Week 9 Flashcards
Def: Ability to be intimate with another person in a mutually satisfying manner
Sexuality!
What is the usual goal of sexuality in younger people vs. in older adulthood?
For younger people, INTERCOURSE is goal.
For older adults, more about relationships, closeness, intimacy
T/F: Married couples tend to have less intercourse than unmarried couples
FALSE. Married couples tend to have MORE intercourse than unmarried couples.
How does culture play a role in sexuality for older adults?
Beliefs, religion, faith, how conservative/liberal one is
How does gender play a role in sexuality for OA?
- For greatest generation, extreme gender roles for adults, but now more fluid roles
- Gender plays role in what types of work they’re doing, what types of roles at home
When working with clients, should we delve into sexuality?
DUH
How does sexuality fit into the OTPF scope?
- Sex is an ADL
- Sex is a social activity
- Activity that results in sexual satisfaction and/or meet relational or reproductive needs (not just about intercourse)
- About intimacy and engaging in desired sexual activity
- Many times, no expert on sex in staff team you’re working with
What are three barriers to sexual expression in OAs?
- Often viewed as asexual in society, so no one wants to discuss
- Physiological changes to the body (e.g., mental illness, chronic disease)
- Attitudes e.g., in U.S., taboo to talk about old people having sex
Who is more likely to talk about sexual relations: men or women?
Men. Almost 40% older men are willing to talk about vs. 22% of women
T/F: generally, older adults feel more comfortable discussing sex with providers who are much younger than them.
False. older adults don’t feel comfortable talking about sex with someone who looks like their child…
Women are more likely to talk with female or male providers?
Women are more likely to talk with female providers about sexual relations. Unfortunately, they usually end up having male providers. This is an opportunity for OT as majority are female!
Providers don’t generally think about what prominent issue related to sexual relations in OA?
HIV
How can we as OTs overcome barriers to providing a safe space for sexual expression for OAs?
- Provide area for privacy
- Make a safe space for older adults to socialize and discuss
- Educate staff and family about OAs sexuality needs
- Body image, difficulties feeling attractive–can do nails/hair with them, help make them feel pretty
How can we as OTs overcome barriers to sexual expression for OAs with dementia ?
- Talk with family about the importance of human touch
- Give someone a soft stuffed animal to care for
Which of the following is not a normal physiological change in men:
- Decreased testosterone
- Decreased sperm production
- Amount and consistency changes in seminal ejaculate
- Decreased ejaculation force
- Decreased likelihood of premature ejaculation
- Decreased frequency of ejaculation with decreased refractory period
- Possible increase in prostate size
- Increased duration to stimulate sexual excitement
- Increased lasting erection
Decreased refractory period. Normal aging often includes an INCREASED refractory period (time it takes before you can ejaculate again)
Time it takes to recover after ejaculation before you can ejaculation again. This is…
Refractory period. This period often increases for OA males, which may not be good for partner–if increased refractory period, decreased vaginal secretions may lead to dyspareunia=painful sex
How can we help older men who are experiencing normal physiological changes that affect sexual relations?
We can try to normalize changes. Men may feel inadequate if they can’t achieve ejaculation, especially after prostate surgery. We can help meet them where they’re at . Tell them what they’re going through is normal and what we can do with where they’re at
Which of the following is not a normal physiological change in women as they age ?
- Menopause
- Decreased estrogen and progesterone
- external genitalia shrinkage
- decreased pubic hair growth
- vaginal wall shrinkage and thinning
- increased vaginal secretions
- increased duration to stimulate sexual excitement and lubrication
Increased vaginal secretions. Normal change is DECREASED vaginal secretions.
What self-assessment assess one’s knowledge and attitudes regarding OAs and sexual activity?
The Aging Sexual Knowledge and Attitudes Scale (ASKAS) (White, 1982). It has lots of info on erectile dysfunction. A higher score means more positive attitudes (most are like this)
T/F: Overall, there is increased diversity and acceptability in families
TRUE!
T/F: In general, family sizes have increased over time
FALSE. We now have smaller families now, for the most part.
How has the structure of families changed with time?
- Not necessarily nuclear family
- Broader definition of family
- Later marriages, takes longer to have children
- Smaller families now
- Blended families e.g., Brady bunch
T/F: Kin relationships are relatively stable across life
True. If you have problems with each other now, you will probably always have them. Hard to change relationships.
What are support exchanges?
Giving and receiving that happens in intergenerational families.
How are support exchanges characterized?
- Support exchanges (giving and receiving in intergenerational families) is complex
- We tend to live farther away from family now, so it’s harder to support them (opportunity for social media)
- Utilize family that is available, however they’re available (How can extended family support OAs from a distance?)
- Family can play a role in chronic disease management for OA (influence how OA may manage disease; if knowledgable about condition, can give suggestions; can also be poor influence)
How has the distance between OA and their families changed?
We now tend to live farther apart from each other now, so hard to support. But can bridge the gap via social media!
How dos health play a role in an OA’s social network?
-OAs that have better health report more social network and support from friends. So, better self-rated health, more support from friends, key for isolation
How can family play a role in chronic disease management for OAs?
