Sexuality in older adults Flashcards
Exam 4 (Final)
What is considered a fundamental human right by most of us living in Western societies
Sexual self-determination is considered a fundamental human right by most of us living in Western societies.
Sexuality in older adults
Why may sexual behavior be an issue for people living with dementia?
For older people with dementia living ( when consent isn’t clear ) in residential aged care facilities the issue becomes more complex.
Sexual function incorporates many physiologic and psychosocial aspects:
Like what?
*Sexuality
*Intimate relationships
*Important component of quality of life
WHO defines sexual health as what?
The World Health Organization defines sexual health as a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity.
According to WHO, what does sexual health require?
Sexual health requires a positive and respectful approach to sexuality and sexual relationships, and the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence.
According to WHO, for sexual health to be attained and maintained, what must be done?
For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled (World Health Organization, 2020)
Background
Sex can be seen as what type of subject?
Sex controversial subject
Background
What can influence the sexual behavior of older adults?
Cultural, biological, psychosocial, and environmental factors can influence the sexual behavior of older adults.
Background
Older adults may face what when it comes to expressing their sexuality?
They may be confronted with barriers to the expression of their sexuality by reflected attitudes, health, culture, economics, opportunity, and historic trends.
Background
Factors affecting a person’s attitudes on intimacy and sexuality include:
Factors affecting a person’s attitudes on intimacy and sexuality include family dynamics and upbringing and cultural and religious beliefs
Background
In the past, how much information was available about sex? How about attitudes? What is increasing over the years?
In the past, limited information on sexuality
Changes in attitudes over the years
Education on sexuality increasing
Background
What exists related to sex and older adults?
Ignorance and prejudice related to sex and older adults
Background
What is a nurse’s prerequisite to discussing sexual function with older adults?
*Nursing - A personal attitude assessment about sexuality and aging is a nurse’s prerequisite to discussing sexual function with older adults.
Enhancing Sexual Intimacy:
How is sexuality seen in healthcare?
Sexuality is seen as separate from healthcare concerns, rather than integral to quality of life.
Not seen as a priority for either the client or the provider.
Enhancing Sexual Intimacy
Not seen as a priority for either the client or the provider. Why?
No consequences seen to not addressing sexual concerns
Anxiety and fear of embarrassment prevent both patients and nurses from bringing up sexual concerns.
Enhancing Sexual Intimacy
Most health promotion strategies have the potential to make a positive impact on sexual relationships and sexual function.
Sexual Health
How is it important to someone?
Is important to an individual’s self-identity and general well-being.
Sexual Health
What does it contribute to?
Contributes to the satisfaction of physical needs.
Sexual Health
What does it fullfil?
Fulfills social, emotional, and psychological components of life.
Sexual Health
What does it evoke?
Evokes sentiments of joy, romance, affection, passion, and intimacy.
What do many people believe about older adults?
Many believe that older adults are asexual human beings.
How does the US view sexual health for older adults?
There is a general discomfort with sexual issues in the U.S.
How are most nurses when it comes to sexual health of older adults?
Most nurses are not educated to manage sexual health issues of older adults.
What is often ignored in the assessment of older adults health?
Sexual health is often ignored in the assessment of older adult health.
Enhancing Sexual Intimacy (cont’d.)
Romantic relationships in the elderly: How is it for some elderly?
Some people have been in the same romantic relationship for over 50 years.
Some people begin their first romantic relationship after retiring.
Enhancing Sexual Intimacy (cont’d.)
What is common and what is overlooked?
Loss of one’s romantic partner is common but sexual loss is overlooked.
Age-Related Changes That Affect Sexual Function
Changes affecting women
Hormonally regulated cycles
Menopause
Perimenopause
Postmenopause
Age-Related Changes That Affect Sexual Function
Changes affecting men
Andropause
Late-onset hypogonadism
Erectile dysfunction
Risk Factors and Social circumstances/influences That Affect Sexual Function include:
Myths and attitudes in society
Social circumstances/influences
Adverse effects of medication, alcohol, and nicotine
Risk Factors and Social circumstances/influences That Affect Sexual Function include:
Myths and attitudes in society:
Societal influences, especially on attitudes, stereotypes, and prejudices
Risk Factors and Social circumstances/influences That Affect Sexual Function include:
Social circumstances/influences
Availability of satisfactory partner
Risk Factors and Social circumstances/influences That Affect Sexual Function include:
Adverse effects of medication, alcohol, and nicotine
Medications adversely affect sexual function
Alcohol depresses central nervous system
Nicotine interferes with circulation to sexual organs
Risk Factors That Affect Sexual Function #2
Effects of chronic conditions: What kind of effect on sexual wellness?
