Point for Practice

Sara and Jacob have just celebrated their diamond wedding anniversary. Jacob who has been becoming increasingly frail is to be admitted to a residential/nursing home. How might the staff in the home help Jacob and Sara meet their need to express their sexuality?

Assessment of sexual function

The PLISSIT model was developed in 1976 by Jack Annon, an American psychologist. There are four levels of intervention in this model:

• Permission.
  
• Limited information.
  
• Specific suggestions.
  
• Intensive therapy.

The goal of assessment using PLISSIT is to collect information in such a way that the patient is allowed to express his or her sexuality in a safe environment and where they can feel at ease discussing any difficulties associated with their sexual activities (Wallace, 2008). The assessment should be completed in a private area, free from disturbance and where others cannot overhear the dialogue. The environment should be prepared in such a way that the older adult feels safe, comfortable and able to communicate freely with the health-care professional. It is important that the health-care worker ensures that their behaviour is non-judgemental and non-critical. The assessment should be carried out in a manner that is respectful to the client and in a way that conveys an understanding of an older person’s sexuality. The health-care worker should never laugh or look surprised at the patients’ responses.

Permission giving

The permission giving stage is the first step of the process and includes assessment of sexual function. Nurses must be willing to introduce the topic which will allow them to identify the patients’ needs. As discussed previously, patients may be embarrassed by initiating discussion about their sexual activity; therefore, the nurse may need to begin the dialogue by giving the patient permission to discuss their sexual activities. This will reassure the patient that discussion about sexual activity is a legitimate remit of the nurse and therefore a reasonable topic of conversation. The patient thus has the opportunity to discuss any concerns.

There may also be opportunities prior to the permission giving stage where information in the form of leaflets and posters can be made available in waiting areas which promote services in relation to sexuality. The nurse may be unable to distinguish between patients who wish to discuss their sexuality or sexual health needs from patients who do not unless the matter is approached on an individual basis. There are many opportunities in primary health care and in the acute setting for giving permission. However, although nurses are giving permission to patients to discuss their sexuality, they are also giving patients the opportunity to refuse to discuss this topic. Wallace (2008) suggests asking the following questions to introduce the subject:

First of all, the nurse should ask a question in the form of seeking permission, for example, ‘Would it be alright if I ask you a question about. . .? ’ Asking permission enables the patient to feel in control of the situation. Other introductory questions can include:

• Many of my patients have problems with their sexual health as they age. Would it be alright if I ask you questions about your sexual health?

If the patient agrees, the nurse can follow up with further open-ended questions, for example,

• What concerns you about your sexual health?
  
• What changes have you noticed in your sexual feelings or functions since you were first diagnosed or treated for your disease?

Then the nurse should follow up these introductory questions by progressing to more specific questions. If permission is given by the patient, and it is appropriate, there is no reason why the partner should not be included. Any issues relating to sexual dysfunction in your patient may well have a negative effect on their partner.

Limited information stage

Stage two reflects the role of the nurse in giving information. The information may take the form of discussing the impact of an illness or treatment on the patient’s sexual function. Nurses can also clarify any misinformation that the patient has. Any opportunities to dispel myths in relation to sexual health and function should be taken, and any factual information which could be construed as within the remit of the nurse should be offered. Information should also include education about the normal changes in sexual health related to the ageing process (Wallace, 2008).

Specific suggestions stage

The third stage involves a problem-solving approach which will help to meet specific needs of the older adult identified through previous discussion. This approach can include advice such as taking pain relief prior to sexual activity, if required, and trying different sexual positions if problems with movement are apparent. Advice in relation to body image can also be offered to help with older adults who may have issues with their perceptions of their body.

Intensive therapy stage

The final stage is more for health professionals who have undergone further education in relation to sexual health and sexual function in older adults, that is, those who have had specialist training in this field. Few nurses have sufficient training to provide intensive therapy and they therefore need to be aware of their limitations and direct the client to an appropriate health professional or services. This may include direction to see a psychotherapist (Wallace, 2008), appointments at genitourinary medicine (GUM) clinics, if required, and use of charitable organisations such as Help the Aged and Age Concern where specific advice is readily available (Taylor and Davis, 2006). Behaviour modification is also available for patients who demonstrate hypersexuality that may be linked to cognitive impairment (Wallace, 2008).

Management of health issues related to sexuality

If an older adult has any sexual worries or concerns, they may first approach a nurse for advice. Nurses must be aware that their attitude to this approach may influence the outcome of the discussion. Patients will be sensitive to others attitudes, feelings and responses to their questions and dialogue. Expressions of discomfort or disgust will be readily identified and discourage the person from further contribution. Sexual problems such as erectile dysfunction should never be discussed as a simple consequence of growing older.

Peate (2004) identified a list of practical tips that a nurse can offer to support the patient in these circumstances:

1.If a patient has any concerns about their sexual health, then they should contact their practice nurse or raise the issue with the nurse caring for them.

2.They should find out what possible side effects there may be of the medicines that they are currently taking. It may be necessary to consider changing medication if the drug is implicated in any sexual dysfunction.

3.They may need to alter positions when they have sex.

4.If dryness is a problem, they may wish to think about using a water-soluble lubricant.

5.If they tend to tire as the day goes on, then they may want to think about engaging in sexual activity in the morning.

6.If they have been provided with pain relief, they may want to take some prior to sexual activity to provide some pain relief.

7.Sexual intercourse is not the only way of experiencing sexual pleasure; they may want to try touch or massage.

8.They should be advised to relax and enjoy the sexual encounter, make sure that they have enough time without interruptions.

9.Older people should be advised to use safe sex techniques, for example, condoms if they are unfamiliar with their partner.

10.They must not assume that because they experience difficulties during sex, that they can’t have a healthy sexual life.

11.Too much alcohol prior to activity inhibits, not enhances performance.

(Peate, 2004)

Summary

We hope that this chapter has caused you to rethink sex and older people. Too often in the popular psyche sex is seen as something that only the ‘beautiful young’ have any interest in. The reality is of course very different from this misperception.

In this chapter we have looked, in detail, at how ageing affects sex and sexuality. We have examined the physical and physiological changes that occur with ageing.

We have gone on to explore the issue of HIV/AIDS as it relates to older people. The evidence makes clear that HIV/AIDS is an issue for older people. Not only are people who developed HIV/AIDS now living into older age, but older people are also at risk of acquiring HIV/AIDS. We cannot provide the necessary care and advice that older adults need unless we first acknowledge that HIV/AIDS is an issue for this population.

References and further reading

Related posts:

Growing Older Controlling Body Temperature Theories of Ageing Eating and Drinking Eliminating Breathing

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