Intimacy and Sexuality in Aged Care

Closeness and intimacy are basic aspects of the human experience.

Connection and the need for human contact matter. Not only do they make life worth living, these ties also act as a protection against things like depression and anxiety, and offer us security, support, and connectedness, across the lifespan (Beyond Blue 2019).

With age, however, comes many significant changes to our lifestyle, such as the loss of a spouse or loved ones, physical decline and mobility issues, therefore maintaining social connections can become more difficult over time.

Thankfully loneliness and social isolation are not an inevitable part of ageing (Miley 2019), and with the right support, new and existing friendships and intimate relationships can flourish.

Supporting a resident’s choices to make connections with others and maintain relationships, including intimate relationships, is directly tied to Standard 1 of the Aged Care Quality Standards: Consumer Dignity and Choice.

This article will offer guidance on how you can best support the intimacy and sexuality of the residents and clients in your care.

Intimacy and Sexuality

• Intimacy: the relationship between two individuals and how they connect (gentle touch, intellectual and emotional closeness, romance, intercourse, etc.)
• Sexuality: how an individual experiences and expresses themselves as a sexual being (their biological sex, gender identity, sexual behaviours, orientation, sexual activity, etc.)

(Clark 2018; PalliAged 2019)

On admission to residential aged care, new residents undergo a lengthy period of needs assessments. One need that is often overlooked is the client’s sexuality (Suter 2016).

A common misperception is that older people are asexual; that they lack sexual appeal, sexual drive or desire (PalliAged 2019). In reality, sexuality and intimacy remain important to adults over the age of 65 and these can still provide physical and psychological benefits (PalliAged 2019).

It’s important to note that every person’s sexuality and intimacy is different, and support should be individualised to reflect this (Clark 2018). Some ways in which residents may express intimacy and sexuality include:

• Daydreaming or reminiscing;
• Reading romance/erotic literature;
• Dressing up;
• Witty, flirtatious remarks or compliments;
• Hand holding, hugging;
• Touching, stroking and caressing;
• Kissing;
• Fascination;
• Masturbation;
• Intercourse;
• Oral sex;
• Using sexual materials and services.

(PalliAged 2019; Bauer, McAuliffe & Nay 2014a)

Sexuality Assessment Tool (SexAT)

A recent study by McAuiliffe et al. (2018) found most residential aged care staff do not have access to policies on sexuality or sexual health to guide their practice and that resident intimacy and sexual health needs are at risk of being ignored.

The Sexuality Assessment Tool (SexAT) has been developed, as an Australian Government Initiative, to help aged care facilities support the expression of their residents, by identifying areas where further improvements may be needed to improve the wellbeing of its residents (Bauer et al. 2013).

The SexAT guides practice to support the normalisation of sexuality in aged care homes and assists facilities to identify where enhancements to the environment, policies, procedures and practices, information and education/training are required. The tool also enables facilities to monitor initiatives over time, for further improvement (Bauer et al. 2014b).

The areas of care assessed by the SexAT are:

1. Facility policies;
2. Determining the needs of the older person;
3. Staff education and training;
4. Information and support for older people;
5. Information and support for families;
6. The physical environment;
7. Safety and risk management.

For more information, access the Sexuality Assessment Tool, available at: .../Sexuality-Assessment-Tool-for-residential-aged-care-facilities.pdf.

Residents with Dementia

Dementia can affect how people think, behave and communicate. People living with dementia may still have feelings of intimacy and sexuality, and how they express this will vary across a wide spectrum, from normal, to ‘problem’ sexual behaviour. It is important to be aware of this unpredictable nature and to note that it may be different across individuals (PalliAged 2019).

For more information on sexuality and dementia, visit dementia.org.au.

Consent and Sexual Abuse

Consideration should be given to issues of consent and sexual abuse in residential aged care, for the protection of residents, but also staff members, too.

You must be aware that the Aged Care Act 1997 has mandatory reporting provisions for unlawful sexual contact (i.e. non-consensual sexual activity involving residents in aged care facilities). If you witness any unlawful sexual contact, you have a duty to report it.

When a report is made, the capacity of the resident to consent to sexual activity may be considered, and will be based on an assessment by a health professional on a case-by-case basis (PalliAged 2019).

Non-judgmental Care

It’s reported that older adults are particularly conscious of the societal expectations and norms around sexual activity, which has made the subject somewhat of a taboo between residents, family, and their carers (PalliAged 2010; Bauer & Fetherstonhaugh 2016). Be aware that if needs such as sexual health are not raised by a health professional with a resident, they may go unmet.

Education and further support, such as the adoption of the SexAT, and policies around inclusive language should be offered by your organisation to empower staff to make a safer environment for their residents’ needs (Clark 2018).