- Influence how OA may manage disease
- If knowledgable about condition, can provide suggestions
- Can also be poor influence
In U.S., how do expectations for family co-residency differ for whites vs. African American families
In African American families in the U.S., stronger expectation for co-residency compared to whites. Their social support network is resilient
How do Latino families view family?
Latino families hold family central
How does religion affect health?
Religion influences attitudes towards health and behaviors related to health
Family views in Asian American families?
-For Asian-Americans, tend to have strong obedience to parents and respect for older adults
Health behaviors in Asian American families?
-Family members tend to engage in positive health behaviors and influence family
T/F: There is very little research available regarding Native American/American-Indian families
True
T/F: In Native American/American-Indian families, elderly men play strong roles in the family
False. Elderly Native American/American-Indian women play strong roles in family:
- Maintain cultural norms
- Pass down traditions, care for tradition
How do Native American/American-Indians view illness?
Notion of tolerated illness–don’t seek care
For whites, who tends to be the caregiver of OAs?
Caregiver tends to be spouse, if available
-Tend to provide monetary support to take care of
What services do SAGE and OpenHouse offer for OA?
-Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders (SAGE) and OpenHouse offers resources to older adults in LGBT community to offer safe space and socialize
Challenges to LGBT:
- Lots of stigma, hate crimes
- Providers may not know how to act towards LGBT older adult, so act awkwardly
- Chronic stress for older LGBT adult
- Stress from stigma impacts health and wellness
- Often have to rely on informal supports as opposed to kin–family may have stepped aside
What is a major barrier to LGBT community?
- Providers may not know how to act towards LGBT OA, so act awkwardly
- Chronic stress for older LGBT adult
- Stress from stigma impacts health and wellness
- Often have to rely on informal supports as opposed to kin–family may step aside
How does Medical care and seeking the medical care one needs change for LGB adults?
- LGB adults more likely to delay or not seek medical care
- Lesbian and bisexual women less likely to receive mammograms
- LGB adults more likely to delay or not get needed prescription meds
- LGB adults more likely to receive health care services in ERs
- May have to reach out to them
T/G: LGB adults are more likely to seek medical care?
FALSE. LGB adults are more likely to delay or not seek medical care
Within the LGBT community, who is especially likely to not seek medical care?
Transgender adults–tend to shy away from medical services of any kind
How does the mental health tend to differ for adults in the LGBT community?
- LGB adults more likely to experience psychological distress
- LGB adults more likely to need meds for emotional health issues
- Transgender adults muchnmore likely to have suicide ideation
- LGB adults more likely to have problems with alcohol abuse
T/F: Transgender adults have lower risk of becoming obese
False. Significant higher obesity rates in transgender older adults–they tend not to engage in physical activity. This many be due to fear of being out in the community
Model that focusses on permission and continued permission to revisit and reflect upon sex
PLISSIT model! Permission at any stage in the model!
-OT usually doesn’t specialize in sex. Can refer out.
T/F: In the PLISSIT model, it is important to only ask questions about sex once so you do not put extra pressure on the OAs to answer.
False! Ask questions more than once!
When using the PLISSIT model, why is it important for a practitioner to first recognize his/her own strengths and limitations?
Must recognize own strengths and limitations in the domain. Must be comfortable with self so doesn’t make it super awkward to speak about
When using the ______ model, avoid assumptions such as:
- OAs are sexually inactive
- Your moral beliefs about sexuality align with theirs
- Chronological age indicates libido
- Someone is monogamous
PLISSIT model!
Remember therapist face!
Inappropriate sexual behavior is especially common in OA with _____
Inappropriate sexual behavior is especially common in OAs with cognitive issues!
Who determines where OTs must draw the line on inappropriate sexual behaviors?
The OT! Must define where you draw the line based on your own attitudes and beliefs
T/F: When an OA acts sexually inappropriate, it is best to ignore it.
False. Ignoring accomplishes nothing. Be assertive, state matter of factly if there is an issue, come up with an interdisciplinary plan on how to fix it. Must be very honest with OA and be very clear about lines
T/F: STDs are fairly uncommon in OA
False! STDs are pretty prominent in OA.
Reasons for STD prominence in OA?
- OA believe protection is used to prevent child birth, so they don’t know they should be using it
- Health care providers are not talking about sexuality or safe sex with OA
How can we as OTs assist OA in STD prevention?
Step up and educate parents and staff about the reasons and importance in using protection
Which of the following do we as OTs mainly address regarding sexual concerns in OA? A. self-esteem B. Body image C. Relationships D. Family
A. Self-esteem
AND
B. Body image
-Body image is an emerging area of practice in OT
-We can interact with relationships and family, but we are not relationship counselors. We must look at sex from a social angle and as an ADL
What symptoms of arthritis impede one’s ability to engage in sex?
- Stiffness
- Pain
- Issues with mobility or ROM
- Fatigue
How can sexual activity benefit OA with arthritis?
- Encouraged to engage in sexual activity for exercise
- Good for the joints
Strategies to engage in sexual activity for OA with arthritis include all of the following EXCEPT which?
