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Shippee T, Simon Rosser BR, Wright MM, Aumock C, Moone R, Talley KMC, Duran P, Henning-Smith C, Cahill S, Flatt JD, Slaughter-Acey J, Greenwald S, McCarthy T, Ross MW. Scoping Literature Review: Experiences of Sexual and Gender Minority Older Adults, With Diagnoses of Dementia, Who Use Residential Long-Term Services and Supports. J Appl Gerontol 2024; 43:562-576. [PMID: 37975683 PMCID: PMC10981565 DOI: 10.1177/07334648231213532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
The number of sexual and gender minority (SGM) older adults utilizing residential long-term supports and services (LTSS) will increase in the forthcoming decades. Paradoxically, while requiring more LTSS services than their non-SGM counterparts, SGM older adults are less likely to access these services, partly due to fears of discrimination. Furthermore, SGM older adults living with Alzheimer's disease and related dementias (AD/ADRD) present unique challenges and opportunities for LTSS facilities. This article provides a scoping review on the intersection between experiences of SGM older adults with AD/ADRD who use residential LTSS. This review identified three themes: (1) the experiences of discrimination among SGM residents in LTSS facilities, (2) the need for comprehensive staff training in residential LTSS to ensure proper care of SGM populations, and (3) the crucial role of inclusive facility policies. As the number of SGM older adults is expected to increase, further research is necessary.
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Affiliation(s)
| | | | | | | | | | | | - Phil Duran
- Aging and Gender Care Access, Saint Paul, MN, USA
| | | | - Sean Cahill
- Fenway Institute, Fenway Health, Boston, MA, USA
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Horne M, Youell J, Brown Wilson C, Brown L, Simpson P, Dickinson T. Using participatory research to co-produce an education and training e-resource to support care home staff to meet the sexuality, intimacy and relationship needs of care home residents with and without dementia. FRONTIERS IN DEMENTIA 2023; 2:1235517. [PMID: 39081975 PMCID: PMC11285635 DOI: 10.3389/frdem.2023.1235517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/24/2023] [Indexed: 08/02/2024]
Abstract
Aim To present the methodological approach and research methods chosen in a research study designed to enable the collaborative creation of an education and training e-resource designed to facilitate and support care home staff to address the sexuality, intimacy and relationship needs of older care home residents. Design Co-production using community-based participatory approach. Methods Four participatory workshops with care home staff, residents and their significant others. Results Workshops 1 and 2 identified and developed real-world case scenarios related to sexuality, intimacy and relationship needs and identified care staff training needs in this area. Then workshop 3 provided valuable feedback on the prototype training e-resource, and the final workshop identified care home staff engagement with and implementation of the e-resource in practice. Conclusion The findings provide evidence that using participatory approaches, such as co-production, to develop education and training resources in a sensitive subject area with care home residents, significant others, carers and care home staff, was a useful approach in engaging a vulnerable population group, in a sensitive area. However, this approach is not without challenges in care home communities.
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Affiliation(s)
- Maria Horne
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Jane Youell
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, United Kingdom
| | | | - Laura Brown
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Paul Simpson
- School of Social Sciences, University of Manchester, Manchester, United Kingdom
| | - Tommy Dickinson
- Department of Mental Health Nursing, Kings College London, London, United Kingdom
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Skeldon L, Jenkins S. Experiences and Attitudes of the LGBTQ+ Community on Care/Nursing Homes. JOURNAL OF HOMOSEXUALITY 2023; 70:3075-3107. [PMID: 35816357 DOI: 10.1080/00918369.2022.2086751] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Recent research has found that older lesbian, gay, bisexual, transgender and queer (LGBTQ+) people have a negative attitude toward long term care services. To build upon this, we conducted a systematic review analyzing current research into the LGBTQ+ communities' perspectives and experiences of care/nursing homes. Additionally, we sought to explore the attitudes of care/nursing home staff toward providing care for LGBTQ+ residents. To conduct this study, we used the databases Embase, Medline and Web of Science, which identified 19 articles for review. From this, we were able to draw several conclusions, including that LGBTQ+ participants were concerned that they would have to conceal their identity and experience abuse. Most staff had a positive attitude toward LGBTQ+ residents, but there were exceptions to this. Despite their positive attitude, staff often lacked awareness of LGBTQ+ issues. The results of this review suggest that care/nursing homes are not welcoming environments for sexual and gender minorities, and that staff require more training to support this community. We end with innovative suggestions to tackle these issues, such as designing coproduced services with the support of LGBTQ+ communities.
