Abstract
This paper discusses sexuality and intimacy behaviors of the elderly with dementia living in residential care. The study explores this thematic from the perspectives of healthcare professionals and family caregivers. The methodology used is based on a qualitative method approach. The research was conducted in Portugal, using semi-structured face-to-face in-depth interviews. Thirty-two people participated in this study. The qualitative data was analyzed using thematic analysis to help identify repeated patterns of meaning in the dataset. The following key findings emerged: (1) participants identified the presence of sexuality, intimacy and sexual behavior in elderly people with dementia, primarily due to the physiological needs of individuals; (2) sexuality was mostly considered as an important manifestation of love, affectivity and proximity; (3) social and cultural beliefs influenced participant’s perception of the issue, some considering it a taboo subject; (4) participants expressed the need for these behaviors be considered natural and acceptable as sexuality and intimacy are inherent in humans and contribute to an individual’s quality of life hence they should also be dealt with in a practical manner; (5) a general limitation in training and institutional guidelines was identified; (6) decision-making in the area of sexuality should be determined by the elderly if they maintain the ability to manifest what their wishes are. As life expectancy increases along with dementia cases, a better understanding of sexuality in dementia, is of great importance as it could potentially help increased the quality of life for these individuals.
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References
Moreira, J.: Mudanças na percepção sobre o processo de envelhecimento: reflexões preliminares. Psicologia: Teoria e Pesquisa 28(4), 451–456 (2012). https://doi.org/10.1590/S0102-37722012000400003
Mascayano, F., Tapia, T., Gajardo, J.: Estigma hacia la demencia: una revisión. Revista Chilena de Neuro-Psiquiatría 53(3), 187–195 (2015). https://doi.org/10.4067/S0717-92272015000300006
Mental Health First Aid Australia: Guidelines for helping the confused older person, pp. 1–11. Mental Health First Aid Australia, Melbourne (2015)
Nogueira, M.M.L., Brasil, D., de Sousa, M.F.B., Santos, R.L., Dourado, M.C.N.: Satisfação sexual na demência. Revista de Psiquiatria Clínica 40(2), 77–80 (2013). https://doi.org/10.1590/S0101-60832013000200005
Devesa, D., Cruz, H., Simões, J.: A velha Sexualidade nos Idosos de Hoje: Quando surge a Demência. Revista Associação Dos Docentes e Orientadores de Medicina Geral e Familiar 2, 29–34 (2013). Retrieved from http://adso.com.pt/revadso/article/view/15
Harris, P.B.: Intimacy, sexuality, and early-stage dementia—the changing marital relationship. Alzheimer’s Care Today 10(2), 63–77 (2009). https://doi.org/10.1097/ACQ.0b013e3181a40d80
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., Ferri, C.: The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s Dement. 9(1), 63–75 (2013). https://doi.org/10.1016/j.jalz.2012.11.007
Santana, I., Farinha, F., Freitas, S., Rodrigues, V., Carvalho, Á.: Estimativa da prevalência da demência e da doença de Alzheimer em Portugal. Acta Médica Portuguesa 7, 182–188 (2015)
Campos, A.C.V., Ferreira, E.F., Vargas, A.M.D.: Determinantes do envelhecimento ativo segundo a qualidade de vida e gênero. Ciência Saúde Coletiva 20(7), 2221–2237 (2015). https://doi.org/10.1590/1413-81232015207.14072014
Seng, A.: Senior care and sexuality. Ethics Med. 42(4), 1–3 (2017)
Kalra, G., Pinto, C., Subramanyam, A.: Sexuality: desire, activity and intimacy in the elderly. Indian J. Psychiatry 53(4), 300 (2011). https://doi.org/10.4103/0019-5545.91902