A. Rest prior to intercourse
B. Strategic use of pillows
C. Aspirin before
D. Using cold shower to get joints ready
E. Communicate with partner about fears of what may happen
F. Alternate positions
D. Using cold shower to get joints ready
-You would want a HOT shower to get joints warmed up!
Symptoms of CVA that may impede sexual activity : ?
- How much stress heart can take
- Sensation/paralysis
- May affect speech/communication during
- Visual field may be effected
Strategies for sexuality activity for CVA include all of the following EXCEPT?
A. Placing: have loved one on side so they can see and feel
B. Use vision instead of touch, taste, and smell
C. Use vibrator to compensate for issues with sensation
D. Experiment with positions
B. Use vision instead of touch, taste, and smell.
You would want to use touch, taste, smell
Symptoms of Heard Disease that may impede sexual activity:
- High BP
- Low endurance –> fatigue
- Fear of sudden death
- Medication and erectile dysfunction
Good strategies for sexual activity engagement for Heart Disease include all of the following except which?
A. Engage during very cold or hot temperatures
B. Use masterbation as alternative
C. Educate about foreplay
A. Symptoms may be due to temperature outside, so don’t engage during extreme temperatures
Role of OT in sexuality
- Practice within realm of intimacy (OTPF)
- Be self-aware and knowledgable
- Know your limits–seldom is there an “expert” on staff
- Educate others
According to Taylor and Davis (2006), the Ex-PLISSIT model is a useful tool for what and who?
According to Taylor and Davis (2006), the Ex-PLISSIT model is a useful tool for nurses working in primary care to address sexuality and sexual health
T/F: According to Taylor and Davis (2006), the term sexual health is about feeling comfortable and secure in a relationship
False, kind of. Sexual health according to Taylor and Davis is subjective–each person defines health differently. While this may mean feeling comfortable and secure in a relationship to one person, another may see it as freedom from infection or having a positive self-image and sense of feeling ‘at one’ with self.
T/F: According to Taylor and Davis, research shows that patients often raise the subject of sexuality with nurses
According to Taylor and Davis, research shows that patients do not voice their concerns about sexuality and sexual health because they prefer nurses to raise the subject first. Unfortunately, Nurses are fearful of not being able to respond to the sexual health issues raised by patients, so they tend to wait for patients to initiate discussion
According to Taylor and Davis, what is the first point of contact for patients with sexual health concerns
Primary health care services are often the first point of contact for patients with sexual health concerns. This is particularly important for middle aged or older adults less likely to access services
In the Taylor and Davis study, what did authors state were barriers to discussing sexual health with patients based off of?
Barriers were based on the practitioners’ belief that certain patients would be less likely to want to talk about sexual health.
What is the PLISSIT model? What does the acronym PLISSIT stand for?
The PLISSIT model was developed for use by practitioners in meeting the sexuality and sexual healthcare needs of patients. PLISSIT signifies the four levels of intervention:
- P: Permission
- LI: Limited Information
- SS: Specific Suggestions
- IT: Intensive Therapy
-As levels progress, greater knowledge, training, and skills are required
According to Taylor and Davis (2006), how does the Ex-PLISSIT model differ from the PLISSIT model?
- Unlike the linear PLISSIT model, where practitioners are able to progress from one level to the next, a key element of the Ex-PLISSIT model is Permission-giving at every stage. All interventions with patients should begin with Permission-giving
- Requirement to review all interactions with patients
- Incorporation of reflection as means of increasing self-awareness by challenging assumptions
According to Taylor and Davis, what is the P in the Ex-PLISSIT model?
P: Permission
- Explicit permission giving provides patients with the opportunity to voice their concenrs
- Unless Permission-giving is explicit, patients won’t know that this is what the nurse is offering
- Unless healthcare professionals raise the matter of sexual health, many patients won’t
- If patients appear uncomfortable, don’t assume they don’t want to talk about it anymore–may be reflecting nurse’s own embarrassment. Bring it up again!
According to Taylor and Davis, what is the LI in Ex-PLISSIT model?
LI: Limited Information stage
- Reflects the important role of nurses as source of info
- At this stage, info should be about impact of illness on sexuality and affects of tx on sexual functions
- Clarify information, dispel myths, give factual info in limited manner
According to Taylor and Davis, what is the SS in Ex-PLISSIT model?
SS: Specific Suggestions stage
- Problem-solving approach needed to address an individual’s particular problem e.g., difficult arthritic pain and stiffness can be overcome by experimenting with different sexual positions and pain relief before sexual activity
- Needs to address all aspects of sexuality and sexual health rather than only focussing on sexual behavior e.g., look at body image, make-up and clothing, femininity and attractiveness
- Suggestions tailored to individual needs
According to Taylor and Davis, what is the IT in Ex-PLISSIT model?
IT: Intensive Therapy
- Most advanced stage of both the PLISSIT and Ex-PLISSIT models
- Few nurses (or OTs) have sufficient training to provide Intensive Therapy–refer to other services e.g., sexual dysunction clinics, psychosexual counseling
