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Sexuality in Long-Term Care

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Sexuality and Aging

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Abstract

In the USA alone, more than two million older adults live in nursing homes and assisted- living facilities, and their numbers are only expected to increase. Acknowledging the sexuality of older adults in institutional settings is essential, although the issues surrounding the expression of sexuality in institutional settings are often complex. An overarching theme regarding sexuality within an institutional context is that of stigma and discrimination, in which older residents are assumed to be asexual. In contrast, the majority of nursing home residents who responded to a recent survey report that sexuality is at least moderately important in their lives. A consistent challenge in long-term care is the need to protect individual residents’ rights to privacy and sexual expression with the duty to protect residents from harm. For example, many LGBT elders fear discrimination if their sexual orientation is revealed. Case examples are used to illustrate commonly encountered issues in long-term care related to sexuality including room sharing, masturbation, dating, pornography, and the impact of disabilities such as stroke and dementia. Newly released APA guidelines regarding the assessment of cognitively impaired residents’ sexual consent capacity are highlighted. Recommendations for the management of clearly inappropriate resident behavior (e.g., abuse of non-consenting or non-competent residents or visitors; masturbation in public areas; and inappropriate sexual comments and behavior toward staff) also are offered. Additional topics include the examination of benchmark programs and policies (e.g., the U.S. Nursing Home Bill of Rights) that may lead to a more ethical balance of residents’ rights to privacy and sexual expression, with the rights and safety of other residents and staff.

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References

  • Abner, C. (2006). Graying prisons: States face challenges of an aging inmate population (pp. 8–11). Nov/Dec: State News.

    Google Scholar 

  • Aizenberg, D., Weizman, A., & Barak, Y. (2002). Attitudes toward sexuality among nursing home residents. Sexuality and Disability, 20, 185–189.

    Article  Google Scholar 

  • American Psychological Association (2011b, October 19). Broad professional issues of concern to Psychologists working with older adults. http://www.apa.org/pi/aging/resources/guides/practitioners-should-know.aspx. Accessed 19 Oct 2011.

  • Ames, T., & Samowitz, P. (1995). Inclusionary standard for determining sexual consent for individuals with developmental disabilities. Mental Retardation, 4, 254–268.

    Google Scholar 

  • Anderson, L. (2007, November 18). Alzheimer’s: intimacy found after all is lost. Chicago Tribune. Retrieved from http://articles.chicagotribune.com/2007-11-18/news

  • Bauer, M. (1999). The use of humor in addressing the sexuality of elderly nursing home residents. Sexuality and Disability, 17, 147–155.

    Article  Google Scholar 

  • Biskupic, J. (2007, November 13). A new page in O’Connors’ love story. USA Today. Retrieved from http://www.usatoday.com/news/nation/2007-11-12-court_N.htm

  • Bostwick, J. M., Hecksel, K. A., Stevens, S. R., Bower, J. H., & Ahlskog, J. E. (2009). Frequency of new-onset pathologic compulsive gambling or hypersexuality after drug treatment of idiopathic Parkinson Disease. Mayo Clinic Proceedings, 84(4), 310–316.

    PubMed  Google Scholar 

  • Bouman, W. P., Arcelus, J., & Benbow, S. M. (2007). Nottingham study of sexuality and ageing (NoSSA II). Attitudes of care staff regarding sexuality and residents: A study in residential and nursing homes. Sexual and Relationship Therapy, 22, 45–61.

    Article  Google Scholar 

  • Council on Social Work Education. (2011). Rethinking aging stereotypes: “But I Don't Want to Work With Older Adults!” Accessed 19 Oct 2011. http://www.cswe.org/CentersInitiatives/GeroEdCenter/Students/LearnMore/RethinkingAgingStereotypes.aspx

  • Eckert, J. K., Carder, P. C., Morgan, L. A., Frankowski, A. C., & Roth, E. G. (2009). Inside assisted living: The search for home. Baltimore, MD: Johns Hopkins University Press.

    Google Scholar 

  • Engber, D. (2007, September 27). Is it time to let the elderly have more sex? Slate on-line magazine, 9/27. Retrieved from www.slate.com/articles/life/the_sex_issue/2007/09/naughty_nursing_homes.html.