When do changes in sexual function begin?
Detrimental effects on sexual wellness,
Changes in sexual function may begin as early as age 40 and in almost every adult by age 80.
Risk Factors That Affect Sexual Function #2
Effects of chronic conditions: What are examples of chronic conditions?
Pain, cancer, diabetes, cardiovascular disease, obstructive sleep apnea
Risk Factors That Affect Sexual Function #2
Gender specific conditions: like?
[genitourinary syndrome of menopause (GSM)]
Prostatic hyperplasia
Urethritis
Urge/stress incontinence leads to vaginal infections and
Dyspareunia(painful intercourse)
Risk Factors That Affect Sexual Function #2
What is the most common issue?
Vaginal dryness and erectile dysfunction—*most common
Risk Factors That Affect Sexual Function #2
Vaginal dryness and erectile dysfunction—*most common:
What are ways to manage both conditions?
Therapeutic management for both conditions includes stopping smoking, only moderate alcohol intake, exercise, and reducing obesity.
Risk Factors That Affect Sexual Function #2
Vaginal dryness and erectile dysfunction—*most common:
What are meds for erectile dysfunction?
ED medications:
phosphodiesterase inhibitors (PDE5) such assildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra)
Risk Factors That Affect Sexual Function #2
Vaginal dryness and erectile dysfunction—*most common:
What can result in dyspareunia? What doesn’t occur at menopause?
Students:Though decreased lubrication can result in dyspareunia for older women, lubricant production does not completely cease at menopause.
Risk Factors That Affect Sexual Function #2
Vaginal dryness and erectile dysfunction—*most common:
What occurs for older men?
Older men are slower to erect, mount and ejaculate.
Risk Factors That Affect Sexual Function #2
Vaginal dryness and erectile dysfunction—*most common:
Compared to younger people how are older people’s sexual responsiveness?
Older people are less sexually responsive than younger people and there is a reduction of orgasm in older people.
Which disease is identified as the most common risk factor that causes sexual dysfunction in older men and women?
A. Chronic renal failure
B. Diabetes mellitus
C. Benign prostatic hyperplasia
D. Hyperthyroidism
B. Diabetes mellitus
Prevalence of sexual dysfunction in people with diabetes ranges from 35% to 75%. Men with diabetes are likely to experience retrograde ejaculation, whereas women experience delayed and diminished vaginal lubrication
Risk Factors That Affect -Sexual Function #3
Functional impairments: What can chronic conditions do?
Chronic illnesses and their related treatments may bring many challenges to intimacy and sexual activity.
Risk Factors That Affect -Sexual Function #3
Functional impairments: Chronic illnesses and their related treatments may bring many challenges to intimacy and sexual activity.
What is affected?
Physical capacity may be affected.
Psychological factors affect sexual activity.
Risk Factors That Affect -Sexual Function #3
Functional impairments:
What do individuals want/need?
Individuals want and need information on sexual functioning.
Risk Factors That Affect -Sexual Function #3
Functional impairments:
What do providers need to do?
Providers need to become more knowledgeable and more actively involved in sexual counseling
Risk Factors That Affect -Sexual Function #3
COPD: What can it cause?
COPD: can cause hypoxia and severe SOB
Risk Factors That Affect -Sexual Function #3
Arthritis: What can it cause?
Arthritis: pain, stiffness, muscle spasms, and limited flexibility
Risk Factors That Affect -Sexual Function #3
Urinary incontinence: What can it cause?
Urinary incontinence: interfering with satisfaction
Risk Factors That Affect -Sexual Function #3
What else can occur?
