The Preservation of Spousal and Partner Relationships Among Nursing Home Residents

Deciding to seek placement in a nursing home can be difficult for both older adults and their families, but especially so for spouses or partners of potential nursing home residents. Disruption of the attachment relationship following placement is likely to influence the psychosocial well-being of nursing home residents. This mixed-method study explored services and activities offered that emphasize the preservation of spousal and partner relationships among nursing home residents. A survey was administered to nursing home social workers in the states of Alabama, Georgia, Mississippi, and Tennessee. Survey results reveal that approximately 49% of respondents reported having a written policy to preserve these relationships, however, only 22% reported having a program to carry out the facility's written policy. Both survey respondents and interview participants highlighted privacy and outings as ideal relationship-preserving practices. Nursing home social workers can utilize the study results in the design and implementation of specific services to preserve relationships between residents and their spouses/partners.

Intimate relationships in residential aged care: what factors influence staff decisions to intervene?

Intimacy contributes to our well-being and extends into older age, despite cognitive or physical impairment. However, the ability to enjoy intimacy and express sexuality is often compromised-or even controlled-when one moves into residential aged care. The aim of this study was to identify what factors influence senior residential aged care staff when they make decisions regarding resident intimate relationships and sexual expression. The study used vignette methodology and a postal survey to explore reactions to a fictionalised case study of a couple-Norm and Carol-who develop a close, mutually satisfying relationship. Staff were first asked whether they would intervene in the relationship. Using an innovative approach, several variations to the case study were then presented to explore whether views about intervening changed according to varying contextual factors. Findings indicated that over 90% of respondents initially agreed that the relationship should continue, and only 10% indicated they would intervene. However, when the case study was varied, respondents indicated they were more likely to intervene, particularly if Norm was exhibiting distress in Carol's presence (89%), but also if Norm was married and his wife was living in the community (40%). Other factors including level of cognitive impairment and family disapproval were also found to influence staff views. This study provides insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people living in residential aged care and how personal views and values likely guide practice in the absence of formal policies.

Development and Initial Validation of the Attitudes Towards Older Adult Sexuality in Long-term Care Scale (AOASLC)

In long-term care facilities where older adults may reside, negative attitudes about later life sexuality can result in restrictive facility policies and staff behaviors that suppress residents' rights to sexual expression. No assessment instrument specifically focuses on the sexual behaviors of long-term care residents and existing measures of attitudes toward older adult sexuality do not include sexual expression in long term care, nor do they assess a full range of sexual behaviors. We developed the Attitudes toward Older Adult Sexuality in Long-term Care Scale (AOASLC). A large, diverse sample of 295 community-dwelling adults in the United States completed an online survey through Amazon Mechanical Turk. The survey included the AOASLC and self-report measures of related constructs. Two-hundred-and-ninety-five participants completed the survey (M_age = 49.16, SD = 14.69, range = 18- 84 years). Of the sample, 50.2% identified as female, 49.5% identified as male, and one person identified as transgender male. An exploratory factor analysis indicated a two-factor structure. Factor 1 represented general attitudes toward sexual behaviors, and Factor 2 represented acceptability of various sexual behaviors. The instrument evidenced good reliability and validity. While further validation research is necessary, the AOASLC is a promising new measure.

What makes tics tick? Insights into Tourette syndrome

This issue of Biomedical Journal provides the reader with articles concerning the latest understanding of Tourette syndrome (TS), the relation to genetic predisposition, defects in the dopaminergic system, and related comorbidities which further complications like sleep disruption. Treatment approaches for TS, attention deficit hyperactivity disorder and developmental coordination disorder are discussed. The second section of this issue offers insights into inside out integrin activation and its link to T cell activation, demonstrates how polarity in immune cells allows adoption to specialized functions, and describes the endosomal signaling of internalized T cell receptors (TCRs). The link between mutations in TCR signaling and immunodeficiencies is elucidated, as well as the interactions of thymocyte-expressed molecule involved in selection in T cell development. Additionally, we learn about a potential biomarker for colorectal cancer, screening tools for determining frailty in older adults, surgical approaches in spinal metastases, the influence of autophagy on mating behavior, and the effect of nitrite administration on SNARE proteins associated with insulin secretion. Finally, parameters for surgery in breast cancer are discussed, as well as gender and age dependent pain perception in a lysosomal storage disease, and the use of laser meridian massage in opioid use disorder. Three letters complement this issue, one concerning neuroimaging in pediatric COVID-19 patients, and two discussing the role of cancer antigen-125 and renal impairment in ovarian cancer patients.

