How do community-dwelling LGBT people perceive sexuality in residential aged care? A systematic literature review.

OBJECTIVES: To investigate what empirical studies report on the perceptions of community-dwelling LGBT adults regarding sexuality and sexual expression in residential aged care (RAC), and how their sexuality should be addressed in RAC. METHODS: Relevant papers were identified through electronic searches in databases; and by reference tracking and citation tracking. Data were extracted using a standardized data extraction form and were compared, related, and synthesized using thematic analyses. We evaluated the methodological quality of the studies. RESULTS: Eighteen articles were identified. Three major topics emerged regarding sexuality in RAC: (1) factors affecting LGBT people's perceptions, subdivided into (a) discrimination, (b) loss of sexual identity, (c) failure to acknowledge the same-sex partner, and (d) lack of privacy; (2) LGBT-specific RAC facilities; and (3) characteristics of LGBT friendly RAC facilities and caregivers. CONCLUSIONS: LGBT people have clear perceptions about how sexuality and sexual expression is or should be managed in RAC. Despite the general increase in acceptance of sexual minorities, many community-dwelling LGBT people believe older LGBT residents are discriminated against because of their sexual orientation or gender identity. Taking into account these opinions is crucial for increasing accessibility of RAC to LGBT people and to ensure the quality of the provided care.

Nurses' experiences and reactions towards intimacy and sexuality expressions by nursing home residents: A qualitative study.

OBJECTIVES: To better understand how nurses experience and react to intimate and sexual expressions of nursing home residents. BACKGROUND: Although many nursing home residents continue to desire intimacy and sexual expression, they commonly perceive negative attitudes of nursing staff towards them as a major barrier to their sexual well-being. To eliminate this barrier, it is crucial to gain a more in-depth understanding of nurses' personal experiences and reactions towards intimacy and sexuality in aged care. DESIGN: Our study used a qualitative design, rooted in grounded theory. METHODS: Semi-structured interviews with 15 nurses between 34 and 59 years of age were conducted. Participating nurses were recruited from seven different nursing homes in Flanders, Belgium. We used the Qualitative Analysis Guide of Leuven (QUAGOL) for data analysis. We followed the COREQ guidelines to ensure rigour in our study. RESULTS: Nurses experienced and dealt with intimate and sexual expressions of residents in an individual way, which was focused on setting and respecting their own sexual boundaries and those of residents and family members. Depending on their comfort level with residents' expressions, nurses responded in three ways: active facilitation, tolerance and termination. Nurses' responses depended on contextual factors, including their personal experiences with sexuality, the nature of their relationship with the residents involved, the presence of dementia and the organisational culture of the facility. CONCLUSIONS: Nurses face a wide range of experiences and emotions when confronted with residents' expressions of sexuality and intimacy. A supportive approach is needed to guide nurses in dealing with these highly sensitive situations. This approach can be promoted at the institutional level through continuous educational programmes. RELEVANCE TO CLINICAL PRACTICE: This study advocates a contextual and interpretative ethical approach to sexuality in older adults, taking as starting point nurses' own vulnerability and that of residents and relatives.

"How do ethnic minority patients experience the intercultural care encounter in hospitals? a systematic review of qualitative research".

BACKGROUND: In our globalizing world, caregivers are increasingly being confronted with the challenges of providing intercultural healthcare, trying to find a dignified answer to the vulnerable situation of ethnic minority patients. Until now, international literature lacks insight in the intercultural care process as experienced by the ethnic minority patients themselves. We aim to fill this gap by analysing qualitative literature on the intercultural care encounter in the hospital setting, as experienced by ethnic minority patients. METHODS: A systematic search was conducted for papers published between 2000 and 2015. Analysis and synthesis were guided by the critical interpretive synthesis approach. RESULTS: Fifty one articles were included. Four dimensions emerged, describing the intercultural care encounter as (1) a meeting of two different cultural contexts of care, (2) in a dynamic and circular process of (3) balancing between the two cultural contexts, which is (4) influenced by mediators as concepts of being human, communication, family members and the hospital's organizational culture. CONCLUSIONS: This review provides in-depth insight in the dynamic process of establishing intercultural care relationships in the hospital. We call for a broader perspective towards cultural sensitive care in which patients are cared for in a holistic and dignity-enhancing way.

Intimacy and Sexuality in Institutionalized Dementia Care: Clinical-Ethical Considerations.

Intimacy and sexuality expressed by nursing home residents with dementia remains an ethically sensitive issue for care facilities, nursing staff and family members. Dealing with residents' sexual longings and behaviour is extremely difficult, putting a burden on the caregivers as well as on the residents themselves and their relatives. The parties in question often do not know how to react when residents express themselves sexually. The overall aim of this article is to provide a number of clinical-ethical considerations addressing the following question: 'How can expressions of intimacy and sexuality by residents with dementia be dealt with in an ethically responsible way?' The considerations formulated are based on two cornerstones: (1) the current literature on older peoples' experiences regarding intimacy and sexuality after the onset of dementia, and (2) an anthropological-ethical framework addressing four fundamental pillars of human existence namely the decentred self, human embodiment, being-in-the-world and being-with-others. The resulting considerations are oriented toward the individual sphere, the partnership sphere, and the institutional sphere. The continuous interaction between these spheres leads to orientations that both empower the residents in question and respect the complex network of relationships that surrounds them.

