Fatores que interferem na sexualidade de idosos: uma revisão integrativa

Construction and validation of a scale of sexual self-concept for the elderly Chilean population

BACKGROUND

Sexual self-concept has a central role in the life of the elderly population. Indeed, their sexual self-concept has significant and positive relationships with their satisfaction with life, pleasure, and willingness to interact with others. However, social-cultural prejudice means that the elderly are considered asexual individuals, harming their sexual self-concept. This prejudice is prominent in Chile, where the elderly do not have access to clear information about their sexuality. However, research on the Chilean elderly population is still in its infancy and requires more attention. Hence, this research aims to construct and validate a scale of sexual self-concept for the elderly Chilean population to cover this identified gap in the literature.

METHODS

Sixty items were integrated into the first version of the scale. Ten external judges were asked to assess the content validity. Twenty-eight items were maintained. Subsequently, an instrumental and cross-sectional design was implemented with a non-probabilistic sampling (N = 188). Items were refined with corrected homogeneity indices and conditional estimates of Cronbach's alpha and Omega coefficient.

RESULTS

A final scale of nine items equally distributed in three dimensions was obtained: Sexual self-efficacy (ω = 0.867), Sexual assertiveness (ω = 0.764), and Sexual self-esteem (ω = 0.803). The confirmatory factor analysis reflects that the theoretical model has an adequate fit (CFI = .989; TLI = .984; RMSEA = .086).

CONCLUSIONS

The data analyses confirmed that the scale has adequate psychometric properties. This scale can be used for multidimensional measurements of sexual self-concept in the elderly in Chile. Further research can confirm its psychometric properties in different settings within the Spanish language population.

Atitudes e Conhecimentos de Idosos sobre Intercurso Sexual no Envelhecimento

Resumo A sexualidade no processo de envelhecer é um fenômeno que precisa ser compreendido de forma sistematizada. Dada a amplitude de possibilidades em discussões acerca da sexualidade, o presente estudo focou no intercurso sexual no envelhecimento. Assim, o objetivo traçado foi compreender as atitudes e os conhecimentos de idosos de um município do agreste de Pernambuco sobre o intercurso sexual no envelhecimento. Foi utilizado o método quantitativo descritivo, com instrumento de coleta e de análise dos dados a escala ASKAS (Aging Sexual Knowledge and Attitudes Scale) aplicada à amostra de 150 participantes de ambos os sexos. Os resultados evidenciaram que a maioria dos entrevistados compreende que práticas sexuais podem trazer benefícios psicológicos. Apesar disso, a maior parte dos participantes, tanto das mulheres quanto dos homens, indicaram que o interesse sexual inevitavelmente desaparece depois dos 65 anos. As mulheres da amostra, como já era esperado, mostraram-se mais afetadas por tabus e proibições quanto à realização de desejos sexuais, consideraram o sexo como algo perigoso e alegaram vergonha para demonstrar interesse sexual, o que aponta para a necessidade de uma discussão de gênero.

Profile of nursing diagnoses in indigenous older adults in the community: a cross-sectional study

OBJECTIVE

to describe the profile of nursing diagnoses evidenced in indigenous elderly in the community.

METHODS

this is a cross-sectional study, carried out with 51 indigenous elderly people of Potiguara ethnicity, through a nursing consultation. The clinical data, obtained from the consultation, were analyzed following Risner's diagnostic reasoning process and the NANDA-I Taxonomy (2018-2020). For greater accuracy, the diagnoses obtained underwent peer review by a specialist.

RESULTS

37 diagnoses were identified, such as Impaired dentition (98.0%), Risk for impaired skin integrity (66.7%), Chronic pain (64.7%), Risk for deficient fluid volume (54.9%), Impaired swallowing (45.1%), Impaired walking (45.1%), Disturbed sleep pattern (43.1%), Stress urinary incontinence (41.2%), Risk for falls (35.3%), and Sexual dysfunction (33.3%).

CONCLUSION

the diagnoses identified were predominantly from Safety/protection domain and result from factors that negatively influence indigenous elderly's functional capacity.