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Nocivelli B, Shepherd V, Hood K, Wallace C, Wood F. Identifying barriers and facilitators to the inclusion of older adults living in UK care homes in research: a scoping review. BMC Geriatr 2023; 23:446. [PMID: 37474927 PMCID: PMC10360346 DOI: 10.1186/s12877-023-04126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of this scoping review is to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers. METHOD The 6-stage scoping review methodology framework proposed by Arksey and O'Malley guided this review. Five electronic databases (MedLine, PsychINFO, Scopus, Web of Science, CINAHL) and grey literature were searched. Identified articles went through two levels of screening, and those deemed relevant were collated, summarised and reported using a thematic analysis approach. RESULTS 90 reports were eligible for inclusion and were synthesised into 7 themes and related subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included. CONCLUSIONS A number of recurring barriers and facilitators to the inclusion of care home residents in research are reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential. Understanding the barriers and facilitators to inclusion will enable these factors to be addressed and increase the evidence-base for care provided to older people living in care homes.
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Affiliation(s)
- Brittany Nocivelli
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales.
| | - Victoria Shepherd
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Carolyn Wallace
- School of Care Sciences, University of South Wales, Newport, Wales
| | - Fiona Wood
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales
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Spalding RL, Katz E, Byers ES, Edelstein B. Development and Initial Validation of the Attitudes Towards Older Adult Sexuality in Long-term Care Scale (AOASLC). JOURNAL OF SEX RESEARCH 2023; 60:137-145. [PMID: 34520304 DOI: 10.1080/00224499.2021.1975624] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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 (Mage = 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.
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Affiliation(s)
| | - Emma Katz
- Department of Psychology, West Virginia University
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Horne M, Youell J, Brown L, Brown-Wilson C, Dickinson T, Simpson P. Feasibility and acceptability of an education and training e-resource to support the sexuality, intimacy and relationship needs of older care home residents: a mixed methods study. Age Ageing 2022; 51:6776176. [PMID: 36309975 PMCID: PMC9618283 DOI: 10.1093/ageing/afac221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/01/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND sexuality, intimacy and relationship needs are often a neglected aspect of the care of older adults in residential care facilities. Improving awareness, knowledge and improving attitudes about these needs among care staff could enhance quality of care and lead to better outcomes for residents. OBJECTIVE to evaluate the feasibility and acceptability of a co-designed education and training e-resource to help care staff support their residents' sexuality, intimacy and relationship needs. METHODS we delivered the education and training e-resource to five UK care homes over a 6-month period in a pre-post mixed methods study using surveys, focus groups and individual interviews. RESULTS fifty-nine members of staff from participating care homes undertook the education and training e-resource. 18/59 (31%) of participants completed all six modules and the pre-post surveys. Eleven participants participated in focus groups/interviews to explore experiences of using the e-resource. The e-resource was successfully implemented in the study homes and found to be acceptable. We found preliminary evidence of positive changes in staff attitudes. Factors that facilitated implementation included support from the care home manager. Barriers identified included IT infrastructure and technology. CONCLUSIONS the findings provide initial evidence that a co-designed education and training e-resource raised awareness of, and improved attitudes towards, older adults' sexuality and intimacy needs. This work provides the foundation for a next phase to establish the effectiveness of the e-resource on staff practice and resident outcomes.
