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Sexuality and the Older Adult


Sexuality and the Older Adult

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Overview of Teaching Strategy

Sexuality is at the core of who we are and has an impact on our lives in so many ways. It does not stop once we hit the age of 60 or 70 or 90 or even 100 despite the myths and assumptions of society. Sexual desire does not necessarily dissipate with age, but the physical, cognitive, and psychosocial changes that can occur with aging may interfere with sexual outcomes. Issues of sexuality with older adults often become a taboo topic; whether it is the expression of desire or the inappropriate sexual acting out of the individual with dis-inhibition secondary to dementia. 

In the long-term care environment, expressions of sexuality are frequently labeled as problem behaviors.  The number of older adults testing HIV positive is on the rise thereby making safe sex practices a priority topic of discussion for health care professionals. Clearly sexual issues are fairly common among older adults, but the health care team infrequently addresses these issues. Student nurses are no different. They frequently report a level of discomfort with initiating discussions of sexual assessment with their patients in general but more so with their patients who are older adults. There are sexuality assessments that are often a sub-section of general assessments, but are often glazed over secondary to the discomfort of the examiner or the hypothesis that it is not of importance to the examiner.  Common sexual side effects of medications such as antidepressants are regularly discussed with younger patients but very rarely addressed with older adult patients. 

The need to raise a student’s awareness of the complex issues surrounding sexuality of older adults is a focus of this teaching strategy. In addition, this teaching strategy is designed to increase the comfort level of the student and to routinely include an integration of sexuality assessment in the plan of care of older adults. The landmark Masters and Johnson study (1986) links increased quality of life with the fulfillment of sexual desire. Empowering nurses to advocate for the sexual needs of their older adult patients and to look at sexuality in the context of functionality may start to break down the taboos seen as a barrier to optimal quality of life for this population. This teaching strategy can be used for the pre-licensure nursing student or to address the complexity of the issue for current nurses achieving further degrees.

Learning Objectives
Students will: 

  • Identify physical changes in older adults that can contribute to or inhibit the expression of sexuality.
  • Identify the functional, psychosocial, cultural, and cognitive issues that can affect expression of sexuality.
  • Develop a comfort level with assessing the sexuality of their older adult clients.
  • Demonstrate an awareness of the link between fulfillment of sexuality and optimal quality of life.
  • Identify  the  sexual  risks  and  associated  interventions  of  sexuality  in  the  older  adult population.
  • Assess function in the context of expectations of sexuality of their clients.
  • Discuss tactics for advocacy for the client’s expectations.
  • Reflect on the impact their own beliefs regarding sexuality have on their perceptions about the needs and expectations of others.
  • Understand  the  pathophysiology  around  disinhibited  sexual  behaviors  as  a  residual  effect  of cognitive issues. 

ACE.S Knowledge Domains 

  • Individualized Aging
  • Complexity of Care

 ACE.S Essential Nursing Actions 

  • Assess Function and Expectations
  • Coordinate and Manage Care
  • Make Situational Decisions

NLN Competencies for Graduates of Nursing Programs

  • Human Flourishing
  • Nursing Judgment
  • Spirit of Inquiry