Remember that all care should be non-judgmental. It is important that the values and beliefs of the care staff do not interfere with the rights of people in your care to express their sexuality when it does not harm others.

Some practical ways for care staff to support the sexuality of a resident:

• Ask questions;
• Review your policy around intimacy and sexuality (consider utilising the SexAT);
• Provide non-judgmental care;
• Help to personalise each resident’s dressing and grooming;
• Offer privacy when appropriate (e.g. use of ‘do not disturb’ signs, always knock before entering a resident’s room);
• Refer residents to the right resources (e.g. sexual health educational material, relevant health professionals);
• Communicate with residents’ families;
• If possible, organise for a double bed, connecting adjoining rooms;
• Use LGBTI-inclusive language.

(Bauer & Fetherstonhaugh 2016; Bauer et al. 2014a)

Additional Resources

• Aged Care Quality Standards: https://www.agedcarequality.gov.au/providers/standards.
• Sexuality Assessment Tool (SexAT): https://.../Sexuality-Assessment-Tool-for-residential-aged-care-facilities.pdf.
• Aged Care Awareness ‘Resident’s Rights and Intimacy’ Module: http://agedcareawareness.com.au/introduction-to-module-2/.

References

• Aged Care Awareness 2019, Module Two: Resident’s Rights and Intimacy, ACA, viewed 3 September 2019, http://agedcareawareness.com.au/introduction-to-module-2/.
• Bauer, M, Fetherstonhaugh, D, Nay, R, Tarzia, L & Beattie, E 2013, Sexuality Assessment Tool (SexAT) for residential aged care facilities, La Trobe University, viewed 3 September 2019, https://w6p3u3w8.stackpathcdn.com/wp-content/uploads/2015/11/Sexuality-Assessment-Tool-for-residential-aged-care-facilities.pdf.
• Bauer, M, McAuliffe, M & Nay, R 2014, Sexual expression in residential aged care - A person-centred approach, La Trobe University, viewed 3 September 2019, http://www.ifa-fiv.org/wp-content/uploads/2014/01/Sexual-Expression-–-A-Person-Centered-Approach-2.pdf.
• Bauer, M, Fetherstonhaugh, D, Tarzia, L, Nay, R & Beattie, E 2014, ‘Supporting residents’ expression of sexuality: the initial construction of a sexuality assessment tool for resdidential aged care facilities’, BMC Geriatrics, vol. 14, p. 82, viewed 3 September 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4.
• Bauer, M & Fetherstonhaugh, D 2016, Sexuality and people in residential aged care facilities: A guide for partners and families, La Trobe University, viewed 3 September 2019, http://dementiakt.com.au/wp-content/uploads/2016/08/SexualityConsumerGuide.pdf.
• Beyond Blue 2019, Connections matter, Beyond Blue, viewed 3 September 2019, https://www.beyondblue.org.au/who-does-it-affect/older-people/connections-matter.
• Clark T 2018, ‘Tracy Clark, Montefiore’, AgedCareInsite podcast, viewed 3 September 2019, https://www.agedcareinsite.com.au/2018/07/how-to-talk-with-aged-care-residents-about-sexuality-and-intimacy/.
• Dementia Australia 2016, Intimacy and Sexual Issues, Dementia Australia, viewed 3 September 2019, https://www.dementia.org.au/files/helpsheets/Helpsheet-CaringForSomeone19-IntimacyAndSexualIssues_english.pdf.
• McAuliffe, L, Fetherstonhaugh, D & Bauer, M 2018, ‘Sexuality and sexual health: Policy in Australian residential aged care.’, Australasian Journal on Ageing, viewed 3 September 2019, https://www.ncbi.nlm.nih.gov/pubmed/30516308.
• Miley, A 2019, ‘Maintaining social connections as we age’, the Other Paper, 4 April, viewed 3 September 2019, https://www.otherpapersbvt.com/opinion/opinion_columns/maintaining-social-connections-as-we-age/article_a773e36a-5641-11e9-98d9-67b3d66f5fb8.html.
• PalliAged 2019, Intimacy and Sexuality - Synthesis, Palliative Care Aged Care Evidence, viewed 3 September 2019, https://www.palliaged.com.au/tabid/5736/Default.aspx.
• Suter, C. 2016, 'Aged Care Sexuality', Ausmed, 3 August, viewed 3 September 2019, https://www.ausmed.com/cpd/articles/aged-care-sexuality.
• Waddington-Feather, A 2017, ‘It’s not just about sex’, Aged Care Guide, viewed 3 September 2019, https://www.agedcareguide.com.au/talking-aged-care/its-not-just-about-sex.