Sexual Expression, Policies, and Practices in Skilled Nursing Settings Serving Older Adults: An Updated Assessment in the State of Kansas

Doll assessed sexual expressions, policies, and practices in Skilled Nursing Facilities (SNFs) in the state of Kansas. This study provided an updated and expanded assessment. A mixed-methods survey was distributed to administrators of all SNFs in the state of Kansas. Among 60 administrations, 84% reported any sexual expression among residents in their community within the past year and 55% reported expressions involving an individual with cognitive impairment. In response to sexual expressions, 70% of administrators believe staff would treat residents with dignity and respect and about 40% anticipated staff discomfort. About 40% of administrators reported having a policy related to sexual expression. Attitudes and responses of staff and administrators appear to be shifting in a sex-positive direction. While policies related to sexuality are more common than a decade ago, there is room for additional uptake, standardization, and infusion of person-centered language and practices.

Dementia and sexuality in long-term care: Incompatible bedfellows?

Despite the recognized benefits of sexual expression and its importance in the lives of people living with dementia, research demonstrates that there are multiple barriers to its positive expression (e.g., expression that is pleasurable and free of coercion, discrimination, and violence) in RLTC homes. These barriers constitute a form of discrimination based on age and ability, and violate the rights of persons living with dementia to dignity, autonomy, and participation in everyday life and society. Drawing on a human rights approach to dementia and sexual expression, we explored the experiences of diverse professionals, family members, and persons living with dementia with explicit attention to the ways in which macro-level dynamics are influencing the support, or lack thereof, for sexual expression at the micro level. Focus groups and in-depth interviews were conducted with 27 participants, and the collected data were analyzed thematically. While all participants acknowledged that intimacy and sexual expression of persons living with dementia should be supported, rarely is such expression supported in practice. Micro-level factors included negative attitudes of professionals toward sexual expression by persons living with dementia, their discomfort with facilitating intimacy and sexual expression in the context of their professional roles, their anxieties regarding potential negative reactions from family members, and concerns about sanctions for failing to prevent abuse. In our analysis, we importantly trace these micro-level factors to macro-level factors. The latter include the cultural stigma associated with dementia, ageism, ableism, and erotophobia, all of which are reproduced in, and reinforced by, professionals' education, as well as legal and professional standards that exclusively focus on managing and safeguarding residents from abuse. Our analysis demonstrates a complexity that has enormous potential to inform future research that is critically needed for the development of educational initiatives and to promote policy changes in this area.

Effectiveness of a Sexuality Workshop for Nurse Aides in Long-Term Care Facilities

BACKGROUND

In long-term care facilities, there are frequent conflicts related to elderly residents' sexual expression. Nurse aides usually handle such conflicts with negative or negligent attitudes; therefore, elderly sexuality is considered "problem behavior" and is stigmatized.

OBJECTIVES

This study aimed to improve elderly residents' quality of sexual life by enhancing nurse aides' knowledge and attitudes toward elderly sexuality through sexuality workshops.

METHODS

A quasi-experimental study was conducted with 64 nurse aides and 58 residents, who were divided into two groups, i.e., an experimental group and a control group, according to the floor where the residents resided. The nurse aides in the experimental group participated in sexuality workshops and were compared with those in the control group with respect to their knowledge of and attitudes toward sexuality; the residents' quality of sexual life was also compared between groups.

RESULTS

Compared with the control group, in the experimental group, the nurse aides' knowledge of and attitudes toward elderly sexuality as well as the residents' quality of sexual life significantly and continually improved after the sexuality workshops.

CONCLUSION

The four-week sexuality workshop is effective and may be used as an example in developing occupational education programs regarding elderly sexuality in long-term care facilities.

Sexuality, sexual expression in long-term care and the law

Balancing risk and safety in long-term care settings can be challenging while providing and respecting patients’/residents’ needs and rights in terms of sexual expression. We look at factors affecting the expression of sexuality, including staff attitudes and reactions, and the lack of policies governing sexuality. We review the various statute and case law, other legislative and quasi-legal provisions governing sexuality and sexual expression. Finally, we consider the need for clear policies and training for both staff and family members.

"If you do not find the world tasty and sexy, you are out of touch with the most important things in life": Resident and family member perspectives on sexual expression in continuing care

Over the past three decades, there has been growing attention to sexual expression in continuing care homes. However, resident perspectives continue to be underrepresented, particularly in the Canadian context. In this article, we share findings from a qualitative, exploratory study looking at the experiences of residents and family members in Alberta, Canada. As continuing care demographics and social norms about sexuality shift, it is increasingly important to understand these perspectives. We asked participants about how they define sexual expression, its place in continuing care, their experiences with/thoughts about sexual expression in care homes, and suggestions for how to improve this aspect of resident life. We heard diverse accounts of what sexual expression can look like in continuing care homes, the importance of resident autonomy, how privacy matters, complex communication dynamics, and challenges with distinguishing between appropriate and inappropriate expressions. These findings foreground the voices of residents and family members and highlight key areas of opportunity for policy and practice change.

Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care

Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

"That Is So Common Everyday . . . Everywhere You Go": Sexual Harassment of Workers in Assisted Living

In assisted living (AL) facilities, workers are intimately involved in the lives of residents. Existing research on AL demonstrates the imbalance of this environment, which is a personal home for the residents and a workplace for staff. Using observational and interview data collected from six AL facilities, this grounded theory project analyzes how AL staff define, understand, and negotiate sexual comments, joking, and physical touch. We developed a conceptual model to describe how such harassment was perceived, experienced by AL workers, and how they responded. Sexualized behavior or harassment was experienced by workers of every status. We found that words and actions were contextualized based on resident and worker characteristics and the behavior. Staff members refused to engage residents, redirected them, or reframed the words and gestures to get the job done. Reporting the incidents was less common. We conclude by discussing implications for policy and research.

A Practitioner's Guide to End-of-Life Intimacy: Suggestions for Conceptualization and Intervention in Palliative Care

Sexuality and intimacy, including contact, tenderness, and love, are important at every life stage. Intimate expression is especially vital at the end of life, when relationships with loved ones are time limited. Unfortunately, care providers often ignore the potential need for sexual expression, especially at the end of life. In this article, we consider current research on sexuality and end-of-life care and situate these two fields in an ecological framework. We explore how end-of-life sexuality and intimacy can be supported by practitioners in multiple nested contexts and provide suggestions for theoretically-driven interventions. We also provide reflexive considerations for practitioners.

Gay-friendly elderly care: creating space for sexual diversity in residential care by challenging the hetero norm

Studies on older lesbian, gay, bisexual and transgender (LGBT) adults in residential care point to their discrimination, invisibility and the taboo on LGBT lifestyles, and call for development of ‘gay-friendly’ care. Yet, the literature is short on how to create inclusive residential care for older LGBT people. We aim to acquire in-depth understanding of experiences and needs of LGBT older people concerning their inclusion and participation in care settings to contribute to development of inclusive and responsive care that structurally enhances visibility, ‘voice’ and wellbeing of LGBT residents. Responsive, multi-stakeholder research using interviews, participant observations and focus groups was conducted within three elderly care homes in the Netherlands. Thematic, interpretative analysis was performed. LGBT respondents reported social exclusion and the need to feel safe and at home and be yourself. Exclusive activities for LGBT people foster personal and relational empowerment. However, heterogenous activities seem crucial in dealing with stereotypical imaging, heteronormativity and an equality-as-sameness discourse that influenced culture and daily practice in the homes and negatively affected the position of LGBT older adults. For development of gay-friendly elderly care exclusionary social norms need to be addressed. Dialogical sharing of narratives can help to empower LGBT older adults and stimulate understanding and shared responsibility between LGBT and heterosexual older people, as well as professionals.

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

Public Attitudes Toward Sexual Expression in Long-Term Care: Does Context Matter?

The purpose of this study was to (a) examine how age and sex of long-term care (LTC) residents influence public attitudes toward sexuality in LTC and (b) understand how, in the absence of cognitive decline, residing in LTC influences the perception of sexuality as a basic human right. Attitudes were examined using a factorial vignette with a probability sample of 325 respondents from a southern state. Results indicate that attitudes were not statistically affected by a vignette character's age or sex; but respondent education level, parenthood status, and religious affiliation did have direct bearing on attitudes. The notion of sexuality as a basic human right for residents of LTC was ultimately challenged as 19% of respondents said that LTC residents should not be permitted to have sexual relations with their spouse in the facility.

Need or right: Sexual expression and intimacy in aged care

This paper explores how the residential aged care sector could engage with residents' sexual expression and intimacy. It is informed by a study of 19 aged care staff members and 23 community members, and initially designed on the principles of Appreciative Inquiry methodology. The data were collected through focus groups and interviews and analyzed using discourse analysis. We found that staff members mainly conceptualize sexual expression as a need to be met, while community members (current and prospective residents) understand it as a right to be exercised. We conclude that the way in which sexual expression is conceptualized has critical implications for the sector's engagement with this topic. A 'needs' discourse informs policies, procedures and practices that enable staff to meet residents' needs, while a 'rights' discourse shapes policies, practices and physical designs that improve residents' privacy and autonomy, shifting the balance of power towards them. The former approach fits with a nursing home medical model of care, and the latter with a social model of service provision and consumption.