Older adult sexuality in the practice and training of geriatricians: a qualitative study

OBJECTIVE: To understand the academic training of geriatrics residents and their supervisors regarding the sexuality of older adults, as well as practical approaches to the subject in their work routines. METHODS: This qualitative study was conducted with geriatrics residents and their supervisors at a public hospital in Recife, PE, Brazil in 2019 and 2020. RESULTS: A partial understanding of the respondents’ concept of sexuality was identified through statements that expressed confusion between sexual intercourse and sexuality, as well as a lack of knowledge about sexuality on an individual level. Although the respondents affirmed the importance of discussing the subject, they reported that they do not, except passively, depending on the patient’s questions, despite the fact that they perceive their patients’ difficulty in seeking out a health service to talk about sexuality-related issues. Finally, the lack of an approach to sexuality in geriatric consultations was linked with gaps in undergraduate and specialization programs about general care for older adults, resulting in a feeling of unpreparedness to face the taboos and prejudices associated with sexuality. CONCLUSION: Although professionals consider it important to address sexuality with patients, most of them do not do so in medical consultations due to a number of difficulties, including the lack of a protocol to follow, which leads to a passive approach. Therefore, professionals acknowledge the difficulty of addressing the subject and associate it with deficiencies in their academic training.

The silenced sexuality in dependent older adults

Sexuality is a silent theme concerning the elderly population who is socially perceived as asexual. This qualitative approach paper is part of research on dependent older adults, which aimed to analyze their sexual experiences. The topic was retrieved from interviews with 26 of them, who talked about sex in their lives. The Thematic content analysis identified two main categories in the statements: gender differences in the treatment of sexuality and difficulty in talking about sex. Differences were observed in the perception and valuation of sexuality by gender. Older men give importance to sexual potency, and older women consider the cessation of sexual life in old age to be natural. Older men enunciate a sexuality concept based on biological satisfaction and sexual act, while women value partnership, affection, and fondness. Researchers were silent on the topic, although it was included in the research manual to guide the interview with older adults. However, while only 26 mentioned the subject, sexuality of older adults is modulated by gender perception. It is a poorly studied and challenging theme to approach in research and healthcare settings.

Factors Conditioning Sexual Behavior in Older Adults: A Systematic Review of Qualitative Studies

The sexual behavior of older adults, especially women, has undergone changes in recent years, though there are still certain stereotypes today related to pathophysiology, beliefs, culture and tradition that negatively affect older adults’ sexual activity. The aim of our review is to present the main qualitative studies analyzing how physiological and psychosocial factors affect sexual behavior in older adults. A systematic review of these qualitative studies was carried out. All stages of this review were carried out peer-to-peer in order to guarantee minimized bias. A bibliographical search was completed between February and April 2019, in Web of Science, Scopus, PubMed Medline, PsycINFO ProQuest and CINAHL. To analyze the findings of the selected qualitative studies, a “Thematic Synthesis Analysis” was performed, using Eppi-Reviewer 4 software (UCL Institute of Education, University of London, UK). The quality of the studies was assessed with a CASP-Qualitative-Checklist. A total of 16,608 references were screened and 18 qualitative studies were included in this review. The studies involved 2603 participants across seven countries, most being women (approximately 80%). We identified a wide variety of physiological and psychological factors that can influence the sexual behavior of older adults, such as the presence of pathologies (erectile dysfunction and menopause), the strength of spiritual beliefs, and patriarchal roles upheld by upbringings conveying that women’s role is to provide men with sexual pleasure. Biological age in relation to stereotypical models of sexual behavior, emphasized as a risk factor in the contraction of sexual diseases, seems to play a relevant role as a factor limiting sexual behavior in older adults.

Aging, sexuality and nursing care: the elderly woman's look

OBJECTIVE

to analyze the perception of elderly women about sexuality and practice of nursing care in this context.

METHOD

a descriptive qualitative study. Fifty elderly women from Guanambi City - Bahia State were interviewed in 2016. Data collection technique was direct interview by using an unstructured script. Analysis of the semantic content described was carried out, and two empirical categories: the elderly woman's view of nursing care in the promotion of sexual health and experience of sexuality in the elderly; and nursing care in the context of women's aging.