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Affiliation(s)
- Maria Horne
- Address correspondence to: Maria Horne, Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds LS1 9JT, UK.
| | - Jane Youell
- Faculty of Medicine and Health, School of Healthcare, University of Leeds, Leeds, UK
| | - Laura Brown
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Tommy Dickinson
- Department of Mental Health Nursing, King’s College London University, London, UK
| | - Paul Simpson
- School of Social Sciences, University of Manchester, Manchester, UK
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Nilsson ML, Annersten Gershater M, Bengtsson M. Registered Nurses' experiences of caring for persons with dementia expressing their sexuality. Nurs Open 2022; 9:1723-1730. [PMID: 35170245 PMCID: PMC8994936 DOI: 10.1002/nop2.1197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 12/22/2021] [Accepted: 01/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Sexuality is an integral part of human beings and persons living with dementia still perceive negative attitudes from caregivers in this regard. Aim This study aimed to explore registered nurses' experiences of caring for persons with dementia living in nursing homes and expressing their sexuality. Methods A qualitative inductive design was adopted; data were collected through semi‐structured interviews and analysed through content analysis. Results The analysis reflected three categories. (1) Dealing with different reactions and responding to nursing staff and relatives: The registered nurses experienced discomfort, insecurity, frustration, distress and embarrassment when confronted with sexual expressions in people with dementia. (2) Caring with a focus on the person: The registered nurses expressed the importance of protecting the integrity of the person and consequently their right to sexual expressions. (3) Needing more competence development: The registered nurses expressed the need to educate and inform not only themselves but also the nursing staff and relatives.
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Affiliation(s)
- Mari-Louise Nilsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | | | - Mariette Bengtsson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
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Hand A, Hill B. Exploring sexual dysfunction in care homes. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 162:135-170. [PMID: 35397784 DOI: 10.1016/bs.irn.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual needs and sexuality in older adults continues to be a neglected area of clinical intervention, particularly in longer term care settings. This is often due to older adults in long term care beds presenting with increased frailty, and often with significant neurocognitive disorders, making it difficult for care staff to evaluate the capacity of an older adult resident to participate in sexual activities or a sexual relationship. Talking about sexuality, intimacy and sexual health can be embarrassing at any age and sex is often still considered taboo for people who live in care homes. The World Health Organization recently declared that sexual health is a central aspect of life and that each individual has the right to love and be loved, to receive appropriate information and treatment, and to enable intimate relationships and personal control over sexual behavior. This chapter explores sexual behaviors, and barriers to this, in later life, and focuses on the sexual behavior of care home residents with Parkinson's disease. Reasons for sexual dysfunction, potential age-related changes to sexual functioning, along with issues such as changes to body image, intimacy and hyper sexuality, are examined for people with Parkinson's disease. Recommendations for practice are given, and acknowledge that older people may still want to be sexually active or intimate is the first step to addressing the issues and overcoming any barriers.
