Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development

Racial Differences in Nursing Home Quality of Life Among Residents Living With Alzheimer's Disease and Related Dementias

ObjectivesAmong nursing home (NH) residents with Alzheimer's disease (AD) and AD-related dementias (AD/ADRD), racial/ethnic disparities in quality of care exist. However, little is known about quality of life (QoL). This study examines racial/ethnic differences in self-reported QoL among NH residents with AD/ADRD. Methods: Validated, in-person QoL surveys from 12,562 long-stay NH residents with AD/ADRD in Minnesota (2012-2015) were linked to Minimum Data Set assessments and facility characteristics. Hierarchical linear models assessed disparities in resident-reported mean QoL score (range, 0-100 points), adjusting for case-mix and facility factors. Results: Compared to White residents, racially/ethnically minoritized residents reported significantly lower total mean QoL scores (75.53 points vs. 80.34 points, p < .001). After adjustment for resident- and facility-level characteristics, significant racial/ethnic differences remained, with large disparities in food enjoyment, attention from staff, and engagement domains. Discussion: Policy changes and practice guidelines are needed to address racial/ethnic disparities in QoL of NH residents with AD/ADRD.

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.

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.

Person-Centered Sexual Expression: Determining Preferences of Future Nursing Home Residents

BACKGROUND AND OBJECTIVES

Approaches to sexual expression in nursing homes are often devoid of person-centered components, such as resident choice. Little is known about residents' preferences for sexual and intimate expression across different situations. To evaluate future resident preferences, a convenience sample of 389 midlife and older adults in the United States were assessed for their perceptions of appropriateness of sexual and intimate activity among couples in nursing homes, given certain situational factors (e.g., cognitive impairment, relationship status, assent behaviors).

RESEARCH DESIGN AND METHODS

A randomized experimental vignette design was implemented to determine situational factors that influence future resident preferences for sexual expression in nursing homes. Data were analyzed via multilevel modeling, allowing for multiple vignette ratings to be nested among respondents.

RESULTS

Behavioral indications of assent, level of intimacy between the couple, and age of respondent affected respondents' ratings of appropriateness of sexual and intimate activities. Also, cognition and relationship levels interacted for more nuanced effects on activity appropriateness.

DISCUSSION AND IMPLICATIONS

Future resident preferences are often incongruent with attitudes and common practices for approaching sexual expression in nursing home settings. This marks a unique opportunity for person-centered policy development and implementation in the realm of sexual expression.

Public acceptability of public health policy to improve population health: A population-based survey

BACKGROUND

For public health policies to be effective, it is critical that they are acceptable to the public as acceptance levels impact success rate.

OBJECTIVE

To explore public acceptance of public health statements and examine differences in acceptability across socio-demographics, health behaviours (physical activity, diet, binge drinking and smoking), health status and well-being.

METHOD

A cross-sectional survey was conducted with a nationally representative sample (N = 1001) using a random stratified sampling method. Face-to-face interviews were conducted at homes of residents in Wales aged 16+ years. Individuals reported whether they agreed, had no opinion, or disagreed with 12 public health statements.

RESULTS

More than half of the sample were supportive of 10 out of 12 statements. The three statements with the greatest support (>80% agreement) reflected the importance of: a safe and loving childhood to becoming a healthy adult, schools teaching about health, and healthier foods costing less. Individuals who engaged in unhealthy behaviours were less likely to agree with some of the statements (eg 39.8% of binge drinkers agreed alcohol adverts should be banned compared to 57.6% of those who never binge drink; P < .001).

CONCLUSIONS

Findings show an appetite for public health policies among the majority of the public. The relationship between supporting policies and engaging in healthy behaviours suggests a feedback loop that is potentially capable of shifting both public opinion and the opportunities for policy intervention. If a nation becomes healthier, this could illicit greater support for stronger policies which could encourage more people to move in a healthier direction.

