Ageing International

, 36:401 | Cite as

Taking a Person-Centered Approach to Understanding Sexual Expression among Long-term Care Residents: Theoretical Perspectives and Research Challenges

  • Merea D. Bentrott
  • Jennifer A. Margrett


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.


Sexuality and older adults Long-term care Resident rights to sexual expression Bioecological theory Quality of life Stereotypes about the aged 


  1. Age Discrimination Act of 1975 (n.d.). In United States Department of Labor. Retrieved January 1, 2011, from
  2. Archibald, C. (2002). Sexuality and dementia in residential care: Whose responsibility? Sexual and Relationship Therapy, 17, 301–309. Retrieved December 15, 2009, from doi:10.1080/14681990220149103.CrossRefGoogle Scholar
  3. Béland, F., Zunzunegui, M., Alvarado, B., Otero, A., & del Ser, T. (2005). Trajectories of cognitive decline and social relations. Journal of Gerontology: Psychological Science, 6(60), 320–30. doi: 10.1093/geronb/60.6.P320.CrossRefGoogle Scholar
  4. Belinky v. Drake Center, Inc., 690 N.E.2d 1302, 1308 (Ohio Ct. App. 1996).Google Scholar
  5. Black, B., Muralee, S., & Tampi, R. R. (2005). Inappropriate sexual behaviors in dementia. Journal of Geriatric Psychiatry and Neurology, 18, 155–162. doi: 10.1177/0891988705277541.CrossRefGoogle Scholar
  6. Brotman, S., Ryan, B., & Coremier, R. (2003). The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 43(2), 192–202.CrossRefGoogle Scholar
  7. 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
  8. 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
  9. 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
  10. 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
  11. DeLamater, J., & Karraker, A. (2009). Sexual functioning in older adults. Current Psychiatry Reports, 11, 6–11. doi: 10.1007/s11920-009-0002-4.CrossRefGoogle Scholar
  12. Forbes-Thompson, S., Gajewski, B., Scott-Cawiezell, J., & Dunton, N. (2006). An exploration of nursing home organizational processes. Western Journal of Nursing Records, 28, 935–954. doi: 10.1177/0193945906287053.CrossRefGoogle Scholar
  13. Ginsberg, T. B., Pomerantzz, S., & Kramer-Feeley, V. (2005). Sexuality in older adults: behaviours and preferences. Age and Ageing, 34, 475–80. doi: 10.1093/ageing/afi143.CrossRefGoogle Scholar
  14. Guan, J. (2004). Correlates of spouse relationship with sexual attitude, interest, and activity among Chinese elderly. Sexuality and Culture, 8, 104–131. doi: 10.1007/s12119-004-1008-z.CrossRefGoogle Scholar
  15. Hajjar, R. R., & Kamel, H. K. (2003a). Sexuality in the nursing home, part 1: attitudes and barriers to sexual expression. Journal of the American Medical Directors Association, 4, 152–156. doi: 10.1016/S1525-8610(04)70325-4.CrossRefGoogle Scholar
  16. Hajjar, R. R., & Kamel, H. K. (2003b). Sexuality in the nursing home, part 2: managing abnormal behavior- legal and ethical issues. Journal of the American Medical Directors Association, 4, 203–206. doi: 10.1016/S1525-8610(04)70347-3.CrossRefGoogle Scholar
  17. Heath, H., & White, I. (2002). The challenge of sexuality in healthcare (pp. 138–148). Maiden: Blackwell Science Ltd.Google Scholar
  18. 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
  19. 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
  20. Hubbard, G., Tester, S., & Downs, M. G. (2003). Meaningful social interactions between older people in institutional care settings. Aging and Society, 23, 99–114. doi: 10.1017/S0144686X02008991.CrossRefGoogle Scholar
  21. Huston, T. L. (2000). The social ecology of marriage and other intimate unions [Electronic version]. Journal of Marriage and Family, 62(2), 298–320. doi: 10.1111/j.1741-3737.2000.00298.x Google Scholar
  22. Kaplan, L. (1996). Sexual and institutional issues when one spouse resides in the community and the other lives in a nursing home. Sexuality and Disability, 14, 281–293. doi: 10.1007/BF02590100.CrossRefGoogle Scholar
