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Addressing sexual needs_in_residential_care[1]

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  • 1. Addressing Sexual Needs in Residential Care Who says you’re too old for sex?
  • 2. Topics
    • Sexuality and quality of life
    • Sex and ageing
    • Intimacy, sexuality and sexual behavior in dementia
    • Attitudes and Issues of Concern
    • Appropriate residential settings
  • 3. Sex
    • Sex in not only a biological drive for pleasure and reproduction, it is also a powerful way for human beings to relate to one another and express intimacy
    • Sexual expression is a resident right which must be observed and preserved to the extent possible
  • 4. Sexually-orientated expression is defined as
    • Words, gestures, movements and activities (including reaching, pursuing, touching or reading) which appear motivated by the desire for sexual gratification ’ Porter and Homes
  • 5. Sexuality and quality of life
    • Positive approach to sexual expression can:
    • Provide tension release
    • Abate loneliness
    • Give a sense of belonging
    • Lead to positive relationships
    • Be mutually pleasurable
    • Enhance self esteem
    • Maintain overall fitness
    • Restored energy
    • Exercise of muscle groups
    • Lead to emotional healing
    • Decrease depression
    • And enhance quality of life
  • 6. Sexuality and quality of life
    • Negative perceptions of sexuality and older people can:
    • Provoke ageist sentiments
    • Provoke guilt
    • Constitute inappropriate behaviour and an impulse control problem
    • Create social stigma
    • Contribute to peer discomfort
    • Lead to emotional and physical harm
    • Potentiate family upset
    • Involve unpredictable behaviour
    • Create jealousy
    • Lead to victimisation of more impaired partner
    • Lead to discomfort
    • Be offensive to staff, coercive to residents
    • Behaviours expressed in public without regard to others
  • 7. Sex and ageing
    • Older people
    • Are capable of having sex
    • Can be interested in sex
    • Are aware of what is happening in their environment (even with cognitive impairment)
    • Long for relationships, and mourn the loss of previous relationships
    • Can enjoy singing, dancing and learning new things, as well as meeting new people
    • Will express sexuality in words, expressions or actions
  • 8. Physiological Changes
    • Numerous endocrine, vascular, and neurological disorders may interfere in sexual function, as may many forms of medication and surgery
    • Physiological changes such as erectile disfunction, reduced lubrication and decreased size of genitalia need not have any functional impact on the subjective enjoyment of a sexual encounter
  • 9. Intimacy, sexuality and sexual behavior in dementia
    • Cognitive deterioration may affect sexual behaviour, producing problems such as disinhibition or relationship difficulties with subsequent effects on the relationship
    • Some people continue to desire sexual contact while others lose interest
    • It is important to remember that any change is part of the illness and not directed in a personal way. The person may no longer know what to do with the sexual desire, or when or where to exercise the desire
  • 10. Attitudes and Issues of Concern
    • Expressions of sexuality are considered to be among the most disturbing behaviours (particularly masturbation) in residential care
    • In some instances staff simply deny the importance of sexual expression
    • Relatively little attention is given to ensure residents rights to freedom of expression of sexuality is observed and preserved
    • Homophobia and heterosexist attitudes and discrimination particularly towards gay, lesbian, bisexual, transgender and intersex people
    • Health Issues: STDs, emotional and physical safety
  • 11. Appropriate Residential Settings
    • Create an inclusive environment by:
    • Having a pre -entry assessment that includes questions around sexual preferences
    • A residential design that includes private areas for residents to meet
    • Having policies that describe the rights regarding sexual expression and physical expression
    • Regular staff training that addresses responding to sexuality amongst older people and include non-heterosexual sexuality (and education regarding the negative effects of homophobia and heterosexism )
  • 12. Skills to manage sexual expression
    • Do
    • Use effective communication
    • Make eye contact
    • Show respect & compassion
    • Use a warm, nurturing tone
    • Support what the resident can do – don’t emphasize what s/he cannot do
    • Stay calm and upbeat
    • Show kindness and patience
    • Move slowly and gently so the resident isn’t startled or agitated
    • Help the resident to maintain dignity
    • Redirect activity eg to a private area
    • Praise good behaviours
    • Set clear limits
    • Be consistent
    • Don’t
    • Over react and become aggravated
    • Demean/humiliate the resident
    • Shame the resident
  • 13. Responding to issues– eg. non consenting or inappropriate behaviour eg: masturbating in the lounge room
    • Tips on the identification of potential problems
    • Be observant
    • Get as much information about the situation as you can before it becomes a problem
    • Always consider the when, where, who what and how in any given situation
    • Think about the problem before it occurs
    • Watch the time frame of certain behaviours, eg same time each day,
    • Look for changes over time
    • Look for repeating patterns
  • 14. The ABC is one way of responding
    • A = Antecedent: The trigger for the behaviour. What happened before the emergence of the behaviour
    • B = Behaviour: The actual behaviour such as crying ,screaming, and or touching someone, which one is trying to extinguish
    • C = Consequence: the results, which happen after the behaviour
  • 15. Summary
    • Each issue requires a different intervention based on the people involved – never avoid intervening
    • Ensure the organisation’s policy and procedure is maintained and implemented
    • Remember: sex is not in and of itself wrong. It is only a problem if it is abusive, without consent, and/or if it disturbs others