Taking a Person-Centered Approach to Understanding Sexual Expression among Long-term Care Residents: Theoretical Perspectives and Research Challenges
- 375 Downloads
Sexual activity among older adults tends to be an uncomfortable and unaddressed topic, especially within long-term care settings where caregiver responses to sexual expression ranges from acceptance to isolation and eviction (Reingold and Burros 2004). Previous definitions of sexual expression have incorporated a broad range of behaviors including sexual intercourse, solo and partnered masturbation, oral sex, personal grooming, touch, and displays of affection, companionship, and romance (DeLamater and Karraker 2009; Hajjar and Kamel 2003a, b). Inconsistencies in responses to such behaviors cause concern regarding legal and ethical boundaries and responsibilities, and raise questions regarding whether thwarting sexual expression is a violation of residents’ rights (Black et al. 2005). Given the toll on residents, caregivers, and family members, sexual expression in residential and care settings poses significant policy implications. In this paper, we suggest a theoretical perspective and identify gaps in the empirical research which must be addressed in order to support institutional strategies and ultimately, consistent and ethical caregiver responses to sexual expression among older adults in long-term care settings. Extrapolating from this specific application, discussion focuses on future directions for research and policy work related to the field of sexuality among older adults.
KeywordsSexuality and older adults Long-term care Resident rights to sexual expression Bioecological theory Quality of life Stereotypes about the aged
- Age Discrimination Act of 1975 (n.d.). In United States Department of Labor. Retrieved January 1, 2011, from http://www.dol.gov/oasam/regs/statutes/age_act.htm.
- Archibald, C. (2002). Sexuality and dementia in residential care: Whose responsibility? Sexual and Relationship Therapy, 17, 301–309. Retrieved December 15, 2009, from http://web.ebscohost.com.proxy.lib.iastate.edu:2048/ehost/pdf?vid=2&hid=108&sid=b4e4d73e-8b42-4174-9630-2c547600b0be%40sessionmgr114. doi:10.1080/14681990220149103.CrossRefGoogle Scholar
- Belinky v. Drake Center, Inc., 690 N.E.2d 1302, 1308 (Ohio Ct. App. 1996).Google Scholar
- Cahill, S., South, K., & Spade, J. (2000). Outing Age: Public policy issues affecting gay, lesbian, bisexual and transgender Elders. New York: The Policy Institute of the Gay and Lesbian Task Force.Google Scholar
- Carr, A. J., Gibson, B., & Robinson, P. G. (2001, May 19). Measuring quality of life: Is quality of life determined by expectations or experience. Retrieved October 9, 2010 Alison J Carr, Barry Gibson, Peter G Robinson BMJ 2001; 322:1240 (Published 19 May 2001). doi: 10.1136/bmj.322.7296.1240
- Casta-Kaufteil, A. (2004). The old and the restless: mediating rights to intimacy for nursing home residents with cognitive impairments. Journal of Medicine and Law, 8, 69–86.Google Scholar
- Cooper, C., Selwood, A., & Livingston, G. (2008). The prevalence of elder abuse and neglect: a systematic review. Age and Ageing, 37, 151–160. doi: 10.1093/ageing/afm194. Adapted from “Pioneering Change to Promote Excellent Alternatives in Kansas Nursing Homes,” (or the title of the module used), 2003–2008, Center on Aging, Kansas State University, Manhattan, KS. Used by permission.CrossRefGoogle Scholar
- Heath, H., & White, I. (2002). The challenge of sexuality in healthcare (pp. 138–148). Maiden: Blackwell Science Ltd.Google Scholar
- Hillman, J. (1994). A linkage of knowledge and attitudes toward elderly sexuality: not necessarily a uniform relationship. The Gerontological Society of America, 39, 20–256.Google Scholar
- Holmes, D., Reingold, J., & Teresi, J. (1997). Sexual expression and dementia. International Journal of Geriatric Psychiatry, 12, 695–701. doi: 10.1002/(SICI)1099-1166(199707)12:7<695::AID-GPS546>3.3.CO;2-3.CrossRefGoogle Scholar
- Knaplund, K. S. (2008, August). The right of Privacy and America’s Aging Population. In works.bepress.com. Retrieved March 3, 2011, from http://works.bepress.com/cgi/viewcontent.cgi?article=1002&context=kristine_knaplund.
- Levine, J. M. (2003). Elder neglect and abuse: A primer for primary care physicians. Geriatrics, 58, 37–44.Google Scholar
- Meston, C. M. (1997). Aging and sexuality. Successful Aging, 167(4), 285–290.Google Scholar
- Miles, S. H., & Parker, K. (1999). Sexuality in the nursing home: iatrogenic loneliness. Generations, 23, 36–43.Google Scholar
- Morgaine, C. (2001). Family systems theory. Retrieved January 1, 2011, from http://web.pdx.edu/~cbcm/CFS410U/FamilySystemsTheory.pdf.
- Nusbaum, M. R. H., Lenahan, P., & Sadovsky, R. (2005). Sexual health in aging men and women: addressing the physiologic and psychological sexual changes that occur with age. Geriatrics, 60, 18–23.Google Scholar
- Requirements for Nursing Facilities, 42 U.S.C. § 1396r. (2010). Retrieved March 4, 2011 from http://www.law.cornell.edu/uscode/42/1396r.html.
- Sánchez, M., Butts, D. M., Hatton-Yeo, A., Henkin, N. A., Jarrot, S. E., Kaplan, M. S., et al. (2007) Intergenerational programs: Towards a society for all ages. Barcelona, Spain: La Caixa Foundation.Google Scholar
- Tenenbaum, E. (2009). To be or to exist: Standards for deciding whether dementia patients in nursing homes should engage in intimacy, sex, and adultery. Indiana Law Review. 42 (3). Albany Law School Research Paper No. 15. Retrieved December 29, 2010, from SSRN: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1470316
- Tessler Lindau, S., Schumm, P. L., Laumann, E. O., Levinson, W., O’Muircheartaigh, C. A., & Waite, L. J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 762–774. doi:10.1056/NEJMoa067423.
- The Hebrew Home for the Aged at Riverdale. (n.d.). Retrieved January 1, 2011, from http://www.hebrewhome.org/mission.asp.
- Volpe, E. M., & Wertheimer, J. C. (2004). Exploring sexuality attitudes and knowledge in nursing: An education program (Doctoral dissertation). Retrieved February 24, 2011, from esextherapy.com.Google Scholar
- White, M. C. (2010). The eternal flame: capacity to consent to sexual behavior among nursing home residents with dementia. Elder Law Journal, 18(1), 133.Google Scholar
- White, J. M., & Klein, D. M. (2002). Family theories (2nd ed., pp. 117–228). Thousand Oaks: Sage.Google Scholar