Chapter 22: Sexuality

Learning Objectives Discuss the sexual development of older adults and changes in the sexual response due to aging and chronic illness. Identify strategies to overcome vaginal dryness and erectile dysfunction. Implement appropriate policies that promote intimacy in community and long-term care settings. List strategies to extinguish sexually inappropriate behavior.

Enhancing Sexual Intimacy Sexuality is seen as separate from healthcare concerns Nurses tend to ignore patient’s concerns about sexuality because sexuality is not seen as a priority for elders. Anxiety and fear of embarrassment prevent both patients and nurses from bringing up sexual concerns Most health promotion strategies have the potential to make a positive impact on sexual relationships and sexual function

Enhancing Sexual Intimacy Sexuality and quality of life 2004 AARP study showed sexuality was an essential part of life to those age 45+ Robinson and Molzahn (2007) found that satisfaction with personal relationships, health status, and sexual activity strongly contributed to quality of life in older adults, regardless of gender, marital status, and education

Enhancing Sexual Intimacy Romantic Relationships in the Elderly Some people have been in the same romantic relationship for over 50 years Some people begin their first romantic relationship after retiring Loss of one’s romantic partner is common but sexual loss is overlooked (Box 22-1, p. 795)

Enhancing Sexual Intimacy Sexual Development in Older Adults Adults continue to develop sexually throughout their lives Chronic illness can affect sexual function Those now age 65+ were raised not to talk about sex, but they have lived through many sexual revolutions (women gained the right to vote, sexual freedom, using birth control, legalization of abortion, men use of condoms, viagra…)

Enhancing Sexual Intimacy Triphasic Human Sexual Response and Changes with Aging Desire Excitement Orgasm Changes in sexual response has been considered normal consequence of aging, which different couples adapt to differently

Enhancing Sexual Intimacy Vaginal Dryness and Erectile Dysfunction (ED) Therapeutic management for both conditions includes stopping smoking, only moderate alcohol intake, exercise, reducing obesity Erectile dysfunction was the most common problem among men (37%) Vaginal dryness was one of common problem among women (39%) Vaginal dryness can be treated with lubricants or cream form of estrogen.

Enhancing Sexual Intimacy Promoting Sexual Function in Community-Dwelling Elders Overcoming fatigue and pain Plan activities for most energetic time of day (morning) Endorphins released during sex may ease chronic pain Adopting new positions and learning new techniques for lovemaking

Enhancing Sexual Intimacy Promoting Romantic and Sexual Relationships in Long-Term Care Facilities Barriers to intimacy in long-term care facilities Lack of privacy and door locks Lack of queen-size beds and room for couples Staff are uncomfortable with residents having sex lives - stigma Caring for the Ages (AMDA) provides guidelines for sex in long-term care facilities

Enhancing Sexual Intimacy Extinguishing Sexually Inappropriate Behavior (sexual harassment) Cognitive impairment Goal is to stop the behavior while maintaining the dignity of the patient Inappropriate language Inappropriate touching of others Masturbation in public Displaying sexually explicit materials

Extinguishing sexually inappropriate behavior Redirect Do not tolerate Educate Consider disease processes such as dementia Use nurse managers Provide privacy as needed Do not keep quiet and be sure to inform others - Confront behavior calmly and firmly

Summary There are many topics related to sexuality and intimacy among older adults The goal is to promote intimacy when appropriate by assisting older adults to overcome the effects of age and chronic illness