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Affiliation(s)
- Annette Hand
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Barry Hill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, United Kingdom
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Yang MH, Yang ST, Wang TF, Chang LC. Effectiveness of a Sexuality Workshop for Nurse Aides in Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312372. [PMID: 34886098 PMCID: PMC8657160 DOI: 10.3390/ijerph182312372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/23/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Man-Hua Yang
- College of Nursing, National Yang Ming Chiao Tung University, NO. 155, Sec. 2, Li-Nong Street, Beitou Dist., Taipei 112, Taiwan;
| | - Shu-Ting Yang
- Taipei City Haoran Senior Citizens’ Home, Taipei 110204, Taiwan;
| | - Tze-Fang Wang
- College of Nursing, National Yang Ming Chiao Tung University, NO. 155, Sec. 2, Li-Nong Street, Beitou Dist., Taipei 112, Taiwan;
- Correspondence: ; Tel.: +886-228267907; Fax: +886-228202487
| | - Li-Chun Chang
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 333, Taiwan;
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Henrickson M, Cook CM, MacDonald S, Atefi N, Schouten V. Not in the Brochure: Porneia and Residential Aged Care. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 19:588-598. [PMID: 33815627 PMCID: PMC8010488 DOI: 10.1007/s13178-021-00573-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Sexuality and intimacy in residential aged care (RAC) are receiving increased research attention. In this article, porneia refers to access to sex workers, as well as online pornography, and masturbation by residents in RAC. Sex work is legal and regulated in Aotearoa New Zealand. METHODS The present study was a two-arm mixed-method cross-sectional study using a concurrent triangulation design. A validated survey tool was developed. Data were collected in 2018-2019: 433 staff surveys were collected from 35 RAC across the country; 61 interviews were carried out with 77 staff, residents, and family members. RESULTS Staff opinions about sex work and pornography were inconclusive. Nevertheless, access to sex workers occurs in many RAC facilities across the country. Interviews demonstrated a diversity of responses among the three groups; staff attitudes are paramount. CONCLUSIONS Some staff are prepared for resident requests for sex workers; others continue to look to policies and management for guidance, but such policies are often lacking. Most staff have adopted the language of needs vs. rights which dominates the literature. POLICY IMPLICATIONS Staff education on sexuality and facility policy is essential; education for residents and their families is also desirable. Facilities often over-notify third parties. Discourse about sexuality needs to move towards a person-centred, salutogenic approach.
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Affiliation(s)
- Mark Henrickson
- School of Social Work, Massey University, Private Bag 102904, North Shore MSC, Auckland, 0745 New Zealand
| | - Catherine M Cook
- School of Clinical Sciences, Nursing Department, AUT University, Auckland, New Zealand
| | - Sandra MacDonald
- School of Nursing, Manukau Institute of Technology, Auckland, New Zealand
| | - Narges Atefi
- School of Social Work, Massey University, Auckland, New Zealand
| | - Vanessa Schouten
- School of Humanities, Massey University, Palmerston North, New Zealand
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Syme ML, Johnson PE, Fager M. Person-Centered Sexual Expression: Determining Preferences of Future Nursing Home Residents. THE GERONTOLOGIST 2020; 60:725-734. [PMID: 30772898 DOI: 10.1093/geront/gnz016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
| | - Paul E Johnson
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence
| | - Meghan Fager
- Center for Research Methods and Data Analysis, University of Kansas, Lawrence
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Villar F, Serrat R, Celdrán M, Fabà J, Martínez T, Twisk J. 'I do it my way': long-term care staff's perceptions of residents' sexual needs and suggestions for improvement in their management. Eur J Ageing 2020; 17:197-205. [PMID: 32549873 PMCID: PMC7292849 DOI: 10.1007/s10433-019-00546-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
This study is aimed at exploring to what extent staff perceive older residents in long-term care facilities (LTCFs) as still having sexual needs, and how they think care in relation to sexual issues could be improved. The sample was self-selected and comprised 2115 staff members (including managers, technical and care assistants) employed at 152 Spanish LTCFs. Data were collected in the second half of 2016. Participants were asked to estimate the proportion of older residents who had sexual needs in their institution and, by means of open-ended questions, they were also asked about how they satisfied such needs and how to improve care in relation to sexual issues. Responses to the open-ended questions were analysed using content analysis. Differences were assessed according to participants' work position. Results showed that most participants did not see sexual needs as being present in many (or even any) older people living in LTCFs. Masturbation was the most common way staff thought residents' sexual needs were being satisfied. The participants mentioned a broad range of measures to improve care regarding sexual issues, including providing more training opportunities for staff, guaranteeing privacy and improving negative attitudes held by family, residents or staff members. Work position influenced participants' responses: managers and technical staff were more likely to recognise sexual needs among residents, perceived a greater need for training, and proposed more ambitious and far-reaching improvements than care assistants.
