Addressing sexual needs_in_residential_care[1]


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Addressing sexual needs_in_residential_care[1]

  1. 1. Addressing Sexual Needs in Residential Care Who says you’re too old for sex?
  2. 2. Topics <ul><li>Sexuality and quality of life </li></ul><ul><li>Sex and ageing </li></ul><ul><li>Intimacy, sexuality and sexual behavior in dementia </li></ul><ul><li>Attitudes and Issues of Concern </li></ul><ul><li>Appropriate residential settings </li></ul>
  3. 3. Sex <ul><li>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 </li></ul><ul><li>Sexual expression is a resident right which must be observed and preserved to the extent possible </li></ul>
  4. 4. Sexually-orientated expression is defined as <ul><li>Words, gestures, movements and activities (including reaching, pursuing, touching or reading) which appear motivated by the desire for sexual gratification ’ Porter and Homes </li></ul>
  5. 5. Sexuality and quality of life <ul><li>Positive approach to sexual expression can: </li></ul><ul><li>Provide tension release </li></ul><ul><li>Abate loneliness </li></ul><ul><li>Give a sense of belonging </li></ul><ul><li>Lead to positive relationships </li></ul><ul><li>Be mutually pleasurable </li></ul><ul><li>Enhance self esteem </li></ul><ul><li>Maintain overall fitness </li></ul><ul><li>Restored energy </li></ul><ul><li>Exercise of muscle groups </li></ul><ul><li>Lead to emotional healing </li></ul><ul><li>Decrease depression </li></ul><ul><li>And enhance quality of life </li></ul>
  6. 6. Sexuality and quality of life <ul><li>Negative perceptions of sexuality and older people can: </li></ul><ul><li>Provoke ageist sentiments </li></ul><ul><li>Provoke guilt </li></ul><ul><li>Constitute inappropriate behaviour and an impulse control problem </li></ul><ul><li>Create social stigma </li></ul><ul><li>Contribute to peer discomfort </li></ul><ul><li>Lead to emotional and physical harm </li></ul><ul><li>Potentiate family upset </li></ul><ul><li>Involve unpredictable behaviour </li></ul><ul><li>Create jealousy </li></ul><ul><li>Lead to victimisation of more impaired partner </li></ul><ul><li>Lead to discomfort </li></ul><ul><li>Be offensive to staff, coercive to residents </li></ul><ul><li>Behaviours expressed in public without regard to others </li></ul>
  7. 7. Sex and ageing <ul><li>Older people </li></ul><ul><li>Are capable of having sex </li></ul><ul><li>Can be interested in sex </li></ul><ul><li>Are aware of what is happening in their environment (even with cognitive impairment) </li></ul><ul><li>Long for relationships, and mourn the loss of previous relationships </li></ul><ul><li>Can enjoy singing, dancing and learning new things, as well as meeting new people </li></ul><ul><li>Will express sexuality in words, expressions or actions </li></ul>
  8. 8. Physiological Changes <ul><li>Numerous endocrine, vascular, and neurological disorders may interfere in sexual function, as may many forms of medication and surgery </li></ul><ul><li>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 </li></ul>
  9. 9. Intimacy, sexuality and sexual behavior in dementia <ul><li>Cognitive deterioration may affect sexual behaviour, producing problems such as disinhibition or relationship difficulties with subsequent effects on the relationship </li></ul><ul><li>Some people continue to desire sexual contact while others lose interest </li></ul><ul><li>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 </li></ul>
  10. 10. Attitudes and Issues of Concern <ul><li>Expressions of sexuality are considered to be among the most disturbing behaviours (particularly masturbation) in residential care </li></ul><ul><li>In some instances staff simply deny the importance of sexual expression </li></ul><ul><li>Relatively little attention is given to ensure residents rights to freedom of expression of sexuality is observed and preserved </li></ul><ul><li>Homophobia and heterosexist attitudes and discrimination particularly towards gay, lesbian, bisexual, transgender and intersex people </li></ul><ul><li>Health Issues: STDs, emotional and physical safety </li></ul>
  11. 11. Appropriate Residential Settings <ul><li>Create an inclusive environment by: </li></ul><ul><li>Having a pre -entry assessment that includes questions around sexual preferences </li></ul><ul><li>A residential design that includes private areas for residents to meet </li></ul><ul><li>Having policies that describe the rights regarding sexual expression and physical expression </li></ul><ul><li>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 ) </li></ul>
  12. 12. Skills to manage sexual expression <ul><li>Do </li></ul><ul><li>Use effective communication </li></ul><ul><li>Make eye contact </li></ul><ul><li>Show respect & compassion </li></ul><ul><li>Use a warm, nurturing tone </li></ul><ul><li>Support what the resident can do – don’t emphasize what s/he cannot do </li></ul><ul><li>Stay calm and upbeat </li></ul><ul><li>Show kindness and patience </li></ul><ul><li>Move slowly and gently so the resident isn’t startled or agitated </li></ul><ul><li>Help the resident to maintain dignity </li></ul><ul><li>Redirect activity eg to a private area </li></ul><ul><li>Praise good behaviours </li></ul><ul><li>Set clear limits </li></ul><ul><li>Be consistent </li></ul><ul><li>Don’t </li></ul><ul><li>Over react and become aggravated </li></ul><ul><li>Demean/humiliate the resident </li></ul><ul><li>Shame the resident </li></ul>
  13. 13. Responding to issues– eg. non consenting or inappropriate behaviour eg: masturbating in the lounge room <ul><li>Tips on the identification of potential problems </li></ul><ul><li>Be observant </li></ul><ul><li>Get as much information about the situation as you can before it becomes a problem </li></ul><ul><li>Always consider the when, where, who what and how in any given situation </li></ul><ul><li>Think about the problem before it occurs </li></ul><ul><li>Watch the time frame of certain behaviours, eg same time each day, </li></ul><ul><li>Look for changes over time </li></ul><ul><li>Look for repeating patterns </li></ul>
  14. 14. The ABC is one way of responding <ul><li>A = Antecedent: The trigger for the behaviour. What happened before the emergence of the behaviour </li></ul><ul><li>B = Behaviour: The actual behaviour such as crying ,screaming, and or touching someone, which one is trying to extinguish </li></ul><ul><li>C = Consequence: the results, which happen after the behaviour </li></ul>
  15. 15. Summary <ul><li>Each issue requires a different intervention based on the people involved – never avoid intervening </li></ul><ul><li>Ensure the organisation’s policy and procedure is maintained and implemented </li></ul><ul><li>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 </li></ul>