  • Ferri, C. P., Prince, M., Brayne, C., Brodaty, H., Fratiglioni, L., Ganguli, M., et al. (2005). Global prevalence of dementia: a Delphi consensus study. The Lancet, 366, 2112–2117.

    Article  Google Scholar 

  • Frankowski, A. C., & Clark, L. J. (2009). Sexuality and intimacy in assisted living: Residents’ perspectives and experiences. Sexuality Research & Social Policy, 6(4), 25–37.

    Article  Google Scholar 

  • Ginsberg, T. B., Pomerantz, S. C., & Kramer-Feeley, V. (2005). Sexuality in older adults: Behaviours and preferences. Age and Ageing, 34, 475–480.

    Article  PubMed  Google Scholar 

  • Grisso, T. (2003). Evaluating competences (2nd ed.). New York: Plenum.

    Google Scholar 

  • Gua, Y. D. (2008). Inappropriate sexual behaviours in cognitively impaired older individuals. The American Journal of Geriatric Pharmacotherapy, 6(5), 269–288.

    Article  Google Scholar 

  • Harrison, P. M., & Beck, A. J. (2004). Prisoners in 2003 (Bureau of Justice Statistics Bulletin NCJ 205335). Washington, DC: U.S. Department of Justice.

    Google Scholar 

  • Hebrew Home. (2010). Sexual expression policy at the home. Retrieved from http://www.hebrewhome/org.

  • Hillman, J., & Stricker, G. (1994). Linkage of knowledge and attitudes toward elderly sexuality: Not necessarily a uniform relationship. The Gerontologist, 34, 256–260.

    Article  PubMed  Google Scholar 

  • Hillman, J. L., & Stricker, G. (1996). Predictors of college students' knowledge and attitudes toward elderly sexuality: The relevance of grandparental contact. Educational Gerontology: An International Journal, 22, 539–555.

    Article  Google Scholar 

  • Hinrichs, K. L. M., & Vacha-Haase, T. (2010). Staff perceptions of same-gender sexual contacts in long-term care facilities. Journal of Homosexuality, 57, 776–789.

    Article  PubMed  Google Scholar 

  • Hyde, J. (2001). Understanding the context of assisted living. In K. H. Namazi & P. K. Chafetz (Eds.), Assisted living: Current issues in facility management and resident care (pp. 15–28). Westport, CT: Auburn House.

    Google Scholar 

  • James, J. W., & Haley, W. E. (1995). Age and health bias in practicing clinical psychologists. Psychology and Aging, 10, 610–616.

    Article  PubMed  Google Scholar 

  • Kasper, J., & O’Malley, M. (2007, October 16). Changes in characteristics, needs, and payment for care of elderly nursing home residents: 1999 to 2004. Kaiser Commission on Medicaid and the Uninsured. Retrieved from http://www.kff.org/medicaid/upload/7663.pdf

  • Kelley, S., O’Neill, D., & O’Brien, J. G. (2011). Elder abuse in residential care. The Lancet, 377, 1076.

    Article  Google Scholar 

  • Kemper, E. (2003). Graying of American prisons; Addressing the continued increase in geriatric inmates. Corrections Compendium, 28, 22–26.

    Google Scholar 

  • Kendig, N., & Adler, W. (1990). The implications of the acquired immunodeficiency syndrome for gerontology research and geriatric medicine. Journal of Gerontology, 45, M77–M81.

    Article  PubMed  Google Scholar 

  • Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179–186.

    Article  PubMed  Google Scholar 

  • Lichtenberg, P. A., & Strzepek, D. M. (1990). Assessments of institutionalized dementia patients’ competencies to participate in intimate relationships. The Gerontologist, 30, 117–120.

    Article  PubMed  Google Scholar 

  • Lyden, M. (2007). Assessment of sexual consent capacity. Sexuality and Disability, 25, 3–20.

    Article  Google Scholar 

  • Malatesta, V., Chambless, D., Pollack, M., & Cantor, A. (1988). Widowhood, sexuality, and aging: A life span analysis. Journal of Sex & Marital Therapy, 14, 49–62.