RESULTS

it has been noted that the elderly women are afraid to talk about sexuality, especially with health professionals. By influences of society, they often exclude this issue of health care for elderly women.

FINAL CONSIDERATIONS

changes must be thought about assistance provided in relation to sexuality.

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.

Understanding sexuality by rural elderly women

OBJECTIVE

to understand the meaning of sexuality by rural elderly women.

METHOD

a qualitative exploratory and descriptive research, carried out through interview at the home with 26 rural elderly women, aged between 60 and 69 years. The data were analyzed by the thematic content analysis technique of Bardin.

RESULTS

understanding sexuality is linked to the construction of sexual and/or loving relationship, and positive and negative factors that interfere with the exercise of sexuality: good relationship with the spouse, physical and mental benefits, chronological age, health problems, no spouse, sexual disinterest and fear of relating for fear or disappointment.

FINAL CONSIDERATIONS

there is a decline in the maintenance of sexuality linked to the end of the reproductive period, to the advancing age and the low social perspective that is common for rural elderly women.

The Attitudes of Elderly Women Regarding the Expression of Their Sexuality

Objective: To identify the attitudes elderly women have with respect to their sexuality. Material and method: Exploratory, descriptive study of qualitative approach conducted during the second semester of 2018, with the participation of 19 elderly women, between 60 and 69 years of age, members of two groups for the elderly located in the city of Rio Grande-RS, Brazil. Data was collected through individual, semistructured interview and audio recorded. Thereafter, the data were subjected to the Bardin thematic analysis. Results: Upon analyzing the data, four categories emerged: Change in the expression of sexuality after 60 years of age; feelings derived from talking about sexuality; with whom do they talk about sexuality; importance of affective relationships for the elderly. The elderly women show favorable attitudes regarding their sexuality and noted no significant changes in the expression of sexuality after turning 60 years of age. However, they were embarrassed to talk about this matter because they had received a repressive education. In addition, they sought friends to address any questions. Conclusion: Affective, loving, and sexual relation are extremely important, given that it promotes physical and mental wellbeing, generates feelings of joy and happiness, which provides more vitality and pleasure in living to the elderly women.

Sobre a Psicanálise e o Envelhecimento: Focalizando a Produção Científica

Resumo Revisão integrativa com objetivo de conhecer a produção científica em psicanálise na relação com o idoso e envelhecimento. O período considerado foi de 2011 a 2015, nas bases de dados: Index-Psicologia, LILACS e MedLine. Utilizaram-se os termos: Aged (Idoso), Elderly (Envelhecimento) e Psychoanalysis (Psicanálise). Encontraram-se 89 referências. Excluíram-se editoriais, artigos repetidos e aqueles que não se adequavam à questão norteadora deste estudo. Onze artigos foram selecionados. Ficou nítida a preocupação da psicanálise com o idoso. Essa preocupação parece preceder a questões epistemológicas, de modo que a prática clínica aparece com maior produção. Contudo, verificou-se a necessidade de um maior número de pesquisas sobre o tema.

REPRESENTAÇÕES DOS ESTUDANTES DE ENFERMAGEM SOBRE SEXUALIDADE: ENTRE ESTEREÓTIPOS E TABUS

Resumo Considerando a sexualidade como parte fundamental da vida humana, esse estudo buscou compreender como os estudantes de enfermagem representam a sexualidade. Optou-se por estudo com delineamento qualitativo, ancorado na teoria das Representações Sociais. A população do estudo foi composta por acadêmicos do curso de graduação em uma instituição pública. A coleta de dados foi realizada por meio da técnica de grupo focal, orientado por um roteiro. A análise foi realizada como auxílio do IRaMuTeQ versão 0.7 alpha 2 e embasada na Análise de Conteúdo. A sexualidade foi representada como algo a ser velado no âmbito familiar e escolar. Apesar da formação ter se revelado como um fator que contribuiu na mudança de concepção sobre a sexualidade, sentimentos como vergonha e timidez se fizeram presentes durante as práticas dos estudantes, constatando que as representações se ancoram em estereótipos e tabus. Assim, é visível a necessidade de mais espaços de discussão no meio acadêmico e na sociedade, de forma que não se limite à teoria, mas que compreenda também a prática.