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Affiliation(s)
| | | | | | - Josep Fabà
- Universitat de Barcelona, Barcelona, Spain
| | - Teresa Martínez
- Social Services and Rights Department of the Principado de Asturias, Oviedo, Spain
| | - Jos Twisk
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Gewirtz-Meydan A, Hafford-Letchfield T, Ayalon L, Benyamini Y, Biermann V, Coffey A, Jackson J, Phelan A, Voß P, Geiger Zeman M, Zeman Z. How do older people discuss their own sexuality? A systematic review of qualitative research studies. CULTURE, HEALTH & SEXUALITY 2019; 21:293-308. [PMID: 29863969 DOI: 10.1080/13691058.2018.1465203] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 04/11/2018] [Indexed: 06/08/2023]
Abstract
This study captured older people's attitudes and concerns about sex and sexuality in later life by synthesising qualitative research published on this issue. The systematic review was conducted between November 2015 and June 2016 based on a pre-determined protocol. Key words were used to ensure a precise search strategy. Empirically based, qualitative literature from 18 databases was found. Twenty studies met the inclusion criteria. Thomas and Harden's thematic synthesis was used to generate 'analytical themes' which summarise this body of literature. Three main themes were identified: (a) social legitimacy for sexuality in later life; (b) health, not age, is what truly impacts sexuality, and (c) the hegemony of penetrative sex. The themes illustrate the complex and delicate relation between ageing and sexuality. Older adults facing health issues that affect sexual function adopt broader definitions of sexuality and sexual activity.
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Affiliation(s)
- Ateret Gewirtz-Meydan
- a Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat-Gan , Israel
| | | | - Liat Ayalon
- a Louis and Gabi Weisfeld School of Social Work , Bar Ilan University , Ramat-Gan , Israel
| | - Yael Benyamini
- c Bob Shapell School of Social Work , Tel Aviv University , Tel-Aviv , Israel
| | - Violetta Biermann
- d Psychology Institute, Friedrich-Schiller-University Jena , Jena , Germany
| | - Alice Coffey
- e Department of Nursing and Midwifery , University of Limerick , Limerick , Ireland
| | - Jeanne Jackson
- f School of Clinical Therapies and Department of Occupational Science & Occupational Therapy , University College Cork , Cork , Ireland
| | - Amanda Phelan
- g School of Nursing, Midwifery & Health Systems , University College Dublin , Dublin , Ireland
| | - Peggy Voß
- h Psychology Institute, Friedrich-Schiller-University Jena , Jena , Germany
| | | | - Zdenko Zeman
- i Institute of Social Sciences Ivo Pilar , Zagreb , Croatia
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Thys K, Mahieu L, Cavolo A, Hensen C, Dierckx de Casterlé B, Gastmans C. Nurses' experiences and reactions towards intimacy and sexuality expressions by nursing home residents: A qualitative study. J Clin Nurs 2018; 28:836-849. [PMID: 30256475 DOI: 10.1111/jocn.14680] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/27/2018] [Accepted: 09/19/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To better understand how nurses experience and react to intimate and sexual expressions of nursing home residents. BACKGROUND Although many nursing home residents continue to desire intimacy and sexual expression, they commonly perceive negative attitudes of nursing staff towards them as a major barrier to their sexual well-being. To eliminate this barrier, it is crucial to gain a more in-depth understanding of nurses' personal experiences and reactions towards intimacy and sexuality in aged care. DESIGN Our study used a qualitative design, rooted in grounded theory. METHODS Semi-structured interviews with 15 nurses between 34 and 59 years of age were conducted. Participating nurses were recruited from seven different nursing homes in Flanders, Belgium. We used the Qualitative Analysis Guide of Leuven (QUAGOL) for data analysis. We followed the COREQ guidelines to ensure rigour in our study. RESULTS Nurses experienced and dealt with intimate and sexual expressions of residents in an individual way, which was focused on setting and respecting their own sexual boundaries and those of residents and family members. Depending on their comfort level with residents' expressions, nurses responded in three ways: active facilitation, tolerance and termination. Nurses' responses depended on contextual factors, including their personal experiences with sexuality, the nature of their relationship with the residents involved, the presence of dementia and the organisational culture of the facility. CONCLUSIONS Nurses face a wide range of experiences and emotions when confronted with residents' expressions of sexuality and intimacy. A supportive approach is needed to guide nurses in dealing with these highly sensitive situations. This approach can be promoted at the institutional level through continuous educational programmes. RELEVANCE TO CLINICAL PRACTICE This study advocates a contextual and interpretative ethical approach to sexuality in older adults, taking as starting point nurses' own vulnerability and that of residents and relatives.
