Addressing sexuality and intimacy in people living with Parkinson's during palliative care and at the end of life

Quality of life and living with Parkinson's disease: a qualitative exploration within an Irish context

BACKGROUND

Parkinson's disease is incurable, and the rate of progression varies meaning that people face a long future with an unpredictable condition that can significantly influence their quality of life. To date, much of the international research has focused on measuring and describing quality of life in Parkinson's from a quantitative perspective. Given its multidimensional nature, the present study aims to explore the concept using a qualitative approach so factors influencing self-reported quality of life can be understood in greater depth.

METHODS

Using a qualitative descriptive approach, people with Parkinson's disease who were survey participants in the first phase of a mixed methods study exploring factors influencing health-related quality of life were invited to participate in semi-structured interviews. Eighteen participants with high (n = 6), average (n = 6), and low (n = 6) health-related quality of life (PDQ-39 SI scores) were purposively invited to participate in this study. Audio recordings were transcribed and thematically analysed using Braun and Clarke's steps (familiarisation, generating initial codes, searching for themes, reviewing, defining, naming themes, and producing the report).

RESULTS

Thematic analysis revealed four overarching themes; 'Living an interrupted life,' 'Striving for 'I' in independence,' 'Unravelling identities, roles, and relationships' and 'Reconfiguring life'. These themes illuminated participants' experiences of living with Parkinson's disease and what influenced their overall quality of life.

CONCLUSIONS

These findings add to the international literature by helping to achieve a deeper understanding of what it means to live with Parkinson's disease and how it influences quality of life. Participants experienced a range of fluctuating, and interconnected motor and non-motor symptoms. This finding draws attention to the impact of the often-unpredictable nature of the condition on the physical, functional, psychological, social, and spiritual dimensions of life. Quality of life was positively influenced by perceptions of independence and negative feelings of dependence. Being independent was associated with freedom to plan, autonomy of choice, and freedom from feeling stressed, strained, or fearful. Having a positive outlook, using problem-focused strategies, and participating in hobbies, holidays, work, and involvement in local community committees were perceived positively across interviews as accentuating social dimensions of life. Resourcing self-management strategies, advanced nursing roles, and developing personalised models of community support may assist healthcare professionals in meeting the unique needs of people with Parkinson's disease thereby supporting quality of life.

Exploring sexual dysfunction in care homes

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.