    Article  Google Scholar 

  • Mattis, S. (1973). Dementia Rating Scale. Odessa, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Medicare. (2008). Nursing homes: resident rights. Retrieved on October 16, 2011 from http://www.medicare.gov/nursing/residentrights.asp.

  • Metlife Mature Market Institute. (2010). Demographic profile: America’s middle boomers. Retrieved from http://www.metlife.com/assets/cao/mmi/publications/Profiles/mmi-middle-boomer-demographic-profile.pdf

  • Ministry of Health and Long Term Care. (2011). Seniors’ care: Long term care homes. Retrieved from http://www.health.gov.on.ca/english/public/program/ltc/15_facilities. html#4.

  • Morgan, L. A. (2009). Balancing safety and privacy: The case of room locks in assisted living. Journal of Housing for the Elderly, 23, 185–203.

    Article  Google Scholar 

  • Moye, J. (2003). Guardianship and conservatorship. In T. Grisso (Ed.), Evaluating competencies (pp. 309–390). New York: Plenum.

    Google Scholar 

  • National Center for Assisted Living. (2009). Resident profile. Retrieved October 16, 2011 from http://www.ahcancal.org/ncal/resources/Pages/ResidentProfile.aspx.

  • National Center for Assisted Living. (2011). Better serving the lesbian, gay, bisexual and transgender populations in assisted living communities. Retrieved October 23, 2011 from http://www.achca.org/content/pdf/LGBT-%20Final%20Draft-%20Slides%20Only-Formatted.pdf.

  • Onishi, J., Suzuki, Y., Umegaki, H., Endo, H., Kawamura, T., Imaizumi, M., et al. (2006). Behavior, psychological and physical symptoms in group homes for older adults with dementia. International Psychogeriatrics, 18, 75–86.

    Article  PubMed  Google Scholar 

  • Parker, S. (2006). What barriers to sexual expression are experienced by older people in 24-hour care facilities. Reviews in Clinical Gerontology, 16, 275–279.

    Article  Google Scholar 

  • Ramsey-Klawsnik, H. (1996). Assessing physical and sexual abuse in health care settings. In L. A. Baumhover & S. C. Beall (Eds.), Abuse, neglect, and exploitation of older persons: strategies for assessment and intervention (pp. 67–87). Baltimore, MD: Health Professions Press.

    Google Scholar 

  • Ramsey-Klawsnik, H., Teaster, P. B., Mendiondo, M. S., Abner, E. L., Cecil, K. A., & Tooms, M. R. (2007). Sexual abuse of vulnerable adults in care facilities: Clinical findings and a research initiative. Journal of the American psychiatric Nurses Association, 12, 332–339.

    Article  Google Scholar 

  • Ramsey-Klawsnik, H., Teaster, P. B., Mendiondo, M. S., Marcum, J. L., & Abner, E. L. (2008). Sexual predators who target elders: Findings from the first national study of sexual abuse in care facilities. Journal of Elder Abuse & Neglect, 20, 353–376.

    Article  Google Scholar 

  • Roach, S. M. (2004). Sexual behavior of nursing home residents: staff perceptions and responses. Journal of Advanced Nursing, 48(4), 371–379.

    Article  PubMed  Google Scholar 

  • Rosen, T., Lachs, M. S., & Pillemer, K. (2010). Sexual aggression between residents in nursing homes: Literature synthesis of an underrecognized problem. Journal of the American Geriatrics Society, 58, 1070–1079.

    Article  Google Scholar 

  • Rosenblatt, A., Samus, Q. M., Steele, C. D., Baker, A. S., Harper, M. G., Brandt, J., et al. (2004). The Maryland Assisted Living Study: Prevalence, recognition, and treatment of dementia and other psychiatric disorders in the assisted living population of central Maryland. Journal of the American Geriatrics Society, 42, 1618–1625.

    Article  Google Scholar 

  • Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health, 5, 165–173.

