Assisted Living Executive

medications also can cause erectile dysfunction (ED). And while medications like Viagra, Cialis, or Levitra have changed the face of sexual behavior for many individuals, ED is still a common sexual health issue among older men. Among older women, cystitis, urethritis, and the hormonal effects of menopause are among the common conditions that can result in decreased sexual health or interest in sex. For both older men and women, changes in sexual health and wellness can trigger feelings of decreased self-esteem and depression, making it imperative that caregivers include sexual health in the resident assessment process.

incorporating Assessments

Providers should consider incorporating sexual health and well-being assessments into the comprehensive assessment completed by a licensed or registered nurse at their communities. Ask residents if they are sexually active and if they have related issues they would like to discuss privately with a physician, nurse, or counselor.

Regular assessments may help some residents achieve greater self-esteem and regain the opportunity to express their sexual needs in a healthy and meaningful way. Issues can be addressed by an interdisciplinary team that may include physicians, nurses, social workers, psychologists, and/or clergy members.

A common issue specific to residents of assisted living communities is lack of privacy, as some individuals may not have private accommodations or do not feel comfortable having sex in a congregate living environment. Providers should find creative ways to provide appropriate and private times and places to allow residents to express their sexual needs and preferences. For example, a continuing care community can develop privacy signs for the doorknobs, similar to what is provided by hotels. Caregivers respect the privacy of the resident or couple in that unit and do not disturb them until the sign has been removed. And except in cases of emergency, caregivers should remember to always knock before entering a resident’s room.

As part of the Journal research study, seniors were also asked about topics that are often considered even more taboo than merely discussing sexual health and behaviors, particularly among older adults. These topics included self-stimulation, homosexuality, and alternative lifestyles,

and some participants chose not to answer these questions at all. Of those who chose to answer questions regarding homosexuality, only three of 1,198 men and five of 815 women reported homosexual preferences. Among older adults in particular, few have ever revealed their homosexuality, which can result in depression, feeling of isolation, and suicidal thoughts. And as most in the industry are aware, long-term care or residential communities that serve gay, lesbian, and transgender individuals are rare.

Providers must be prepared to address the needs and preferences of all their residents and do so in a dignified way. For example, at one assisted living community, a resident who suffered a stroke suddenly became sexually aggressive with a staff member. After discussing this privately with the resident, nurses learned that prior to his hospitalization, he and his wife had enjoyed an active sex life. Nurses counseled the resident about his behavior, provided him with privacy, and taught him about more appropriate outlets for his feelings, needs, and desires. The sexually aggressive behavior stopped.

able and unhealthy behaviors. The topic of consensual versus non-consensual sex also should be clearly outlined. For example, a resident’s aggressive sexual behavior may be the result of depression or dementia and often can be resolved with medical treatment.

And obviously, it is also important for staff to understand that sexual relationships between staff and residents, nonconsenting adults, or those who do not have the capacity to make the decision to engage in sex, are never appropriate and should be reported to the management team immediately. Allegations of rape or assault warrant immediate evaluation by a qualified health-care provider, emergency room, or rape crisis center. Providers also must be prepared to notify the appropriate law enforcement officials and licensing/ regulatory agencies in such cases, as well as have a system in place to notify family members.

Addressing the non-negotiables Providers have an obligation to intervene immediately to protect frail and vulnerable residents who may be victimized by sexually aggressive residents, staff, or visitors. Establishing competency—or the ability to make sound decisions—among residents remains a challenge for providers in this regard, but even so, providers must be prepared to quickly identify inappropriate sexual behavior that could lead to abuse and impact the health, welfare, and safety of residents.

New employee training and orientation must include a component on sexual behavior among seniors, and discussions should include examples of acceptable and healthy behaviors as opposed to unaccept-

talking About sexual health

Seniors may view sex as an expression of passion, affection, admiration, or loyalty. It may be viewed as a renewal of romance, an expression of joy, or a continued opportunity for growth and development. It can also be viewed as an affirmation of life and an opportunity to maintain a sense of identity. Sex can also increase self-esteem and confidence, prevent or reduce anxiety, or just provide physical and emotional pleasure for the older adult.

By continuing to explore this important topic with residents and staff, providers can work together to positively impact the sexual health and wellness of the seniors for whom they are entrusted to provide care and services. ❏

Sara E. Vadakin, MS, RN, is corporate vice president of quality & clinical services, Assisted Living Concepts, Menomonee Falls, WI. Reach her at svadakin@alcco.com.

sex and seniors cd

ALFA’s Critical Issues Webinar in February, “Sex and Seniors: How to Promote Sexual Health and Wellness in Older Adults,” was presented by Sara E. Vadakin and Brenda Abbott-shultz, RN, MBA, vice president of resident & family services, Benchmark Assisted Living, Wellesley, Massachusetts. A CD containing audio and PowerPoint content from the webinar is available for purchase at www.alfa.org. ALFA members enjoy discounts on this CD as well as discounted registration rates for all Critical Issues Webinars and materials.