
Although some see ageing as a release from the demands of sexual relationships, for others, sexual intimacy continues to be a priority, strongly associated with happiness and a sense of quality of life. Modern images of sexuality and the promotion of sexual health focus on the young and beautiful and portrayals of older people’s bodies, especially in reference to sexuality and intimacy, are often denigrating. Although these cartoons or films might be accompanied by humour, they are ageist, portraying sexual desire in older people as unnatural and ‘dirty’. Another way the sexuality of older people is dismissed is by interpreting expressions of intimacy, such as holding hands or kissing, as cute; as almost childlike. These attitudes deny the reality that intimacy is a human right and sexuality is a core aspect of human identity.
When people move to a retirement village or an aged care facility, aspects of what have been important parts of their private lives risk becoming public. This situation is more so when there are degrees of increased dependency and, for some, cognitive decline. During the intake assessment it is rare for questions to be asked about people’s sexual needs and concerns. Are facilities ready for the baby boomers, many of whom have embraced sexual experimentation and choice? Do facilities create an inclusive environment for people who don’t identify as heterosexual? Would your clinical and management staff have any difficulties or dilemmas in responding to the following scenarios and balancing people’s rights with ensuring safety?
- A widower ‘comes out’ as gay and forms an open relationship with another resident
- A lesbian couple asks about attitudes towards same-sex relationships and the availability of a shared double bed in the rest home
- A single woman with a slight degree of cognitive decline initiates a new relationship with another resident, but the family want staff to stop the relationship
- A widower wants to pay for the services of a weekly escort or sex worker
- A resident who is HIV-positive commences a relationship with another resident and assures staff they are using condoms
- A resident who has always cross-dressed throughout his life wants to continue this practice
- A resident who experiences nocturnal incontinence and wears protective pants finds this gets in the way of masturbation
- A resident with an in-dwelling catheter asks if there are any alternatives as he wants to masturbate
- A staff member sees a resident watching adult pornography on his laptop
- A resident appears to be having sexual relationships concurrently with a number of residents
- A resident contracts a sexually transmitted infection.
If you answered ‘yes’ – that responding to any of these situations would be challenging – then your organisation is in the same boat as many throughout the world. Adult children’s opinions, although sometimes important, cannot always guide decisions where issues of competency are involved as they often know little about their parents’ sexuality. Therefore they may not be the best advocates for their rights in this regard. There’s a growing focus on research and education as intimacy and sexuality in the aged residential and care sector remains a troubling, misunderstood and frequently contended issue. Negotiating the sometimes competing interests of residents, staff of various disciplines, families, and regulatory bodies is not simple. In the absence of specific guidance and education, staff are likely to draw on their own values and experience.
In New Zealand, one of the challenges is that although well over 85 per cent of residents of residential aged care facilities are of New Zealand European descent, only 56 per cent of employees identify as New Zealand European. There may be significant cultural and religious differences in carers’ attitudes to intimacy and sexuality.
The good news is that research shows brief, educational interventions for staff work. International studies show that workshop participants’ attitudes and beliefs towards older people expressing their sexuality in long-term care were more open and supportive following education. A group of researchers based at Massey University, Albany, are about to pilot a study looking at what’s needed in the New Zealand context. The views of residents, families and staff will be collected and this research will lead to a larger national study and on to an educational package that will be made available to all levels of residential living.
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