Medical conditions and adverse medication effects
Sensory impairments
Sexual Counseling in CVD
Article: Journal of Cardiopulmonary Rehabilitation and Prevention (2016)
When the Topic Turns to Sex: CASE SCENARIOS IN SEXUAL COUNSELING AND CARDIOVASCULAR DISEASE.
Person with NSTEMI without complications is considered to be at low risk, and can resume sexual activity in a week or more after MI, as long as the pt. does not have any cardiac symptoms with mild to moderate physical
activity.
Sexual Counseling in CVD
Article: Journal of Cardiopulmonary Rehabilitation and Prevention (2016)
When the Topic Turns to Sex: CASE SCENARIOS IN SEXUAL COUNSELING AND CARDIOVASCULAR DISEASE.
Nursing intervention:
Nursing intervention:receipt of sexual counseling was the strongest predictor of return to sexual activity at 1 month post-MI
Risk Factors That Affect Sexual Function #4
If dependent, what affects sexual wellness expressly?
Attitudes and behaviors of families and caregivers
Risk Factors That Affect Sexual Function #4
How important is intimacy and sexuality in dementia? What does it serve has?
Intimacy and sexuality remain important in the lives of persons with dementia and their partners.
May serve as nonverbal communication when cognitive skills have declined.
Risk Factors That Affect Sexual Function #4
What are issues for people with dementia?
Loss of sexual desire
Hypersexuality
Inappropriate language
Inappropriate touching of others
Masturbation in public
*Unmet needs
Risk Factors That Affect Sexual Function #4
What is important to extinguish?
Extinguishing sexually inappropriate behavior.
Risk Factors That Affect Sexual Function #4
Extinguishing sexually inappropriate behavior: What is the goal? What is something to remember?
Goal is to stop the behavior while maintaining the dignity of the patient.
Consent when cognitively impaired
Determining Ability to Give Informed Consent to Participate in Sexual Relationships:
What is essential?
Accurate assessment and documentation of the ability of cognitively impaired older adults to make informed decisions regarding sexual relationships with others while in long-term care, is essential.
Determining Ability to Give Informed Consent to Participate in Sexual Relationships
What is important to remember about sexual health in cognitively impaired older adults?
It is important to remember that participation in sexual relationships may still be within the decision-making capacity of cognitively impaired older adults.
Determining Ability to Give Informed Consent to Participate in Sexual Relationships
How would cognitively impaired people appreciate sexuality?
There’s nothing about being cognitively impaired that means that a person wouldn’t necessarily appreciate being connected with other people through both nonsexual means and sexual means.”
Determining Ability to Give Informed Consent to Participate in Sexual Relationships
If the resident has been determined to be incapable of exercising decisional capacity, what must be done?
If the resident has been determined to be incapable of exercising decisional capacity, then the health care staff must prevent the cognitively-impaired resident from unsolicited sexual advances.
Intimacy and Sexuality in Long-Term Care Facilities
Compared to other needs of older adults in long term facility, how should sexual needs be addressed?
Sexual needs of older adults in long-term care facilities should be addressed with the same priority as nutrition, hydration, and other needs.
Intimacy and Sexuality in Long-Term Care Facilities
What kind of rights do people in long term care have compared to other older adults?
They have the same rights as other elders to engage in or refrain from sexual activity.
Intimacy and Sexuality in Long-Term Care Facilities
What are issues?
Attitudes of staff, family
Privacy
Intimacy and Sexuality in Long-Term Care Facilities
What percent of people in SNF say they are lonely?
25% of people living in SNF say they are lonely
Intimacy and Sexuality in Long-Term Care Facilities
What percent of people in SNF say they are sometimes lonely?
*40% saying they are sometimes lonely
Intimacy and Sexuality in Long-Term Care Facilities
What is a major fear for them?
A major fear is that they’ll die alone30 patient had see
Intimacy and Sexuality in Long-Term Care Facilities #2
Inappropriate Responses: by staff includes?
