DISC 3

Chapter_012.pptx

Chapter 12

Sexuality and Aging

Sexuality is an important part of health, general well-being, and quality of life.

Sexuality includes various types of intimate activity, as well as the sexual knowledge, beliefs, attitudes, and values of individuals.

Nurses play a key role in the assessment of changes related to aging, disabling medical conditions and drugs, and can intervene at an early point to enhance sexuality.

Older Adults’ Sexual Needs

“Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction … is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships …. Sexuality is influenced by the interaction of biologic, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors”

The World Health Organization’s View on Sexuality

Despite evidence supporting not only the need for, but the importance of, sexual expression in older adults, health care professionals carry out few interventions to facilitate expressions of sexuality.

Benefits of sexual expression include increased happiness, energy, and relaxation, decreased pain, improved cardiovascular health, decreased depressive symptoms, increased self-esteem, and improved satisfaction with relationships.

Sexual Expression

Society regards sexuality in older adults as undignified.

Nurses often share society’s ageist beliefs about the asexuality of older adults, which may lead to nurses discouraging sexual activity.

Older adults may face difficulties with sexual expression.

Because of discomfort, myths, ageism, and lack of training in sexual health, problems with newly developed or chronic sexual dysfunction are ignored.

Barriers to Sexual Expression

The orgasm response changes in both sexes.

Reduced availability of sex hormones results in less rapid and less extreme vascular responses to sexual arousal.

Erectile dysfunction

Sexual dysfunction in older women encompasses loss of sexual desire, problems with arousal, inability to achieve orgasm, and painful intercourse.

Normal Changes of the Aging Sexual Response

Changes in the genitourinary tract related to menopause

Genital symptoms include: dryness, burning, and irritation

Sexual symptoms include: decreased lubrication, thinning of the vaginal wall, decreased elasticity and vaginal rugae, leading to pain, and bleeding during intercourse

Urinary symptoms include: urgency, dysuria, and recurrent urinary tract infections

Genitourinary Syndrome of Menopause

Illness, surgery, and medication

Human immunodeficiency virus—45% of age 55 years and older account for adults with HIV; are likely to be diagnosed late in disease, experience progression more quickly, and die sooner after diagnosis than younger adults

Malignancies—breast, prostate, colon cancer

Dementia—changes in cognition and judgment occur, can cause either a decrease in sexuality, or sexual disinhibition

Conditions Affecting Sexual Responses

These adults long for physical closeness and seek out physical touch but their intentions may be misinterpreted as sexual in nature

May express sexually disinhibited behaviors, which include sexually explicit or suggestive language, exhibitionism, repeated attempts to have sex or aggressive sexual demands

Nonpharmacological interventions should be used to diffuse the situation

Pharmacological interventions may become necessary when the behaviors become harmful or detrimental to safe care.

Dementia

Sexual dysfunction may signal other psychosocial disorders such as depression, delirium, and dementia.

Substance abuse including smoking, alcohol, and illicit or recreational drug use, is often associated with sexual dysfunction

Health care professionals working with cognitively impaired older adults need to determine whether the individual is consenting to a sexual activity.

Environmental and Psychosocial Barriers to Sexual Practice

LGBT face many health disparities, including victimization, psychological distress, disability, discrimination, and lack of access to appropriate health services.

Despite stereotypes, it is important for nurses to recognize that LGBT as acceptable expressions of sexuality for both men and women.

LGBT may be hiding their sexual preference and gender identity from family so no information about the sexual orientation should be shared with a patient’s family unless permission has been given.

Lesbian, Gay, Bisexual, and Transgender

Obtain sexual history

Assessment—PLISSIT

Review medications and medical conditions that may contribute to sexual dysfunction.

Physical assessment of the genitalia

Laboratory tests—check hormone levels

Obtain information on sexual preferences

Can you give five Nursing Diagnoses for sexual health?

Sexual Health Nursing Management: Assessment and Diagnosis

203656 (BB) - Please note that in other chapters, for question "Can you name ... nursing diagnose ...", the answer has been listed in the notes part. Please provide the same in this slide.

Permission

Limited information

Specific suggestions

Intensive therapy

PLISSIT

May hinder a patients’ decision making abilities

Meet with both patients to discuss their intentions and expectations regarding the sexual relationship—may reveal whether one patient is being coerced into the relationship or is not mentally competent to decide to enter such a relationship

Perform a cognitive assessment—Montreal Cognitive Assessment.

Cognitive Impairment

The patient will:

Attain a satisfactory level of sexual activity as evidenced by resumption of sexual activity at a level acceptable to the patient.

Verbalizes their sexual concerns and discusses them with their significant other.

Explore various sexual activities and practices to attain sexual satisfaction.

Verbalize their feelings about sexual performance.

Sexual Health Nursing Management: Planning and Expected Outcomes

Provide information, education, and direction to assist patients in creating and sustaining intimate relationships.

Offer teaching and reassurance that some changes are a normal part of aging.

Teach alternative methods of intimacy in the form of touch.

Encourage low-risk behaviors.

Manage difficult behaviors of cognitively impaired patients.

Sexual Health Nursing Management: Interventions

Make proper arrangements for privacy during older adults’ sexual experiences.

Provide room with a pleasant environment, which may be reserved by older adults for private visits with a spouse or partner.

Patient safety should be maintained, call lights easily accessible; side rails on the bed used if necessary; room should be situated so that the nursing staff is aware of when it is in use.

Provide staff education about the sexuality and intimacy of older adults.

Interventions in Acute and Long-term Care Facilities

Based on patient achievement of the established expected outcomes

Older adults may attain a satisfying level of sexual activity that is compatible with functional capacity.

When sexual functioning cannot be restored, alternatives should be explored.

Proper documentation is important to communicate the interventions and progress toward meeting the expected outcomes.

Sexual Health Nursing Management: Evaluation

The nurse is working in a skilled nursing facility. An older married couple are patients at the facility. The nurse enters the female patient’s room and sees the male patient making sexual advances toward his wife. The nurse’s best action would be which of the following?

A. Close the door to allow them privacy, and place a do-not-enter sign on the door.

B. Suggest he go back to his room until visiting hours are over and the other patients are sleeping.

C. Inform the couple that this behavior is not allowed and is offensive to the staff.

D. Ask the female patient if she is comfortable with the situation; leave the room if she says yes.

Quick Quiz!

ANS: D

Answer to Quick Quiz