Feliciano Villar, Carme Triadó, Montse Celdrán and Josep Fabà have recently spoken about Sexuality in the Elderly in their latest research. They refer to the perspective of the institutionalized elderly person, but also to the perspective of the professional.

It is clear, on the one hand, that many medications that treat neurodegenerative diseases in the third and fourth age cause as a side effect behaviors related to hyperxesuality and/or sexual behavior disorders that are so complicated to treat or redirect for a health care professional. In fact, it is common to see uninhibited behavior in the elderly person in relation to the Assistant.

That is why this article deals with sexuality in aging , as well as the most important conclusions that these authors have agreed upon after their research; because it is very important to have a good understanding of Sexuality in Aging in order to treat the elderly from a Person-Centered Care perspective and offer the highest quality of life possible.

Sexuality in aging

It is a reality that almost all people, from birth to death, have sexuality, as well as the need to have sex with others and alone. Therefore, it is also a reality that today in residential centres there is a very relevant lack of intimacy as well as a lack of individualised follow-up of the elderly due to a lack of resources, professionals and, above all, training and communication.

In fact, as they say, Villar, F., Triadó, C., Celdrán, M., Fabà, J. (2017), after having interviewed older residents and professionals, some of them comment that there are professionals who tend to have negative and very pejorative reactions to older people expressing their emotional and sexual needs both in public and in private; in general we do not react naturally to older people or professionals, precisely because there is a clear stigmatization in the third and fourth ages, as well as ageism (age discrimination).

What are the sexual needs in aging?

According to the older people participating in the research and according to the professionals, in this case 83 out of 100, explain that sexual needs are maintained during the aging process, although not completely . However, some particularly consider that “interest is maintained but practice declines”, and the intensity of sexual needs decreases but does not disappear.

In any case, the sexual needs in the Aging, as in the Adult Stage, will depend mainly on the Life History, as well as on the vulnerability to certain neurodegenerative and/or neuropsychiatric diseases, since the sexual desire is strictly related to these diseases that are also so frequent. This set, therefore, must be reviewed by a social health professional, in this case the psychogerontologist, either in residential centres or in home care startups, with the aim of preserving the best possible intimacy of the person and facilitate sexual expression since there are, according to the authors, two barriers that need to be worked on:

Internal Barriers

The modesty and feelings of shame in the face of sexuality in old age are the greatest ageisms that exist, the greatest esteem, the greatest internal barrier. We are talking about moral rules and generational factors such as repressive education.

External Barriers

The context in the Residential Centers as the context in the Home as well as the infrastructure of the space in which the elderly person is located is the main external barrier. In Residential Centres, due to the lack of resources, they usually live in shared spaces with a clear lack of privacy and in the Home, childishness and overprotection are frequent. In this case, in the Centres, the individual rooms would be a Facilitator and at home, an adequate clinical evaluation of the elderly person and his/her context would be a Facilitator.

Barriers and Facilitators for Libido Expression

What can we professionals do about this? According to Villar, F., et al. “When asked about the most frequent sexual behaviors among residents, most of those who respond (many residents do not, since they consider this dimension to be absent in institutions), masturbation is the most mentioned. Practically all professionals mention this type of behavior, which in many cases they have unwittingly witnessed. So, what are the objectives and strategies to follow?

1. In relation to the elderly

To know first hand their Life History as well as evaluate and treat their neurodegenerative diseases and study the possible side effects of their psychopharmacological treatment.

2. In relation to the context

Due to the lack of resources, it is complicated to have individual rooms in the Residential Centres, so in short the best option is to ensure that admission to these centres is delayed and/or avoided by means of the help of the new home care startups.

3. In relation to all professional staff

To encourage continuous communication between Nursing Assistants and Psychologists in order to offer the best possible person-centred care . In addition, counselling is one of the main characteristic functions of social health professionals of the third and fourth ages.

Sexuality and Dementia: 3 points to consider

When dementia and sexuality overlap, the following points should be considered.

1. Discerning consent

Nursing Assistants with more than one patient in charge usually find themselves in situations where they do not know how to handle the situation. Of course, a sexual relationship between two people who have dementia or in a couple where one of the partners has a neurodegenerative disease creates a lot of uncertainty, so it is difficult to know how to discern the consent of the older person. This is why Prevention and Follow-up or carried out between Psychologists and Assistants in a horizontal manner is important to find a solution through the PCA.

2. Advising and collecting information

Sometimes, the reactions of professionals such as Nursing Assistants, Social Workers, Nurses, Psychogerontologists, etc., and/or family members are not accurate, so infantilization may occur . This is why it is fundamental to remain informed and to promote communication between professionals in order to advise and gather information from the different parties involved.

3. De-dramatize

De-dramatize and avoid the uninhibited behavior of the elderly person , if it occurs, are the key in which professionals work to favor the well-being of the elderly; always, but, from the approach of the PCA and from the evaluation and treatment within a clinical context.

Uninhibited behavior of the elderly person in relation to the Nurse’s Aide

Psychopharmaceuticals such as antidepressants and benzodiazepines, which are usually prescribed in the stage of aging to treat generally neurdegenerative diseases or dysthymic symptoms or symptoms specific to anxiety may alter sexual libido, sexual desire or trigger sexual conduct disorders if not properly followed up in the older person.

Uninhibited behavior refers to socially impertinent behaviors such as exhibitionism, indecent language and sexual intentions to the other without consent – decided unilaterally. It may then be due to neuropsychiatric symptoms and/or coexisting with neurodegenerative symptoms.

Generally, such behaviors are seen by the Nurse’s Aide who is the professional who is physically and day-to-day with the elderly resident in a facility or in the ODS, the home service. In both cases, it is important to know the person receiving the service well in order to offer the greatest possible well-being.

Conclusion: Psychogerontologists and Assistants working together

In short, the solution to the stigmatisation of sexuality in older people and the lack of privacy lies above all in the work of professionals, be they assistants, psycho-gerontologists, nurses and assistants who are in direct contact with older people. This is why it is important to prevent (by knowing the neurodegenerative diseases), to know how to discern consent, to advise and to gather information and, above all, to de-dramatize the situations in which affective behaviors occur , as well as to find solutions to inappropriate behaviors, always from the focus of Person-Centered Care and from the evaluation within the clinical context.

Bibliographic references:

  • Villar, F., Triadó, C., Celdrán, M., Fabà, J. (2017) Sexuality and Institutionalised Older People: the perspective of the resident and the perspective of the professional. Madrid: Fundación Pilares.