This is a Practice Question published with the kind permission of the Royal College of Nursing.
In 2008 a letter was sent to 826 residential homes in one state in Australia asking them what information was available that addressed issues of intimacy and sexuality. Less that 20 per cent responded and of those 64 per cent said they had no information available on the topic (Bauer et al 2008).
Less that 20 per cent responded and of those 64 per cent said they had no information available on the topic (Bauer et al 2008).
If the study were to be replicated in the UK would the findings be any different? When people choose residential homes, do questions of intimacy and privacy arise? In hospital settings the promotion of single-gender accommodation has been an issue for a number of years, so would we find it strange if potential residents asked if they might share their rooms from time to time or have a spouse stay overnight?
Weeks (2002) explains that sexual satisfaction is a major contributor to quality of life, ranking at least as highly as spiritual and religious commitment. We often ask people about their religious and spiritual needs but not about their sexual needs.
The Nursing and Midwifery Council code of conduct states that we must treat people as individuals, not discriminate against those in our care and act as an advocate for them. We know that human rights article 8 is the right to respect for private and family life. We also know that the Care Quality Commission checks providers to ensure compliance with essential standards of quality and safety, which include the care and welfare of people who use services, and respecting and involving people so that they understand the care and treatment choices available to them.
We have many imperatives why we should be discussing this issue with residents, but searching a leading care home website using the terms ‘sexual relations’ and ‘intimacy’ produced no results.
Perhaps we only see our residents as people who we need to protect against abuse, and equate sexual activity as a potential form of abuse. Or perhaps our experiences are of residents displaying inappropriate sexual behaviour due to illness or dementia. Series and Degano (2005) suggest that inappropriate sexual behaviour is displayed by between 2 and 17 per cent of people with dementia. It could be that our experiences of trying to manage inappropriate sexual behaviour have made us forget that physical and sexual intimacy can be appropriate and rewarding. Perhaps we are also guilty of ageism.
Staff fears
Staff might argue that they feel ill prepared to discuss these issues with patients or family members. They may be worried that in discussing these sensitive topics they come across histories of abuse or harm. They might also be concerned that they do not have the time or skill to manage these issues; that the language they use may not be understandable to people from other generations or they may be embarrassed or offended.
As nurses we have the skills needed to ask intrusive questions involving issues of continence or memory. We talk to people about their wishes at the end of life, yet talking about intimacy and sexuality can often escape us. Whatever the reason, we need to confront our beliefs and consider this normal activity in a new light, thinking what we might do to sensitively manage and support a human activity that is known to improve people’s quality of life. We need to recognise that expressions of sexual activity vary considerably among people and that such expressions should not stop when people move home, even if that new home is residential care.
References
Bauer M et al (2008) Catering to love, sex and intimacy in residential aged care: what information is provided to consumers? Sexuality and Disability. 27, 1, 3-9.
Series H, Degano P (2005) Hypersexuality in dementia. Advances in Psychiatric Treatment. 11, 424-431.
Weeks D (2002) Sex for the mature adult: health, self-esteem and countering ageist sterotypes. Sexual and Relationship Therapy. 17, 3, 231-240.