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Affiliation(s)
- Kristof Thys
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Lieslot Mahieu
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Alice Cavolo
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
| | - Carolien Hensen
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Chris Gastmans
- Centre for Biomedical Ethics and Law, KU Leuven, Leuven, Belgium
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Lam HR, Chow S, Taylor K, Chow R, Lam H, Bonin K, Rowbottom L, Herrmann N. Challenges of conducting research in long-term care facilities: a systematic review. BMC Geriatr 2018; 18:242. [PMID: 30314472 PMCID: PMC6186062 DOI: 10.1186/s12877-018-0934-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/03/2018] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities. Methods A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included “long term care”, “nursing home”, “research”, “trial”, “challenge” and “barrier”, etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized. Results Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations. Conclusions Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget. Electronic supplementary material The online version of this article (10.1186/s12877-018-0934-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helen R Lam
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Selina Chow
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG19, Toronto, ON, M4N 3M5, Canada
| | - Kate Taylor
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Ronald Chow
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Henry Lam
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Katija Bonin
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Leigha Rowbottom
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Division of Geriatric Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room FG19, Toronto, ON, M4N 3M5, Canada.
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Brown LJE, Dickinson T, Smith S, Brown Wilson C, Horne M, Torkington K, Simpson P. Openness, inclusion and transparency in the practice of public involvement in research: A reflective exercise to develop best practice recommendations. Health Expect 2018; 21:441-447. [PMID: 29105227 PMCID: PMC5867325 DOI: 10.1111/hex.12609] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2017] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Reflective accounts of public involvement in research (PI) are important for helping researchers plan and deliver more effective PI activities. In particular, there is a need to address power differentials between team members that can prohibit effective and meaningful involvement. OBJECTIVE To critically reflect on the PI practices that underpinned our research project on intimacy and sexuality in care homes, to develop a series of recommendations for improving future PI activities. SETTING The research team comprised five academics from nursing, public health, sociology and psychology, and two members of the public with experience of sex education, and lesbian, gay, bisexual and trans issues in older populations. In order to address power differentials within the group, we developed an approach to PI practice that was grounded in values of openness, inclusion and transparency. METHOD Reflective commentaries on the strengths and weaknesses of the team's approach to PI were gathered through interviews and open-ended questionnaires with research team members. These views were collated and discussed at a workshop comprising research team members and an additional member of the public to generate recommendations for future PI practice. RESULTS A number of strengths and limitations of our approach to PI were identified. Clear recommendations for improving PI practice were developed for three broad areas of identified difficulty: (i) communication within and between meetings; (ii) the roles and responsibilities of team members; and (iii) PI resources and productivity. DISCUSSION AND CONCLUSION These recommendations add to the developing body of guidance for conducting effective PI.
