Sexuality and Intimacy In Aging and at the End-of-Life Objectives 1. Define sexuality and intimacy 2. Why it is important 3. Obstacles 4. How to support expressions of sexuality and intimacy 5. How to talk with patient/families

What is the definition of Sexuality? The World Health Organization has an excellent definition: “a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction” Sex is something we do, sexuality is something we are!

What Is the definition of Intimacy? The Oxford English Dictionary defines it as: “close familiarity or friendship, closeness. A private cozy atmosphere, an intimate act, especially sexual intercourse. A study of palliative care patients revealed their definition as: “emotional closeness, physical expressions. Often activities other than intercourse.

Sexuality and Intimacy are essential for Quality of Life Intimate, loving relationship are critical components of the quality of life for all people. Sexuality is an important aspect of holistic care and psychosocial functioning. National Quality Forum (NQF) has established guidelines to be used at the end of life in hospice and palliative care: “a social assessment plan should address sexuality/intimacy, an area frequently overlooked in social planning.”

What do people think about Sex and Aging What do people think about Sex and Aging? Not interested in being sexually active Not capable of having sex Elderly sex is dysfunctional Impossible for those with cognitive loss Not necessary to discuss as there is no danger of STDs/HIV Vaginal intercourse is the only “real sex”

Another Misconception Vaginal intercourse is the only “real sex” Hands and mouth are reliable, penises and vaginas are not.

HERE ARE THE FACTS 73% of Americans age 57-64 reported being sexually active. 53% aged 65-75 reported being sexually active 25% aged 76-85 reported being sexually active People with good health 2x as likely to be sexually active. New England Journal of Medicine

So What Is the Situation at the End-of-life? It is really the “double-barreled Taboo” People don’t want to talk about sex or dying. There is a great discomfort in our culture with the issues of mortality and sexually.

Patients Want To Have The Conversation Many patients with a life threatening illness want to discuss issues related to intimacy, sexuality and their disease

Research at the U of Maryland found 96% of patients reported that they had not been asked about intimacy concerns before a Palliative Care consultation. 6% of PC patients reported that illness had either significantly or moderately impacted intimacy. A majority t the end-of-life indicated that illness had significantly or moderately impacted their intimacy. All reported the research conversation was helpful and wanted to discuss the issues with healthcare providers

Assessing an individual about the possibilities of their sexual health could implement harmony and excitement instead of pain throughout the end of their life. “Being treated as an asexual being because of age or illness by healthcare providers can be a powerful experience for someone whose sexuality is already traumatized and vulnerable.” MacElveen McCorkle

Sexual sensations are among the last of the pleasure-seeking biological processes to deteriorate and may provide an enduring source of gratification when few pleasures remain.

So, Who Is Responsible for Doing Something About the Situation? YOU ARE! Among hospice psychosocial assessments: 2/3 of assessments did no include items exploring issues related to intimacy/sexuality. Issues of intimacy were included in 31%, sexuality in only 9%.

A Few More Facts Sexuality/intimacy should be routinely assessed. Social Workers are best to initiate the topic. Be nonjudgmental; explore personal bias/values Work within the family’s value system, start where they are. Frame worries about sexual issues as normal, legitimate health concerns. Provide education Use clear, nontechnical language and avoid medical jargon. Address myths and misconceptions (i.e. fears that cancer is contagious.

The PLISSIT MODEL This model was developed in England by the Psychologist, Jack Annon in 1976 and has been used very effectively for over 40 years. It will be discussed in the break out sessions.

Melanie G. Ramey 3240 University Avenue, Suite 2 Madison, Wi 53705 608-235-5349 or 608-467-2044 www.melanieramey.com