*Placing notes on the medical record
*Reporting sexuality at meetings
Snickering or giggling
*Reprimanding or otherwise scolding
*Praying over the person
*Invasion of privacy
- Discussing sexuality with colleagues
Intimacy and Sexuality in Long-Term Care Facilities #2
Negative attitudes towards older people’s sexuality can lead to:
Negative attitudes towards older people’s sexuality can lead to residents’ sexual expression being overlooked, ignored, or even discouraged.
Intimacy and Sexuality in Long-Term Care Facilities #2
What is an aspect of western culture that effects views of older adults sexual health?
An aspect of the Western culture is that younger adults tend to discount the sexuality of older adults, leading to issues of ageism and a large part of the media sensationalism of these cases.
Regulations Related to Sexuality in LTC
F Tag 175
The resident has the right to share a room with his or her spouse when married residents live in the same facility and both spouses consent to the arrangement.
Regulations Related to Sexuality in LTC
FTag 164: What does the resident have the right to?
The resident has the right to personal privacy and confidentiality of his or her personal and clinical records.
Regulations Related to Sexuality in LTC
FTag 164: What does personal privacy include?
Personal privacy includes accommodations, medical treatment, written and telephone communications, personal care, visits, and meetings of family and resident groups, but this does not require the facility to provide a private room for each resident.
Regulations Related to Sexuality in LTC
FTag 164:
Nursing: How should they deal with sexual relationships between residents?
*Nursing - sexual relationships between competent and consenting residents should be accommodated by care providers by providing them with privacy and educate on safe sexual practices.
Regulations Related to Sexuality in LTC
F Tag 460: How should LTC be?
Be designed or equipped to assure full visual privacy for each resident
Regulations Related to Sexuality in LTC
FTag 242: What should this include?
*Self-Determination and Participation
The resident has the right to make choices about aspects of his or her life in the facility that are significant to the resident
Regulations Related to Sexuality in LTC
F Tag 460 and FTag 242:
What are nursing roles?
*Nursing: Knock on door before entering, ask permission to enter a room. redirect inappropriate sexual behaviors.
Regulations Related to Sexuality in LTC
F Tag 223: The resident has the right to be free of what?
*The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.
Regulations Related to Sexuality in LTC
F Tag 223:
What is the nursing role?
Among competent older adults, autonomy around sexual relationships should be protected and fostered.
Conclusion Nursing :We should do all we can to facilitate competent residents’ sexual relationships
LGBTQIA+ Older Adults
What amount of older adults identify as LGBTQIA? What exists in this group? How is it different from heterosexual people? What amount identify as women?
Diversity in sexual orientation ( 2.7 million older adults identify as LGBTQIA+) (10% of older adult population) (Burton et al.,2020)
Great diversity among these groups
Demographics of LGBTQIA+ older adults different than heterosexual counterparts
¾ of this group self identify as women
LGBTQIA+ Older Adults
Older(LGBTQIA+) adults at risk for ?
Older(LGBTQIA+) adults at risk for discrimination and being “Invisible” as a result of lifelong experiences with marginalization and oppression
LGBTQIA+ Older Adults
What kind of stigma do they face?
Face the “double stigma” of being old and sexually “different”
LGBTQIA+ Older Adults
What are these adults less likely to do?
Are less likely to access health and social services or identify themselves as LGBTQIA+ to providers
LGBTQIA+ Older Adults
What are issues they encounter?
Homophobia
Ageism
Most of current older adults grew up in an era where homosexuality was considered a mental illness
Fear of discrimination
LGBTQIA+ Older Adults
LTC facilities policies - What must be done?
LTC facilities policies - Examine the policies of communities regarding sexual/gender minority inclusion
Physical Health Issues
Lesbians
Risk factors more prevalent in this group:
Smoking
Obesity
Alcohol use
Nulliparity
Higher risk for breast and ovarian cancer
Physical Health Issues
Gay and bisexual men
Risk factors more prevalent in this group
Lung cancer
Cardiovascular disease
HIV
STDs
Hepatitis
Physical Health Issues
Transgender older adults:
How much research exists for this group?
Little research on this group
Physical Health Issues
Transgender older adults:
Risk factors more prevalent in this group
Substance abuse
HIV
Physical violence and harassment
Physical Health Issues
Transgender older adults:
Transgender older adults face profound challenges and experience striking disparities in areas such as:
Transgender older adults face profound challenges and experience striking disparities in areas such as quality of health and access to health care services, mental health care, employment, housing and other areas of livelihood.
