1. Chapter 22: Sexuality

2. 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.

3. 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

4. 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

5. 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 (B0x 22-1, p. 795)

6. 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

7. 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

8. 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.

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

10. 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
Staff are uncomfortable with residents having sex lives
Caring for the Ages (AMDA) provides guidelines for sex in long-term care facilities

11. 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

12. Extinguishing sexually inappropriate behavior
Redirect
Do not tolerate
Educate
Consider disease processes such as dementia
Confront behavior
Use nurse managers
Provide privacy as needed

13. 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