Sexuality and intimacy are important aspects of quality of life for older adults and nursing home residents. While physiological changes may occur, residents are still capable of enjoying sexual activity and intimacy. Staff should receive training to address residents' sexual needs and preferences respectfully. Issues like inappropriate public behavior or non-consensual activity require intervention, but the focus should be on supporting residents' dignity and rights to intimacy within appropriate boundaries.

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