Rowntree, M.R., Zufferey, C.: Need or right: sexual expression and intimacy in aged care. J. Aging Stud. 35, 20–25 (2015). https://doi.org/10.1016/j.jaging.2015.07.003
Tsatali, M., Tsolaki, M.: Sexual function in normal elders, MCI and patients with mild dementia. Sex. Disabil. 32(2), 205–219 (2014). https://doi.org/10.1007/s11195-014-9353-9
Miller, E., Sehgal, M., Dziegielewski, S.: Sexuality and Intimacy. Center for Aging with Dignity, Cincinnati (2011)
Chen, Y.-H., Jones, C., Osborne, D.: Exploratory study of Australian aged care staff knowledge and attitudes of later life sexuality. Australas. J. Ageing 36(2), 35–38 (2017). https://doi.org/10.1111/ajag.12404
Frankowski, A.C., Clark, L.J.: Sexuality and intimacy in assisted living: residents’ perspectives and experiences. Sex. Res. Soc. Policy 6(4), 25–37 (2009). https://doi.org/10.1525/srsp.2009.6.4.25
Vandrevala, T., Chrysanthaki, T., Ogundipe, E.: “Behind closed doors with open minds?” A qualitative study exploring nursing home staff’s narratives towards their roles and duties within the context of sexuality in dementia. Int. J. Nurs. Stud. 74, 112–119 (2017). https://doi.org/10.1016/j.ijnurstu.2017.06.006
Syme, M.L., Yelland, E., Cornelison, L., Poey, J.L., Krajicek, R., Doll, G.: Content analysis of public opinion on sexual expression and dementia: implications for nursing home policy development. Health Expect. 20(4), 705–713 (2017). https://doi.org/10.1111/hex.12509
Lightbody, E.: Sexuality and Dementia: For Better or Worse? pp. 1–8. Royal College of Psychiatrists, London (1993)
Bartlett, P.: Sex, dementia, capacity and care homes. Liverp. Law Rev. 31(2), 137–154 (2010). https://doi.org/10.1007/s10991-010-9077-6
Benbow, S.M., Beeston, D.: Sexuality, aging, and dementia. Int. Psychogeriatr. Assoc. 24(7), 1026–1033 (2012). https://doi.org/10.1017/S1041610212000257
Venturini, L.: Sexualidade de Idosas Institucionalizadas:percepção da equipa de enfermagem. (Master’s thesis) Universidade Federal Santa Maria, Santa Maria (2017)
Forman, J., Damschroder, L.: Qualitative content analysis. In: Jacoby, L., Siminoff, L. (eds.) Empirical Methods for Bioethics: A Primer, vol. 11, pp. 39–62. Emerald Group Publishing Limited, Bingley (2007). https://doi.org/10.1016/S1479-3709(07)11003-7
Insch, G.S., Moore, J.E., Murphy, L.D.: Content analysis in leadership research: examples, procedures, and suggestions for future use. Leadersh. Q. 8(1), 1–25 (1997). https://doi.org/10.1016/S1048-9843(97)90028-X
Bardin, L.: Análise de Conteúdo (Edições 70). Lisboa (2013)
Braun, V., Clarke, V.: Using thematic analysis in psychology using thematic analysis in psychology. Qual. Res. Psychol. 3(2), 77–101 (2006). https://doi.org/10.1191/1478088706qp063oa
Lad, D. K., & Bhaskaran, V.: Content Analysis: A method in Social Science Research. Research Methods for Social Work. 173–193 (2008) Retrieved from http://repository.upenn.edu/cgi/viewcontent.cgi?article=1232&context=asc_papers&sei-redir=1&referer=http://scholar.google.com.my/scholar_url?hl=en&q=http://repository.upenn.edu/cgi/viewcontent.cgi?article=1232&context=asc_papers&sa=X&scisig=AAGBfm23DWDQYw
Elo, S., Kyngäs, H.: The qualitative content analysis process. J. Adv. Nurs. 62(1), 107–115 (2007). https://doi.org/10.1111/j.1365-2648.2007.04569.x
Branco, C.: Envelhecer … Embelecer … Envilecer : Comprometimento ou Desvinculação com a vida ? Atividade e sociabilidade dos idosos da Alta de Coimbra. (Master’s thesis) Instituto Superior Miguel Torga, Coimbra (2012)
Teles, H., Eugénio, L., Cardoso, P., Figueiredo, V.: Sexualidade na Terceira Idade. (Final year project) Instituto Superior de Serviço Social de Lisboa, Lisboa (2006)