    Google Scholar 

  • Snyder, R. J., & Zweig, R. A. (2010). Medical and psychology students’ knowledge and attitudes regarding aging and sexuality. Gerontology and Geriatrics Education, 31, 235–255.

    Article  PubMed  Google Scholar 

  • Spillman, B. C., & Black, K. J. (2006). The size and characteristics of the residential care population: Evidence from three national surveys. Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

    Google Scholar 

  • Starratt, C., Fields, R. B., & Fishman, E. (1992). Differential utility of the NCSE and MMSE with neuropsychiatric patients. The Clinical Neuropsychologist, 6, 331.

    Google Scholar 

  • Stavis, P. F. & Walker-Hirsch, L. (1999). Consent to sexual activity. In R. D. Dinerstein, S. S. Herr, & J. L. O’Sullivan. (Eds.) A guide to consent (pp. 57–67). Washington, DC: American Association on Mental Retardation.

    Google Scholar 

  • Teaster, P. B., Otto, J. M., Dugar, T. D., Mendiondo, M. S., Abner, E. L., Cecil, K. A. (2006). The 2004 survey of state Adult Protective Services: Abuse of adults 60 years of age and older [Report to the National Center on Elder Abuse, Administration on Aging]. Washington, DC: National Center on Elder Abuse.

    Google Scholar 

  • Teaster, P. B., Ramsey-Klawsnik, H., Mendiondo, M. S., Abner, E., Cecil, K., & Tooms, S. (2007). From behind the shadows: A profile of the sexual abuse of older men residing in nursing homes. Journal of Elder Abuse & Neglect, 19, 29–45.

    Article  Google Scholar 

  • Teaster, P. B., & Roberto, K. A. (2003). Sexual abuse of older women living in nursing homes. Journal of Gerontological Social Work, 40, 105–119.

    Article  Google Scholar 

  • Teaster, P. B., & Roberto, K. A. (2004). Sexual abuse of older adults: APS cases and outcomes. The Gerontologist, 44, 788–796.

    Article  PubMed  Google Scholar 

  • Tsatali, M. S., Tsolaki, M. N., Christodoulou, T. P., & Papaliagkas, V. T. (2011). The complex nature of inappropriate sexual behaviors in patients with dementia: Can we put it into a frame? Sexuality and Disability, 29, 143–156.

    Article  Google Scholar 

  • Walker, B. L., & Harrington, D. (2002). Effects of staff training on staff knowledge and attitudes about sexuality. Educational Gerontology, 28, 639–654.

    Article  Google Scholar 

  • Wallace, M. (1992). Management of sexual relationships among elderly residents of long term care facilities. Geriatric Nursing, 13, 308–311.

    Article  PubMed  Google Scholar 

  • Waslow, M., & Loeb, M. B. (1979). Sexuality in nursing homes. Journal of the American Geriatric Society, 27, 73–79.

    Google Scholar 

  • Wertheimer, A. (2003). Consent to sexual relations. Cambridge, UK: Cambridge University Press.

    Book  Google Scholar 

  • White, C. B. (1982). A scale for the assessment of attitudes and knowledge regarding sexuality in the aged. Archives of Sexual Behavior, 11, 491–502.

    Article  PubMed  Google Scholar 

  • Zeranski, L., & Halgin, R. P. (2011). Ethical issues in elder abuse reporting: a professional psychologist’s guide. Professional Psychology: Research and Practice, 42, 294–300.

    Article  Google Scholar 

  • Zerninke, K. (2007, November 18). Love in the time of dementia. New York Times. Retrieved from http://www.nytimes.com/2007/11/18/weekinreview/18zernike.html?pagewanted=all

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  1. Psychology Department, Pennsylvania State University Berks College, Reading, PA, USA

    Jennifer Hillman

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Appendix

Appendix

The following are organizations that provide information about sexuality in long-term care. Many of these organizations offer assistance specifically in relation to elder abuse and older adults’ rights (also see Zeranski and Halgin 2011).

The following groups and organizations offer materials for staff training or continuing education for professional caregivers in relation to sexuality in long-term care.

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Hillman, J. (2012). Sexuality in Long-Term Care. In: Sexuality and Aging. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3399-6_4

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