Approaches of psychoanalysis in the care of the elderly: an integrative review

Abstract Objective: to map publications about the clinical psychoanalytical care of the elderly and describe their characteristics. Method: an integrative review was carried out, considering the period 2008 to 2017 using the following databases: Index-Psychology, LILACS, MedLine, PubMED, SciELO and RedALyC, irrespective of language. The terms Elderly (Idoso), Aging (Envelhecimento) and Psychoanalysis (Psicanálise) were used. The guiding question was: what scientific literature exists about the elderly and psychoanalytical clinical care? A total of 33 articles were considered. Results: five categories were constructed: "Elderly clinical care with a psychoanalytical approach" (15), "Psychoanalytical Approaches in old age” (9), "Psychoanalytical Interventions in long-term care facilities" (6), "Representations of old age for health professionals in the light of psychoanalysis" (2) and "Generationality and psyche" (1). The concern of psychoanalysis for the elderly is incipient and precedes epistemological issues, meaning that production regarding clinical practice is greater; in turn, there are fewer research studies, as most of the articles are reflective in nature. Conclusion: the published studies indicate the possibility of employing psychoanalysis with the elderly, as the unconscious does not age and symptoms are continuously updated. The timidity of psychoanalysis in contrast to the increase in the numbers of elderly persons may be criticized. It is also emphasized that the losses, the effects on the body and the reduction of social ties require adjustments in clinical care, such as the inclusion of group activities and activities beyond the analytical setting, especially hospitals, homes and LTCFs.

Analysis of the sexual behavior of elderly women treated at a gynecological outpatient clinic

Abstract Objective: to analyze the sexual behavior of the elderly women treated at the gynecological outpatient clinic over a period of one year, estimating the proportion of sexually active women, those with an interest in sex, and those who considered the activity of sex important for quality of life, among other findings. Method: a cross-sectional, descriptive, and exploratory study was performed. A pilot study was carried out in order to adjust and validate the data collection instrument. A convenience sample of 100 women was considered for the evaluation of socio-demographic characteristics and sexual behavior, including questions relating to sexual practice and interfering factors. The data were analyzed using frequencies and percentages, and the associations were verified by Pearson’s Chi-squared test, considering a significance of 5%. Results: it was observed that 60.0% of the elderly women felt sexual desire, although 26.0% were sexually active. While 75.5% reported that aging does not improve the quality of sex, 83.0% believed that it is important for quality of life and 78.0% affirmed that there is no age limit for sexual activity. The cultural view of the elderly may interfere with the maintenance of a sexual life, since 51.0% reported feeling sexual prejudice due to their age. Conclusion: sexuality is directly related to the perception of quality of life and as it is a vital human function, can interfere in the social, professional, physical and psychic performance of the individual. The practice of and the desire for sex are not extinguished with aging, which contradicts the myth that the elderly person is an asexual being.

Knowledge and attitudes about sexuality in the elderly with HIV

This is a cross-sectional quantitative study carried out with 241 elderly diagnosed with HIV, assisted in the services of reference of Recife, Pernambuco State, Brazil. Knowledge and attitudes were evaluated through the Aging Sexual Knowledge and Attitudes Scale (ASKAS). Senior men, participants with higher educational level, those without depressive symptoms and individuals diagnosed with HIV for more than 12 years have a higher level of knowledge about sexuality in old age. Conservative attitudes toward sexuality in aging have been strongly associated with women, illiterate participants, practicing evangelical and Catholic religions, and elderly diagnosed with HIV with less than 12 years. Elderly with less knowledge had more conservative attitudes regarding sexuality in aging (r = 0.42; p < 0.0001). Thus, it is essential to carry out health actions with the aim of improving knowledge and attitudes regarding sexuality in the elderly, paying particular attention to those who are most vulnerable to HIV infection.