  23. Kessler, E. M., Rakoczy, K., & Staudinger, U. M. (2004). The portrayal of older people in prime time television series: The match with gerontological evidence. Ageing and Society, 24, 531–552. doi: 10.1017/S0144686X04002338.CrossRefGoogle Scholar
  24. Knaplund, K. S. (2008, August). The right of Privacy and America’s Aging Population. In Retrieved March 3, 2011, from
  25. Levine, J. M. (2003). Elder neglect and abuse: A primer for primary care physicians. Geriatrics, 58, 37–44.Google Scholar
  26. Mcauliffel, L., Bauer, M., & Nay, R. (2007). Barriers to the expression of sexuality in the older person: the role of the health professional. International Journal of Older People Nursing, 2, 69–75. doi: 10.1111/j.1748-3743.2007.00051.x.CrossRefGoogle Scholar
  27. Meston, C. M. (1997). Aging and sexuality. Successful Aging, 167(4), 285–290.Google Scholar
  28. Miles, S. H., & Parker, K. (1999). Sexuality in the nursing home: iatrogenic loneliness. Generations, 23, 36–43.Google Scholar
  29. Morgaine, C. (2001). Family systems theory. Retrieved January 1, 2011, from
  30. Nay, R. (1992). Sexuality and aged women in nursing homes. Geriatric Nursing, 11–12, 312–14. doi: 10.1016/S0197-4572(05)80377-5.CrossRefGoogle Scholar
  31. Neumark, D. (2009). The age discrimination in employment act and the challenge of population aging. Research on Aging, 31(1), 41–68. doi: 10.1177/0164027508324640.CrossRefGoogle Scholar
  32. 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
  33. Ory, M., Hoffman, M., Hawkins, M., Sanner, B., & Mockenhaupt, R. (2003). Challenging aging stereotypes: strategies for creating a more active society. American Journal of Preventive Medicine, 25(3Sii), 164–171. doi: 10.1016/S0749-3797(03)00181-8.CrossRefGoogle Scholar
  34. Polinski, J. M., & Kesselheim, A. S. (2011). Where cost, medical necessity, and morality meet: should US government insurance programs pay for erectile dysfunction drugs? Clinical Pharmacology & Therapeutics, 89(1), 17–19. doi: 10.1038/clpt.2010.179.CrossRefGoogle Scholar
  35. Reingold, D., & Burros, N. (2004). Sexuality in the nursing home. Journal of Gerontological Social Work, 43(2–3), 175–186. doi: 10.1300/J083v43n02_12.CrossRefGoogle Scholar
  36. Requirements for Nursing Facilities, 42 U.S.C. § 1396r. (2010). Retrieved March 4, 2011 from
  37. Roach, S. M. (2004). Sexual behaviour of nursing home residents: staff perceptions and responses. Journal of Advanced Nursing, 48(4), 371–379. doi: 10.1111/j.1365-2648.2004.03206.x.CrossRefGoogle Scholar
  38. 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
  39. Singh, D. A., & Schwab, R. C. (2000). Predicting turnover and retention in nursing home administrators’ management and policy implications. The Gerontologist, 40(3), 310–319. doi: 10.1093/geront/40.3.310.CrossRefGoogle Scholar
  40. 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:
  41. 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.
  42. The Hebrew Home for the Aged at Riverdale. (n.d.). Retrieved January 1, 2011, from
  43. Ventegodt, S. (1998). Sex and quality of life in Denmark. Archives of Sexual Behavior, 27(3), 295–307. doi: 10.1023/A:1018655219133.CrossRefGoogle Scholar
  44. Volpe, E. M., & Wertheimer, J. C. (2004). Exploring sexuality attitudes and knowledge in nursing: An education program (Doctoral dissertation). Retrieved February 24, 2011, from Scholar
  45. 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
  46. White, J. M., & Klein, D. M. (2002). Family theories (2nd ed., pp. 117–228). Thousand Oaks: Sage.Google Scholar
  47. Zender, R., & Olshansky, E. (2009). Promoting wellness in women across the life span. Nursing Clinics of North America, 44(3), 281–291. Retrieved December 31, 2010, from Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of Human Development and Family StudiesIowa State UniversityAmesUSA

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