Module 2 Discussion on Health assessment and Promotion
After reading an article in The New York Times by Ezekiel Emanuel of Jan 18, 2014 titled “Sex and the Single Senior”, I identified some of sexual issues experienced by residents in assisted living. I related this situation with an experience I had six to seven years ago when my grandfather was living in assisted living facility. During one of our usual visits, he explained his liking to a ‘newbie’ in the facility. He talked lengthily about the woman, which occupied most of our time during the visit. During the second visit after that incident, he was eager to explain how he was in love with Lucille (not her real name). This was controversial where some family members thought it was normal while others thought it was an expression of problematic behaviour. Upon consulting the management, I realized that sexual expression among the elderly is normal and they have rights to sexual feelings, which require expression.
Upon reading the article by Emanuel (2014), I realized that there is need to introduce tools and information to address the issue of sexual health as well as eliminating the barriers of intimacy in this population. Before formulating interventions and education programs effective for this group, it is first important to understand the diverse ways the residents express their sexuality. Another important aspect is the perception for both the residents and families that requires to be considered in the program. One of the major cause of controversy based on my example above is societal expectations. We saw sex as a form of procreation in marriage and was associated with youths and physical activity. Because persons in assisted living care do not meet the youthful standards of attractiveness and beauty, any attempt at sexual relationships in this population evokes denial, disgust, and distaste.
Another aspect to consider during the formulation of the program is tackling the attitudes of nurses. According to Rheaume and Mitty (2008), the majority of nurses in assisted living have minimal understanding of the sexual need and sexuality of the elderly. To enhance continuity of sexual activities among the elderly requires changing the negative attitudes of nurses toward residents. One of the probable interventions is running an assessment using the permission, limited information, specific suggestions, and intensive therapy (PLISSIT). Center on Aging (2003) defines a PLISSIT model as a tool to assess the aspect of sexuality among the elderly and provides a guideline for prevention mechanism of probable sexual related issues.
The first aspect of this model, permission, requires the health professional to ask the elderly about their sexual issues. Nonetheless, this format may alleviate feelings of anxiety or guilt, as they would be uncomfortable. This component of permission is assuring the resident that their fantasies, feelings, and thoughts are normal as long as their behavior does not injure others. The second aspect of this model is providing limited information like the general physiology and anatomy in relation to age related changes as well as sexual functioning. This strategy according to Rheaume and Mitty (2008) eliminates any misconception that has the ability to impair sexual function. In this step, the health professional may guide and provide information to the resident on sexual related illness and way to prevent them by use of condoms.
A therapist or sex counsellor should formulate individualized intervention for the elderly couple. Some of the essential aspects to include in this phase include practical advice on mutual pleasuring exercises, arousal techniques, and safe sex procedures (like HIV testing and condom use). This phase is effective as it will prompt communication and lower the stress and anxiety levels of the resident. Nonetheless, Frankowski and Clark (2009) advise that if the issue is about the relationship rather than the sexual activity, an intensive therapy is required. However, based on the New York article, PLISSIT would be an effective program to reduce the spread of sexually transmitted diseases, misconception and attitudes of families and health professionals, and reducing stress and anxiety among residents. On the last aspect, the medicinal value of companionship and love cannot be ignored. Do you think it will benefit the elderly?
Center on Aging. (2003). Pioneering Change Sexuality in Nursing Homes Education Module. State of Kansas Office Of Technology Services.
Emanuel, E. (2014). Sex and the Single Senior. The New York Times. Retrieved from https://www.nytimes.com/2014/01/19/opinion/sunday/emanuel-sex-and-the-single-senior.html?_r=0
Frankowski, A., & Clark, L. (2009). Sexuality and intimacy in assisted living: Residents’ perspectives and experiences. Sexuality Research and Social Policy, 6(4), 25-37. doi: 10.1525/srsp.2009.6.4.25
Rheaume, C., & Mitty, E. (2008). Sexuality and Intimacy in Older Adults. Geriatric Nursing, 29(5), 342-349. doi: 10.1016/j.gerinurse.2008.08.004
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