Hubbard, D.S.: Alzheimer’s Disease and intimacy: a content analysis of resources available through the Alzheimer’s Association and the National Institute on Aging. (Master’s thesis) College of Arts and Sciences, Georgia State University, Georgia (2012)
Alzheimer’s Association: Changes in sexuality and intimacy. Alzheimer’s Assoc. 1, 1–5 (2014)
Ziello, A., Iavarone, A., Poderico, C., Pastore, F., Fasanaro, A.M.: Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease. Neuropsychiatr. Dis. Treat. 10, 1407–1413 (2014). https://doi.org/10.2147/ndt.s58063
Prince, M., Comas-Herrera, A., Knapp, M., Guerchet, M., Karagiannidou, M.: World Alzheimer Report 2016 improving healthcare for people living with dementia. Coverage, quality and costs now and in the future. Alzheimer’s Disease International (ADI), pp 1–140 (2016). Retrieved from https://www.alz.co.uk/research/world-report-2016
Hellen, C.R.: Intimacy: nursing home resident issues and staff training nursing homes have. Am. J. Alzheimer’s Dis. 1, 1–6 (1995)
Deacon, S., Minichiello, V., Plummer, D.: Sexuality and older people: revisiting the assumptions. Educ. Gerontol. 21(5), 497–513 (2015). https://doi.org/10.1080/0360127950210509
Davies, H.D., Zeiss, A.M., Shea, E.A., Tinklenberg, J.R.: Sexuality and intimacy in Alzheimer’s patients and their partners. Sex. Disabil. 16(3), 193–203 (1998)
Alzheimer Scotland: Sexuality and dementia. Alzheimer Scotland: Action on Dementia (28), pp. 1–7 (2011)
McAuliffe, L., Bauer, M., Nay, R.: Barriers to the expression of sexuality in the older person: the role of the health professional. Int. J. Older People Nurs. 2(1), 69–75 (2007). https://doi.org/10.1111/j.1748-3743.2007.00050.x
Bamford, S.-M., Serra, V.: The last taboo: a guide to dementia, sexuality, intimacy and sexual behaviour in care homes. Int. Longev. Centre 44, 56 (2011)
Medeiros, K., Rosenberg, P.B., Baker, A.S., Onyike, C.U.: Improper sexual behaviors in elders with dementia living in residential care. Dement. Geriatr. Cogn. Disord. 26(4), 370–377 (2008). https://doi.org/10.1159/000163219
Tenenbaum, E.: To be or to exist: standards for deciding whether dementia patients in nursing homes should engage in intimacy, sex, and adultery. Indiana Law Rev. 42, 675–720 (2007)
Taylor, A., Gosney, M.A.: Sexuality in older age: essential considerations for healthcare professionals. Age Ageing 40(5), 538–543 (2011). https://doi.org/10.1093/ageing/afr049
Ballard, E.L.: Attitudes, myths, and realities: helping family and professional caregivers cope with sexuality in the Alzheimer’s patient. Sex. Disabil. J. Devoted Psychol. Med. Asp. Sex. Rehabil. Community Settings 13(3), 255–270 (1995). https://doi.org/10.1007/BF02590071
Spece, R., Hilton, J., Younggren, J.: (Implicit) consent to intimacy. Indiana Law Rev. 50(907), 907–942 (2017)
Heath, H.: Intimate relationships for people with dementia. Nurs. Resid. Care 14(11), 593 (2012)
Wilkins, J.M.: More than capacity: alternatives for sexual decision making for individuals with dementia. Gerontologist 55(5), 716–723 (2015). https://doi.org/10.1093/geront/gnv098
Rodgers, V.: Understanding intimacy needs of the elderly. Kai Tiaki Nurs. N. Z. 22(10), 27 (2016)
Hajjar, R.R., Kamel, H.K.: Sexuality in the nursing home, part 1: attitudes and barriers to sexual expression. J. Am. Med. Dir. Assoc. 4(3), 152–156 (2003). https://doi.org/10.1016/S1525-8610(04)70325-4
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Pinho, S., Pereira, H. Sexuality and Intimacy Behaviors in the Elderly with Dementia: The Perspective of Healthcare Professionals and Caregivers. Sex Disabil 37, 489–509 (2019). https://doi.org/10.1007/s11195-019-09589-0
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DOI: https://doi.org/10.1007/s11195-019-09589-0