Sexuality

AAACN Viewpoint, Mar/Apr 2002 by Wallace, Meredith

Editor's Note:

The following is an installment of the "Try This" series published by the John A. Hartford Foundation Institute for Geriatric Nursing. The content is intended to encourage nurses to understand the special needs of older adults and use the highest standards of practice in caring for these patients. We hope direct care nurses, nurse managers, staff developers, and nursing faculty who do not consider themselves geriatric specialists will gain from this installment, and from future ones which will be published in upcoming issues of Viewpoint

For more information, contact the Hartford Institute via e-mail at hartford.ign@nyul.edu or visit their Web site at www.nye.edu/education/nursing/hartford.institute/

WHY. Although it is commonly believed that sexual desires diminish with age, several researchers have identified that sexual patterns persist throughout the lifespan. The landmark study by Masters and Johnson (1986) indicates that older adults continue to enjoy sexual relationships throughout each decade of their lives. The expression of sexuality among older adults results in a higher quality of life achieved by fulfilling a natural desire. Although the need to express sexuality continues among older adults, they are more susceptible to many disabling medical conditions such as cardiac problems and arthritis, as well as normal aging changes that may make the expression of sexuality difficult. In addition, the treatments used for medical conditions may also hinder the older adult's sexual response. Nurses are in an ideal position to assess these normal aging changes, as well as disabling medical conditions and medications, and to intervene at an early point to prevent or to correct sexual problems.

BEST TOOLS: The PLISSIT model has been used to assess and manage the sexuality of adults (Annon, 1976). The model includes several suggestions for initiating and maintaining the discussion of sexuality with older adults. Suggested questions to guide the discussion of sexuality are also provided.

TARGET POPULATION: The PLISSIT model and the questions suggested on the reverse page may be used with older adults in a variety of clinical settings. The goal of the assessment is to gather information that allows the client to express his or her sexuality safely and to feel uninhibited by normal or pathologic problems. It is common for health care professionals to feel uncomfortable with assessing the sexual desires and functions of all clients. Regardless, a sexual assessment should be performed as a routine part of the nursing assessment. Knowledge, skill, and a sense of one's own feelings and sexuality will provide the comfort necessary for the nurse to assess the sexuality of older adults.

VALIDITY/RELIABILITY: Despite the findings that sexuality continues throughout all phases of life, little material, scientific or otherwise, exists in the literature to guide nurses toward assessing the sexuality of older adults. Consequently, validity and reliability to support the PLISSIT model or the suggested questions are not available. Further research in the area of sexuality among older adults is imperative.

STRENGTHS AND LIMITATIONS: The PLISSIT model and suggested discussion questions are not diagnostic in any manner but rather provide guidance for further work-up or referral. As sexuality is discussed, the model and questions provided help to initiate and maintain discussions of sexuality.

MORE ON THE TOPIC:

Annon, J. The PLISSIT model: A proposed conceptual scheme for behavioral treatment of sexual problems, Journal of Sex Education Therapy. 1976.

Butler, R.N., Lewis, M. I. Love and sex after 60, New York: Ballantine Books. 1993.

Drench, M.E., Losee, R.H. Sexuality and sexual capacities of elderly people. Rehabilitation Nursing. 1996; 21(3), 118-123.

Johnson, B. Older adults' suggestions for healthcare providers regarding discussions of sex. Geriatric Nursing. 1997; 18: 65-66.

Masters, W.H. Sex and aging - expectations and reality. Hospital Practice, August 15, 1986.

Tunstull, P., Henry, M.E. Approaches to resident sexuality. Journal of Gerontological Nursing. 1996; 22:37-42.

Wallace, M. Management of sexual relationships among elderly residents of long-term care facilities. Geriatric Nursing. 1992; 13, 308-311.

PLISSIT MODEL

P Obtaining Permission from the client to initiate sexual discussion

LI Providing the Limited Information needed to function sexually

SS Giving Specific Suggestions for the individual to proceed with sexual relations

IT Providing Intensive Therapy surrounding the issues of sexuality for that client

QUESTIONS TO GUIDE SEXUALITY ASSESSMENT AMONG OLDER ADULTS

* Can you tell me how you express your sexuality?

* What concerns or questions do you have about fulfilling your continuing sexual needs?

* In what ways has your sexual relationship with your partner changed as you have aged?

* What interventions or information can I provide to help you to fulfill your sexuality?

Adapted from Wallace, M. (2000). in sexuality and intimacy. Textbook of Gerontological Nursing. St. Louis: Mosby Year Book, Inc.