September 28, 2023
Looking at intimacy and gender issues through the eyes of residents was a focus of the most recent Caring On-The-Go podcast. Karl Steinberg, MD, HMDC, CMD, the podcast’s host, talked with Caring for the Ages Editor-in-Chief Elizabeth Galik, PhD, CRNP, and Managing Editor Tess Bird, PhD, about some key articles from the August-September issue of the publication.
The discussion started with the article, The Pandora’s Box of Addressing Sexual Expression in Nursing Homes. Dr. Galik noted, “Residents have rights, but we need to understand their capacity to consent.” For instance, can they differentiate between truth and fantasy? Do they know who the person they want a relationship with is, or are they misidentifying them as their spouse or significant other? And do they understand the risks and consequences of sexual activity?
Dr. Galik noted that the article discussed the stigmas that exist relating to sex and older adults and how these often prevent staff and families from having productive discussions. Nonetheless, she said, “We need to have open conversations with staff and families. This can help us determine, for instance, if the current behavior is consistent with their past or is totally out of the realm of what was typical for this individual.” Talking with families can help, she said, but she stressed that there are no easy answers, and the challenges increase when a resident has dementia and wants to engage in sexual expression without understanding the risks.
Next, Drs. Steinberg and Galik discussed Recommendations for Medical and Mental Health Care in Assisted Living: The Be Well in AL Coalition. In the article, Sheryl Zimmerman, PhD, drew attention to how individuals living in assisted living are much more complex than they were 10 or 20 years ago. “We are seeing more people with multiple chronic illnesses. At the same time, nearly 50% have dementia or severe cognitive impairment, and we are seeing people with persistent mental illness residing in this setting,” Dr. Galik noted. The article, she said, delineated five global areas that a group of experts identified as top priorities to address. These are staff and staff training, nursing and related services, assessment and care planning, policies and practices, and medical and mental health clinicians and care. “These are the five global areas the group thinks that all assisted living communities across the country should address in some capacity,” she said.
Dr. Galik noted that smaller ALs particularly face challenges with issues such as dementia symptom management. She said, “A lot of care has to do with quality of staff and the ability to contact a nurse quickly at any given time and having providers willing to come in when needed.” At the same time, she observed that these smaller facilities often have better staff-to-resident ratios, which can enhance care. Dr. Steinberg suggested that telehealth may be one solution to increase AL residents’ access to specialists and clinical care.
Next up was a talk with Dr. Bird about her article, Making Space for Love Stories at Every Age. She said, “I wanted to cover some research on sexuality and older adults,” and she made some interesting discoveries. “I learned from the research that older adults have a greater capacity for more effective means of sexual expression. While sex reduces in frequency as people age, romance, companionship, and touch are more important,” she said. “Sexual intimacy is connected to overall life satisfaction and well-being and considered an activity of daily living, but there are barriers to intimacy in long-term care.” She added, “Part of our mission for this issue of Caring was to address some of the stigmas around sexuality. I learned from the research that women and LGBTQ+ individuals face more stigmas and are more likely not to communicate with care providers about sexual health.”
Finally, Drs. Steinberg and Galik discussed and article by Diane Sanders-Cepeda, D, CMD, Addressing Gender Identity in Post-Acute and Long-Term Care. In this article, Dr. Galik said Dr. Sanders-Cepeda took something from her own clinical experience to promote a wider discussion about gender identity in this setting. “It poses some important questions about how LGBTQ+ patients often experience health disparities,” said Dr. Galik. “They may not be comfortable talking about things, and as a result, they may forgo treatments and face more risks of mental health challenges.”