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Affiliation(s)
- Laura J E Brown
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Tommy Dickinson
- Department of Mental Health Nursing, Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Stuart Smith
- Community Representative in the Older People's Understanding of Sexuality (OPUS) Research Team, Manchester, UK
| | - Christine Brown Wilson
- School of Nursing, Midwifery and Social work, University of Queensland, Brisbane, QLD, Australia
| | - Maria Horne
- School of Healthcare, University of Leeds, Leeds, UK
| | - Kate Torkington
- Community Representative in the Older People's Understanding of Sexuality (OPUS) Research Team, Manchester, UK
| | - Paul Simpson
- Department of Applied Health and Social Care, Edge Hill University, Ormskirk, UK
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Villar F, Celdrán M, Serrat R, Fabà J, Martínez T. Staff's reactions towards partnered sexual expressions involving people with dementia living in long-term care facilities. J Adv Nurs 2018; 74:1189-1198. [PMID: 29285784 DOI: 10.1111/jan.13518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/30/2022]
Abstract
AIMS To explore staff responses, in terms of common practices, towards partnered sexual relationships in long-term care facilities where one or both people involved have dementia. It also tries to determine personal and institutional factors influencing these responses. BACKGROUND Although some studies, mostly qualitative, have focused on reactions to residents' sexual expressions so far the issue has not been assessed in a study using large and diverse samples. DESIGN Cross-sectional quantitative study using vignette technique. METHODS Participants were 2,295 staff members at 152 Spanish long-term care facilities. Data were collected during 2016. A vignette describing sexual situations involving people with dementia was presented to participants. After the vignette, participants had to answer the question: "What do you think most of your colleagues would do in this situation?" with nine possible responses. RESULTS Results showed that relationships involving persons with dementia were perceived as potentially problematic by staff. In both conditions, discussing the case with a colleague or supervisor was the most frequently chosen reaction. More restrictive reactions were mentioned when only one person with dementia was involved in the relationship. Factors such as participants" age and years of experience, professional post and commitment to person-centred care practices were related with the frequency of common restriction practices. CONCLUSION Results highlight the importance of providing staff with clear guidelines regarding the management of specific sexual situations to avoid stereotyped restrictive reactions.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Josep Fabà
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Teresa Martínez
- Social Services and Rights Department, Principado de Asturias, Oviedo, Spain
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18
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Cook C, Schouten V, Henrickson M, McDonald S. Ethics, intimacy and sexuality in aged care. J Adv Nurs 2017; 73:3017-3027. [DOI: 10.1111/jan.13361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Catherine Cook
- School of Nursing; College of Health; Massey University Albany; Auckland New Zealand
| | - Vanessa Schouten
- School of Humanities; Massey University Albany; Auckland New Zealand
| | - Mark Henrickson
- School of Social Work; Massey University Albany; Auckland New Zealand
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Simpson P, Brown Wilson C, Brown LJE, Dickinson T, Horne M. The challenges and opportunities in researching intimacy and sexuality in care homes accommodating older people: a feasibility study. J Adv Nurs 2016; 73:127-137. [PMID: 27461845 PMCID: PMC6881778 DOI: 10.1111/jan.13080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 12/01/2022]
Abstract
Aim To explore the challenges of conducting research on sexuality and intimacy among older care home residents. Background Sexuality and intimacy are neglected in care policies and practices. Design Qualitative analytical study drawing on poststructuralist theorizing. Methods Semi‐structured interviews were conducted with residents and spouses (n = 6) and care staff (n = 16) in two care homes in Northwest England in 2014. The sample was obtained through a network of ‘research‐ready’ care homes. Thematic analysis was used to make sense of narratives with the aid of NVivo10. Results Participant responses highlight the workings of ageist erotophobic discourse that undergirds the assumption of residents (and old people generally) as postsexual. This materialized in reservations about the research ranging from opposition on moral grounds to doubts about its feasibility given the age‐group concerned. However, residents and care home staff can also draw on counter‐discourses that resist/challenge ageist erotophobic thinking, which materialized in methodological and ethical recommendations. Conclusion Participants generally agreed with the principle of the research and made recommendations that could counter/resist ageist erotophobic governance and guide researchers on sampling, style of questioning and communicating with (prospective) study participants on a sensitive subject.
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Affiliation(s)
- Paul Simpson
- Older People's Understandings of Sexuality(OPUS) research group, UK
| | - Christine Brown Wilson
- School of Nursing, Social Work and Midwifery, University of Queensland, Brisbane, Queensland, Australia
| | - Laura J E Brown
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Tommy Dickinson
- Division of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - Maria Horne
- School of Healthcare, University of Leeds, UK
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