Sexuality in the Nursing Home, Part 1: Attitudes and Barriers to Sexual Expression

doi:10.1016/S1525-8610(04)70325-4

Journal of the American Medical Directors Association

Volume 4, Issue 3, May–June 2003, Pages 152-156

https://doi.org/10.1016/S1525-8610(04)70325-4 Get rights and content

Sexuality is a basic human need that begins at birth and continues throughout life. The sexual needs of the elderly are similar to those of the young, but with variations in frequency, intensity, and mode of expression. Regardless of age, every individual has a need for love, intimacy, and companionship. Unfortunately, however, stereotypical thinking, ignorance, and prejudice dominate Western society's view on sexuality in the elderly. In a youth-oriented culture, sexuality is attributed to the young, healthy, and beautiful, and the myth that the elderly are asexual beings predominates. Consequently, the sexual needs of the elderly are frequently overlooked and ignored. Nowhere is this more emphatic than in the nursing home setting. This article explores barriers to sexual expression in the nursing home setting and discusses strategies to overcome them.

Section snippets

Nursing Home Residents’ Viewson Sexuality

In 1979, Wasow and Loeb ⁹ reported that most of the 63 nursing home residents they studied admitted to having sexual thoughts and fantasies. Eighty-one percent of males and 75% of females said that older people should be allowed to have sex, but most were not actively engaged in sexual activity at the time of the interview because of lack of opportunity. The persistence of libido despite infirmity and institutionalization is in agreement with the work of White, ¹⁰ who found more nursing home

Barriers to Sexual Expression in the Nursing Home

Guilt-free sexuality that is fulfilling and therapeutic is dependent on the concept of self-worth, physical health, social acceptance, and a supportive environment. All these factors can be severely encumbered in the nursing home setting. Interestingly, having a sexual partner, particularly in men, is not imperative for fulfilling sexuality, though residents with partners are reported to have more frequent and routine sexual encounters. ⁵ Table 1, Table 2 lists barriers to sexual expression in

Conclusion

Sexual expression among nursing home residents is a basic human need. Physicians and staff caring for older persons in nursing homes should address this need as part of their duty to enhance the quality of life and well-being of their patients.