Nurses' knowledge and attitudes toward aged sexuality in Flemish nursing homes.

BACKGROUND: Admission to a nursing home does not necessarily diminish an older person's desire for sexual expression and fulfillment. Given that nursing staff directly and indirectly influence the range of acceptable sexual expressions of nursing home residents, their knowledge and attitudes toward aged sexuality can have far-reaching effects on both the quality of care they provide to residents and the self-image and well-being of these residents. RESEARCH OBJECTIVES: To investigate nursing staff's knowledge and attitudes toward aged sexuality, to determine whether certain sociodemographic factors of the nursing staff relate to their knowledge and attitudes toward later-life sexuality, and to examine the relationship between knowledge and attitudes. RESEARCH DESIGN: Descriptive cross-sectional survey study. RESEARCH PARTICIPANTS AND RESEARCH CONTEXT: The administered questionnaire collected sociodemographic data and data from an adapted, Dutch version of the Aging Sexual Knowledge and Attitudes Scale. Data were collected from November 2011 through April 2012. A total of 43 geographically dispersed nursing homes in Flanders, Belgium, participated. Out of a potential research sample of 2228 nursing staff respondents, 1166 participated. ETHICAL CONSIDERATIONS: The study protocol was approved by the Ethics Committee of the Faculty of Medicine of the KU Leuven. FINDINGS: Nursing staff appeared to be moderately knowledgeable about aged sexuality and displayed a rather positive attitude toward sexuality in older people. Significant relationships between various variables were found both at univariable and multivariable levels. Knowledge and attitudes proved to be positively related, indicating that a higher level of knowledge of aged sexuality is associated with a more positive attitude toward sexuality in later life. DISCUSSION: Research findings are discussed within a broader international context. CONCLUSION: There is room for improvement for both nursing staff's knowledge and attitudes toward aged sexuality. This might be aided by appropriate educational interventions. Our results identified different target groups of nursing home staff for these interventions.

Eternal sunshine of the spotless mind? An anthropological-ethical framework for understanding and dealing with sexuality in dementia care.

Contemporary bioethics pays considerable attention to the ethical aspects of dementia care. However, ethical issues of sexuality especially as experienced by institutionalized persons with dementia are often overlooked. The relevant existing ethics literature generally applies an implicit philosophical anthropology that favors the principle of respect for autonomy and the concomitant notion of informed consent. In this article we will illustrate how this way of handling the issue fails in its duty to people with dementia. Our thesis is that a more inclusive philosophical anthropology is needed that also heeds the fate of this growing population. Drawing on the tradition of phenomenology, we will chalk out an anthropological framework that rests on four fundamental characteristics of human existence: the decentered self, human embodiment, being-in-the-world and being-with-others. Our aim in this article is thus to tentatively put forward a broader perspective for looking at aged sexuality in institutionalized people with dementia. Hopefully the developed framework will mark the beginning of a new and refreshed ethical reflection on the topic at hand.

Nurses' knowledge and attitudes towards aged sexuality: validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale.

AIM: This paper reports a study testing the content and face validity and internal consistency of the Dutch version of the Aging Sexual Knowledge and Attitudes Scale. BACKGROUND: The ability of older residents to sexually express themselves is known to be influenced by the knowledge and attitudes of nursing home staff towards later-life sexuality. Although the Aging Sexual Knowledge and Attitudes Scale is a widely used instrument to measure this, there is no validated, Dutch translation available. DESIGN: Instrument development. METHOD: Following a standard forward/backward translation into Dutch, the scale was further adapted for use in Flemish nursing home settings. Content and face validity and user-friendliness were assessed. The psychometric properties were determined by means of an exploratory study. Data were collected from March-April 2011 at eight Flemish nursing homes. Reliability was assessed using internal consistency and item-total correlations. RESULTS: Both subscales of the Flemish adaptation showed acceptable content validity. The face validity and user-friendliness were deemed favourable with hardly any remarks given by the expert panel. The Cronbach's α was 0.80 and 0.88 for the knowledge and attitude subscales, respectively. The item-total correlations ranged from 0.21-0.48 for the knowledge section and from 0.09-0.68 for the attitude subscale. CONCLUSION: We conclude from our study that the Dutch version of the scale has acceptable to good psychometric properties. The Flemish adaptation therefore seems to be a valuable instrument for studying nursing staff's knowledge and attitudes towards aged sexuality in Flanders.

Sexuality in institutionalized elderly persons: a systematic review of argument-based ethics literature.