The dialogic educational pathway as a strategy of care with elderly women in sexuality

Abstract Objective: Unveiling the critical knowledge mediated by a care-educational dialogic pathway in sexuality with elderly women. Method: Qualitative and participatory study, outlined in educational action research approach, for which it was anchored in the Paulo Freire's Research Itinerary. 15 elderly women from a group of socialization participated in the study. Three ethical precepts were followed. Results: It was evident that the women of this study had difficulty in conceptualizing sexuality, reducing the concept to sex. In addition to diverging sexuality for men and women and configuring it as a practice of the youth. Conclusion and implications for practice: Dialogic educational activity proved to be an important care tool, since it allowed the unleashing of prejudice concerning sexuality in Aging, promoting elderly health and showing new ways of care.

Quality of life and self-esteem among the elderly in the community

This study sought to investigate the association between the scores for quality of life (QoL) and self-esteem among the elderly in an urban community. A cross-sectional, quantitative and analytical household survey was conducted with 1,691 elderly persons resident in an urban area in a county in Minas Gerais state. The World Health Organization Quality of Life BREF (WHOQOL-BREF), the World Health Organization Quality of Life OLD (WHOQOL-OLD) questionnaires and the Rosenberg Self-Esteem Scale were used in this study. A descriptive statistical analysis and a linear regression model (p < 0.05) were conducted. The results revealed that the social relationships domain (71.19) and the topic of death and dying (74.30) had the highest mean scores among the elderly; while the lowest mean scores were the environment domain (60.39) and the topic of social participation (63.06). The self-esteem scores showed an average of 9.36 ± 4.09. Associations were evident for the lower scores of quality of life in all the WHOQOL-BREF domains and WHOQOL-OLD aspects (except death and dying) with lower levels of self-esteem (p <0.001). The results provide data that contribute to a better understanding of the aspects that influence the QoL of the elderly due to reduced self-esteem, thus providing information for the development of health strategies.

Temporomandibular joint dysfunction in Parkinson's Disease: an integrative literature review

ABSTRACT Temporomandibular joint dysfunction is a set of disorders involving the masticatory muscles, temporomandibular joint and associated structures. It is known that the progression of motor symptoms in Parkinson's disease is an indication that these people are more prone to the development of this dysfunction. Thus, this study aims to investigate the signs and symptoms of temporomandibular dysfunction in people with Parkinson's disease. The search was performed in the databases: MEDLINE/ PubMed, LILACs, CINAHL, SCOPUS, Web of Science and PEDro, without timing or language restriction. Specific descriptors were used for each database and keywords, evaluated by the instruments: Critical Appraisal Skill Program and Agency for Health care and Research and Quality. A total of 4,209 articles were found but only 5 were included. After critical analysis of the methodology of the articles, one did not reach the minimum score required by the evaluation instruments, thus, it was excluded. The selected articles addressed, as signs and symptoms of temporomandibular joint dysfunction, the following: myofascial pain, bruxism, limitation of mouth opening, dislocation of the articular disc and asymmetry in the distribution of occlusal contacts. Further studies are needed in order to determine the relationship between cause and effect of the analyzed variables, so as to contribute to more specific and effective therapeutic interventions.

Knowledge about the human immunodeficiency syndrome among elders in a unit for the care of the elderly

Objective

To analyze the knowledge of elders regarding HIV/AIDS.

Methods

Descriptive, cross-sectional, quantitative study, with 457 elders from the Unit for the Care of Elders in Uberaba - Minas Gerais, lasting 3 months. The instruments used were the Mental State Mini-exam and a questionnaire on the human immunodeficiency virus for elders, together with frequency measures for their analysis.

Results

Most participants were female (74%), between 60 and 69 y/o (51%). The question with the most correct answers was about syringe/needle transmission (96.2%) and the ones with the least (45.3% and 49.6%, respectively) were regarding AIDS transmission through mosquito bites and whether a person with the human immunodeficiency virus always presents symptoms (49.6%). 88.2% of participants never use condoms.

