Tuesday, 24 May 2016

Recommendations for sexual expression management in long-term care

Maggie L. Syme, PhD, MPH
Peter Lichtenberg, PhD, ABPP
Jennifer Moye, PhD

Syme M.L., Lichtenberg P. & Moye J. (2016) Recommendations for sexual expression management in long-term care: a qualitative needs assessment. Journal of Advanced Nursing. DOI: 10.1111/jan.13005

Intimacy and sexual expression in later life is consistently reported as important to older adults. Also, we continue to engage in intimate and sexual activities across the lifespan, and it continues to provide physical, psychological, and social benefits, regardless of how old you are, where you live, or if you have physical and/or cognitive limitations (DeLamater 2012, Doll 2013, Nay 1992, Syme et al. 2015). Unfortunately, the privileged, and often limited, way in which Western values have framed sexuality has many individuals, healthcare providers, and older adults themselves believing that sexual activity is not for the aged (Bouman et al. 2006, Hinchliff & Gott 2011, Hillman 2012).

Nowhere is this a bigger reality than in nursing home settings. Sex is even more taboo for older adults living in long-term care (LTC) with dementia, and the sexual rights of elderly LTC residents are often unacknowledged (Roach 2004, Frankowski & Clark 2009). This is partially due to difficulties reported in managing sexual expression among LTC residents (Elias & Ryan 2011, Lester et al. 2015). Sexual expression management among long-term care residents is a complex issue for nursing home staff, and there is little to no guidance available for many wanting to follow a person-centered approach. Policies and procedures are needed, and must be usable across long-term care settings.

Balancing challenges of supporting sexual and intimate expression with residents’ rights and autonomy is an ongoing struggle for homes. The purpose of this study is to explore both the challenges LTC facilities face in addressing sexual expression and consent and their subsequent recommendations for improving care.

A qualitative design was followed, with semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013. Interview questions prompted them to identify recommendations that address their key challenges to improving sexual expression management within long-term care settings.

Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories.

Directors of Nursing report several challenges to sexual expression management within their facilities, and perceive their current methods to be ad hoc versus proactive. They report that residents’ sexual rights should be seen as important, and recommend that more training and tools be provided from the top (e.g., national organization such as Centers for Medicare and Medicaid in the US) down to the local homes.


Bouman W.P., Arcelus J. & Benbow S.M. (2006) Nottingham Study of Sexuality & Aging (NoSSA I). Attitudes regarding sexuality and older people: a review of the literature. Sexual and Relationship Therapy 21(2), 149–161. DOI:10.1080/14681990600618879

DeLamater J. (2012) Sexual expression in later life: a review and synthesis. Journal of Sex Research 49(2–3), 125–141. doi:10.1080/00224499.2011.603168.

Doll G.M. (2013) Sexuality in nursing homes: practice and policy. Journal of Gerontological Nursing 39(7), 30–37. doi:10.3928/00989134-20130418-01.

Elias J. & Ryan A. (2011) A review and commentary on the factors that influence expressions of sexuality by older people in care homes. Journal of Clinical Nursing 20, 1668–1676. DOI: 10.1111/j.1365-2702.2010.03409.x

Frankowski A.C. & Clark L.J. (2009) Sexuality and intimacy in assisted living: residents' perspectives and experiences. Sexuality Research and Social Policy 6(4), 25–37. DOI: 10.1525/srsp.2009.6.4.25

Hillman J. (2012) Sexuality and Aging: Clinical Perspectives. Springer, New York, NY.
Hinchliff S. & Gott M. (2011) Seeking medical help for sexual concerns in mid- and later life: a review of the literature. Journal of Sex Research 48(2–3), 106–117. doi:10.1080/00224499.2010.548610.

Lester P.E., Kohen I., Stefanacci R.G. & Feuerman M. (2015) Sex in nursing homes: a survey of nursing home policies governing resident sexual activity. Journal of the American Medical Directors Association 000, 1–4. doi:10.1016/j.jamda.2015.08.013.

Nay R. (1992) Sexuality and aged women in nursing homes. Geriatric Nursing 13(6), 312–314.

Roach S. (2004) Sexual behavior of nursing home residents: staff perceptions and responses. Journal of Advanced Nursing 48(4),371–379. DOI: 10.1111/j.1365-2648.2004.03206.x

Syme M.L., Cordes C.C., Cameron R.P. & Mona L.R. (2015) Sexual health and well-being in the context of aging. In: APA Handbook of Clinical Geropsychology (Lichtenberg P.A. & Carpenter B., eds), American Psychological Association, Washington, DC, pp.395–412.

No comments:

Post a Comment