Influence of Sexuality on the Health of the Elderly in Process of Dementia: Integrative Review

Objective: this work sought to inquire on the influence of sexuality on the health of the elderly during dementia. Materials and Methods: this was an integrative review. A careful search was conducted in nine databases; however, only five databases provided articles fulfilling the scope of the study: Medline, Lilacs, BDENF, Scopus, and Web of Science (WoS). The health science descriptors (DeCS) were adopted: “sexualidad”, “demencia” and “anciano”, and the descriptors cataloged in the Medical Subject Headings (MeSH): “sexuality”, “dementia” and “aged”. After applying the inclusion criteria, eight articles were selected to comprise the study sample. Results: the practice of sexuality influences upon the health of the elderly with dementia with some beneficial effects, given that it provides, especially, better perception of quality of life and wellbeing. Nevertheless, it cannot be generalized due to methodological insufficiency evidenced in the studies found to construct this review. Conclusions: due to the limitation of studies addressing the theme and the methodological insufficiency of those included in this review, it is necessary to conduct research that shows in depth the influence of sexuality on this population, given that it can be constituted as another approach for the promotion and protection of health in the elderly with dementia.

Public perspectives toward long-term care staff's interventions in the sexual relationships of residents with dementia

Background and objectives

Sexual expression is an essential component of older adults’ quality of life, including those with lower cognitive functioning. Issues have been raised with long-term care facility policies related to aspects of staff intervention, permissibility of degree of intimacy, and how involved partners of residents with cognitive decline may be in decision-making processes. Research design and methods: This study used a multiple segment factorial vignette to explore the attitudes of the public toward a dementia-caused non-spousal sexual relationship in a long-term care facility. Specific elements examined included the degree of intimacy, obligation of long-term care staff to intervene in the relationship, and the healthy spouse’s disposition. Respondents ( N = 318) were contacted using a list-assisted random-digit dialing method and read a version of the vignette with the independent variables randomly generated. Two logistic regression models and one ordinal regression model were used to analyze the main effects of the independent design variables and respondent characteristics.

Results

The majority of respondents report the need for long-term care staff to intervene in sexual relationships and an obligation to inform the healthy spouse of a resident’s sexual relationship. Results suggest differences of opinion exist based on respondent characteristics of education and religiosity. Discussion and implications: Public opinion is in favor of long-term care facilities incorporating spousal involvement into decisions regarding a cognitively impaired resident’s ability to engage in an intimate relationship. Implications for long-term care policy focusing on staff training about sexual expression and intervention in addition to incorporating the spouse into decision-making processes are discussed.

Elder sexual abuse and implicit agism: examining the warm-incompetent bias among mock jurors

Implicit ageist beliefs about the warmth and incompetence of older adults may influence jurors' perceptions and judgments of an older adult's competence in legal cases hinging on capacity and consent, including elder sexual abuse. However, little is known about the nuances of implicit agism in elder sexual abuse cases, and if it can be attenuated. The current study proposed to address these gaps via a randomized vignette design administered to a community sample of 391 US adults. Mock juror participants evaluated an elder sexual abuse case involving an older married couple, in which the victim had dementia. Results suggest that implicit agism was present among mock jurors, consistent with a warm-incompetence bias, and was predictive of mock jurors' guilt ratings. Age- and dementia-relevant jury instructions and mock juror gender were not found to be predictive of guilt ratings. Implicit agism among jurors should be addressed to reduce the potential for implicit age bias to affect elder sexual abuse cases.

Public Perspectives Toward the Sexual Behavior of an Individual With Dementia Residing in Long-Term Care

OBJECTIVE

This study examines public perspectives toward sexual behavior within a heterosexually married couple in which one individual has dementia and resides in a long-term care facility.

METHOD

Respondents included 318 adults in the Southern United States. Paired sample t tests were used to understand how the diagnosis of dementia statistically influenced participants' responses, and a logistic regression model was used to understand how a vignette character's sex and respondent characteristics influenced attitudes.

RESULTS

Fifty-eight percent of respondents believed that a sexual relationship should be permitted for an adult with dementia, and t tests revealed that dementia had a statistical effect on participants' responses. Sex of the vignette character was not a predictor of attitudes. Participant's qualitative rationales are offered for additional insight.

DISCUSSION

Respondents who felt that a couple should not engage in a sexual relationship commonly cited consent-related issues as their primary concern. Implications for policy development are discussed.