BACKGROUND: Admission to a nursing home might challenge the way in which individuals experience their own sexuality, but it does not automatically diminish their need and desire for sexual fulfillment. Despite the fact that sexuality proves to be an intrinsic part of human existence, the sexual expression of geriatric residents remains a sensitive subject for many caregivers and family members. It evokes a variety of ethical issues and concerns, especially when dementia patients are involved. The overall objective of this review was to examine the ethical arguments and concepts about the debate on sexuality within a nursing home environment. METHODS: We conducted a systematic search for argument-based ethics literature focusing on sexuality in institutionalized elderly people. Twenty-five appropriate studies were identified. RESULTS: A thematic analysis of the included literature led us to distinguish two major groups of ethical arguments: (i) principles and (ii) care. Ethics arguments on sexuality in institutionalized elderly are particularly guided by the principle of respect for autonomy and the concomitant notion of informed consent. Arguments related to care were also apparent within the research literature although they received considerably less attention than the arguments related to the principles of respect for autonomy, beneficence, nonmaleficence and justice. CONCLUSIONS: The lack of clarity in the conceptualization of the arguments referred to in the research literature indicates that there is a pressing need for a better defined, more fundamental philosophical-ethical analysis of the values at stake.

Older residents' perspectives on aged sexuality in institutionalized elderly care: a systematic literature review.

OBJECTIVES: The aim of this systematic literature review is to investigate older residents' thoughts on, experiences of and engagement in sexual behavior and aged sexuality within institutionalized elderly care. DESIGN: Systematic literature review. DATA SOURCES: We conducted an extensive search of the electronic databases Cinahl, Medline, Pubmed, Embase, Web of Science and Invert for papers published between January 1980 and October 2014 when the searches were closed. Additional papers were identified through forward and backward citation chasing. REVIEW METHODS: Data from relevant studies were extracted by means of a data extraction form. Relevant data were isolated, summarized, compared, related and categorized according to theme. Quality assessment of the included studies focused on their adequacy of reporting the study's research aim, sampling, collection, and analysis procedures, ethical considerations and results. RESULTS: Twenty-five appropriate studies were identified. These studies varied in research design (using surveys, vignettes, focus groups, interviews, or observation), objectives, quality of reporting, and sample characteristics (i.e. male and/or female long-term care residents with and/or without dementia). Yet, they all point to the relevance of sex and sexuality in old age and emphasize the highly individual character of both sexual interest and expression. Older residents who wish to sexually express themselves, might do this in a wide variety of ways, including, but not limited to, daydreaming, dressing-up, looking for emotional and intellectual intimacy, stroking, caressing, kissing, and engaging in sexual intercourse. Overall, residents appear to have a rather positive attitude toward aged sexuality as such. When it comes to specific sexual behaviors or homosexuality, however, attitudes tend to be more negative. The perceived appropriateness of the displayed behavior is a predominant factor in determining older people's reactions to the sexual behavior of co-residents, rather than the potential emotional discomfort brought on by witnessing this behavior. CONCLUSIONS: Relatively little work has been published on older residents' perspectives regarding aged sexuality in institutionalized elderly care. If, however, we wish to devote ourselves to individualized or person-centered nursing care, we will have to gain more insight into the patient's perspective and take notice of the needs, expectations, attitudes, experiences and behaviors of residents with regard to (aged) sexuality. Hence more research is needed that depicts the issue of aged sexuality in institutionalized elderly care from a patient's and thus resident oriented perspective.

Nurses' perceptions of sexuality in institutionalized elderly: a literature review.

BACKGROUND: Institutionalized elderly continue to have the need for sexual expression and intimacy. Nurses often display negative responses when they are confronted with the sexual behavior of residents. They feel ashamed and do not know how to react. This generates feelings of discomfort, resulting in the denial of resident's needs and desires for sexual fulfillment. OBJECTIVES: The objective of this review is to thoroughly analyze the literature about the knowledge, attitudes, and experiences of nursing staff toward sexuality in institutionalized elderly. We shed light onto the relationship between knowledge and attitudes, and determined whether certain demographic factors relate to the knowledge and attitudes of nursing home caregivers. DESIGN: We conducted an extensive search of the electronic databases Medline, Cinahl, Psychinfo, Web of Science, Philosophers Index, Google Scholar, and Invert for papers published between January 1980 and September 2010. A broad range of search keywords was used. FINDINGS: The quantitative studies revealed nursing staff to show rather positive attitudes toward later-life sexuality. However, the extent of the staff's knowledge regarding sexuality in the aged seemed to be very limited. There was no consensus found about the relationship between knowledge and attitudes. As regards the influence of demographic variables, the results were very ambiguous. The qualitative studies showed that caregivers hold rather conservative attitudes toward sexuality in institutionalized elderly. Feelings of discomfort prevailed. The responses to residents' sexual behavior were influenced by the staff's own level of comfort related to sexuality issues and the ethos within the institution where they work. CONCLUSIONS: This review gives us a broad outline of the knowledge, attitudes, and experiences of geriatric nurses toward sexuality in institutionalized elderly. If we want the sexual needs of residents to be recognized, more research is needed. Especially needed are more in-depth qualitative studies that explore the experiences of nurses and managers. The development of a more accurate educational program could increase the knowledge of later-life sexuality and cultivate positive and permissive attitudes toward sexuality in the aged.