Health Care Strategies
What do older transgender adults routinely encounter?
They routinely encounter both a health care system and a national aging network that are ill-prepared to provide culturally competent care and services and create residential environments that affirm the gender identities and expressions of transgender older people
Health Care Strategies
What should providers work through when it comes to older adult care of LGBTQIA+ community?
Providers should work through homophobic attitudes, learn about issues facing LGBTQIA+ persons, and be aware of community resources.
Health Care Strategies
What should providers take part in when it comes to older adult care of LGBTQIA+ community?
Cultural Competence
Communication with LGBT elders
Creating a welcoming environment
Health Care Strategies
What is the country’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults?
SAGE (Services and Advocacy for LGBT Elders) is the country’s largest and oldest organization dedicated to improving the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #1
Human immunodeficiency virus (HIV): How many people have this (growing or not)?
Increasing numbers of adults aged 50 years and older have HIV/AIDS
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #1
Human immunodeficiency virus (HIV): What kind of concerns exist?
Health-related concerns associated with HIV/AIDS in older adults
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #1
Human immunodeficiency virus (HIV): What is different for older adults who have HIV compared with those who don’t?
Risk factors differ for older adults (less likely to be tested or to practice safe sex)
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #1
Human immunodeficiency virus (HIV): What population of older adults have a higher rate?
Diversity note: Blacks/African Americans and Hispanics/Latinos have higher rates
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #2
What role do nurses have when it comes to HIV and older adults?
Nurses have important roles in identifying new cases of HIV, assessing risks for sexually transmitted infections, and assessing treatment issues.
*Nurses need to teach about safe sex practices-use of condoms to protect from HIV and other STD’s.
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #2
HIV Treatment: When is it initiated? What is it?
HIV Tx with ART is initiated when the infection is diagnosed.
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #2
What determines stages of HIV?
CD4 count stages HIV (AIDS Dx -less than 200 cells/mm3)
Pathologic Condition Affecting Sexual Wellness: Human Immunodeficiency Virus #2
HIV Treatment: What determines effectiveness?
Tx effectiveness is measured by viral load (under 400 copies adequate response to Tx, less than 50 copies optimal response to Tx)
Recognizing and Analyzing Cues: Sexual Health
Nurse has responsibility to:
help maintain the sexuality of older people by offering opportunity for discussion.
be an educator and provide information and guidance.
know one’s feelings about sexuality.
Recognizing and Analyzing Cues: Sexual Health
Assessment: What is included?
Assess for safe sex practices.
Recognizing and Analyzing Cues: Sexual Health
Assessment: Assess for safe sex practices- how?
Ask elders about their sexual satisfaction.
Screen for HIV/AIDS and other sexually transmitted diseases.
Perform a medication review.
Use the PLISSIT model as a guide for sexual discussion.
Recognizing and Analyzing Cues: Sexual Health
Assessment:
How is the PLISSIT model not? What does it do instead?
The PLISSIT model and suggested discussion questions are not diagnostic in any manner but rather provide guidance for further work-up or referral.
Recognizing and Analyzing Cues: Sexual Health
Assessment:
What is a prereq for nurses to providing sexual function info?
A personal attitude assessment about sexuality and aging is a nurse’s prerequisite to providing information about sexual function and identifying risk factors that may interfere with sexual function with older adults.
Recognizing and Analyzing Cues: Sexual Health
Assessment: A personal attitude assessment about sexuality and aging is a nurse’s prerequisite to providing information about sexual function and identifying risk factors that may interfere with sexual function with older adults.
The next step would be to obtain permission from the individual to initiate discussion about sexual relations.
The nurse admitting a married couple to a long-term care facility best acknowledges the couple’s sexual health by asking:
“How often do you want to have intercourse?”
“What types of sexual activities do you enjoy?”
“What have you been doing to keep your sex life active?”
“Do you have any sexual concerns related to your being here?”
ANS: D
Using a broad, open-ended question to address sexual health communicates a willingness to discuss the issue.