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Older adults are sexual beings with complex sexual lives. However, this runs contrary to the stigma, stereotypes, and biases that individuals carry, society projects, and media displays. This chapter attempts to highlight the challenges and strengths encountered by older adults as they navigate not just sexual dysfunction but also sexual wellness. Using a systemic and holistic approach to understand sexual wellness, the authors, guided by theory, offer contextual understanding of the lives of older adults, provide insights into the experiences of older adults in long term care facilities, and offer an overview of methods and measures used to provide high-quality, culturally-infused, and age-informed care to older adults.
“Behind Closed Doors with open minds?”: A qualitative study exploring nursing home staff's narratives towards their roles and duties within the context of sexuality in dementia
2017, International Journal of Nursing Studies
Citation Excerpt :
Sexuality is viewed as a core need and a right throughout the life span of an individual that takes into account their gender roles, identities, sexual orientation, activity, pleasure, eroticism and feelings of intimacy (World Health Organisation, 2006). Although the right to be sexually ‘alive’ is recognised as a fundamental human need, sexuality in old age is often ignored, neglected and frequently misunderstood (Walker, 1997), with older people often viewed as asexual or incapable of being sexually active in society and its institutions (Hajjar and Kamel, 2003). In care home settings, there is variation in how the sexual needs of older people are perceived and managed and often limited discussions about their sexual needs and desires of older people take place (Mahieu and Gastmans, 2015).
Despite sexual expression being recognised as a fundamental human need, sexuality in old age is often ignored and frequently misunderstood, with residents with dementia in a nursing home often viewed as asexual or incapable of being sexually active.
The current study aims to understand the views held by nursing care home staff towards dementia and sexuality and explore the roles they may adopt whilst responding and managing sexual needs and expression for residents with dementia.
Face to face, in-depth, semi structured interviews were conducted with eight staff members working in two nursing homes in Greater London, United Kingdom. Data were analysed using Interpretative Phenomenological Analysis.
The findings suggest that representations of sexuality in dementia held by nursing home staff ranged from the perception that sexual expression in old age was part of human nature and a basic human right to others that proposed that with the loss of memory, people with dementia may also experience loss of interest in sexuality and intimacy. Based on the representation of sexuality held (personhood versus biomedical model), nursing home staff adopted a role or a combination of roles (a facilitator, an informant, a distractor, an empathiser, a safeguarder) that legitimised past and anticipated responses in managing sexual expression in the nursing home setting. Nursing home staff’s responses varied depending on the severity of the condition, level of involvement of the resident’s family and their own personal views on their duty of care, old age, sexuality and dementia.
The simplified binary labelling and classification of sexual behaviour in dementia as appropriate or inappropriate often applied in institutional settings, fails to account for complex factors that may influence staff’s decisions on the ethical dilemmas raised by dementia. A role based continuum approach could help staff move away from rigid binary judgments and train them to adopt formal carer roles that promote a more contextualised rights based approach in the provision of dementia care.
Older widows’ perspectives on sexuality: A life course perspective
2017, Journal of Aging Studies
Sexuality is a significant component in human experience and has an important impact on the individual's general well-being. Life course events and the social construction of sexuality lead older widows to reflect upon their sexuality.
To explore and describe the ways in which older widows construct and perceive their sexuality along the life course.
A phenomenological-qualitative approach was conducted. Data collection was performed through in-depth, semi-structured interviews with 17 widows, between the ages of 62–91, followed by content analysis.
Three major themes emerged: (a) Approaching sexuality: Conservative vs. progressive attitudes; (b) Multiple ways of perceiving sexuality: Constructing a sexual identity along the life course; and (c) Sexual self-perception: Integrating late life and widowhood.
Sexuality among widows in later life includes continuity and change processes. In the context of social construction, sexuality is a subject that should be examined in greater depth.
Expressing sexuality in nursing homes. The experience of older women: A qualitative study
2016, Geriatric Nursing
In nursing homes, a number of barriers to the expression of sexuality exist, such as the lack of privacy, certain attitudes on behalf of the staff and the family, the lack of a sexual partner, and physical limitations. The aim of this study was to describe the lived experience of sexuality in elderly Spanish women residing in nursing homes. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2013 and 2015. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using thematic analysis. Twenty female residents participated. Three main themes emerged from the data: a) expressing sexuality, b) sexuality as a duty and c) respecting vows. Female residents reported key elements influencing how they manage their sexuality in Nursing Homes. These results serve to improve our understanding regarding the expression of sexuality in older female nursing home residents.
Could We Hold Hands? Older Lesbian and Gay Couples' Perceptions of Long-Term Care Homes and Home Care
2016, Canadian Journal on Aging
Granny and the sexbots: An ethical appraisal of the use of sexbots in residential care institutions for elderly people
2022, Social Robotics and the Good Life: The Normative Side of Forming Emotional Bonds With Robots

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ReviewSexuality in the Nursing Home, Part 1: Attitudes and Barriers to Sexual Expression

Section snippets

Nursing Home Residents’ Viewson Sexuality

Barriers to Sexual Expression in the Nursing Home

Conclusion

Clin Geriatr Med

Sexual behavior and attitudes of geriatric residents in long-term care facilities

J Sex Marital Ther

Sexuality in the nursing home patient

Am Fam Physician

Psychoeducational intervention for sexuality with the aged, family members of the aged, and people who work with the aged

Int J Aging Hum Dev

Sexual interest, activity, and satisfaction among male nursing home residents

Arch Sex Behav

Sexual expression of the elderly in nursing homes

Gerontologist

The importance of intimacy to men living in a nursing home

Arch Sex Behav

The Starr-Weiner Report on Sex and Sexuality in the Mature Years

Sexuality in nursing homes

J Am Geriatr Soc

Sexual interest, attitudes, knowledge, and sexual history in relation to sexual behavior in the institutionalized aged

Arch Sex Behav

Old Age Deferred: The Causes of Old Age and its Postponement by Hygienic and Therapeutic Measures

Their only privacy is between their sheets. Privacy and the sexuality of elderly nursing home residents

J Gerontol Nurs

The medical model and its effect on autonomy: A comparison of two long-term care settings

Review
Sexuality in the Nursing Home, Part 1: Attitudes and Barriers to Sexual Expression