Conclusion

The general level of knowledge can be considered good, responding to our goal. However, gaps in knowledge were identified due to the lack of campaigns aimed exclusively at such public, as well as to the lack of awareness of professionals.

Sexuality through the eyes of the elderly

Abstract Objective: to identify the perception of elderly persons about sexuality. Methods: a quantitative, observational and analytical cross-sectional study was performed in an institution specializing in elderly care in Belém, in the state of Pará. A questionnaire, produced by the authors, was applied to 200 elderly persons, aiming to identify issues related to sexuality both in their youth and today, as well as stimulant strategies and sexuality inhibiting factors among the elderly, among other issues. Data was statistically analyzed through the G-Test for adherence. Results: The researched elderly had an average age of 72 (±5.92) years. The majority said they were not prepared for the beginning of sexual activity when young (62.5%), and had little knowledge about sexually transmitted diseases or methods of preventing them (42.3%). Today, the majority (84%) did not understand the distinction between sexuality and sex, even though most (69.5%) believed that they can stimulate their own sexuality. They also identified family (16.5%) and religion (15.5%) as inhibitory factors for their sexuality. A total of 28.5% of those interviewed reported having a sexual dysfunction and more than half (52.5%) did not seek medical support. They believed that health professionals are prepared to deal with the issue, although such professionals are almost the last information source consulted (17.5%) in relation to sexuality. Conclusion: many factors support the myth that older people are asexual: limited access to information from their youth to the present day, the physiological changes connected to aging itself, religious precepts and family oppression. However, further studies and actions directed at this population are important to promote the health of the elderly.

Exercícios terapêuticos domiciliares na doença de Parkinson: uma revisão integrativa

Resumo Exercícios terapêuticos domiciliares vêm assumindo importância em estudos recentes como estratégia do cuidado para o controle de sinais e sintomas da doença de Parkinson (DP). Essa revisão integrativa da literatura objetivou reunir estudos publicados entre o período de 2010 e 2014, disponibilizados em português, inglês ou espanhol sobre a utilização de exercícios terapêuticos domiciliares como estratégia do cuidado fisioterapêutico na DP. Realizou-se levantamento de artigos nas bases de dados LILACS, PEDro, PubMed e Cochrane, mediante as combinações: Fisioterapia AND doença de Parkinson ou Home Exercise AND Parkinson's Disease. Para análise da qualidade metodológica, os instrumentos utilizados foram o Critical Appraisal Skill Programme (CASP) adaptado e o Agency for Healthcare and Research and Quality (AHRQ). Os benefícios da cinesioterapia foram: estímulo ao autocuidado; ganho de força e amplitude de movimento; redução do número de queixas e do medo de cair; melhora de sintomas motores relacionados ao Parkinson e à qualidade de vida. Com relação aos benefícios da reabilitação com realidade virtual houve: melhora na marcha, na capacidade funcional e no equilíbrio, além de boa aceitação e aspecto motivacional.

Paradox of life among survivors of bladder cancer and treatments

Abstract OBJECTIVE: To interpret the meanings attributed to the experience of bladder cancer among survivors in therapeutic follow-up. METHOD: Qualitative methodological approach, based on medical anthropology and narrative methodology. After approval by the research ethics committee of a public university hospital, data were collected from January 2014 to February 2015, by means of recorded semi-structured interviews, direct observation and field journal entries on daily immersion with a group of six men and six women, aged between 57 and 82 years, in therapeutic follow-up. Narratives were analyzed by means of inductive thematic analysis. RESULTS: The meanings revealed difficulties with the processes of disease and treatment, such as breakdown of normal life, uncertainty about the future due to possible recurrence of the disease, difficulty with continuity of care and emotional control, relating it to conflicting ways of understanding the present life. Thus, the meaning of this narrative synthesis is paradox. CONCLUSION: Interpretation of the meaning of experience with bladder cancer among patients provides nurses with a comprehensive view of care, which encompasses biological, psychological and social dimensions, and thereby systematizes humanized care.