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Sexual Health in Middle Aged and Older People

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In response to the statement provided this assignment explores the nurse’s role in promoting the achieving of sexual health and well-being in the aged population. It discusses how the attaining of holistic health and well being in the middle aged and older population is dependent on patient’s being able to access comprehensive information regarding their sexuality in an environment that affirms and promotes sexual health in accordance to Nursing and Midwifery Council (NMC) (2010).

Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and a respectful approach to sexuality and sexual relationship, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence (WHO, 2014).

Sexuality is part of us as humans and it shapes our individuality right throughout the life span. However it is not one that is easily constructed or defined. WHO (2014) defines sexuality as incorporating gender, individualities and roles, sexual orientation, desire, pleasure, intimacy and reproduction. Furthermore it considers that sexuality can be expressed and experienced through thoughts, fantasies, desires, attitudes, values, beliefs, roles and relationships, practices and behaviours.

Bouman et al, (2006) considers that sexuality reflects the social interpretation that relates to the perception within society that middle age and older people do not experience sexual desires or feelings. Even within healthcare professionals sexuality is still very much considered to be an unmentionable issue (Bouman et al, 2006). The result of which is that all too often older people are not given the required information on sexuality as well as the risk factor for sexually transmitted disease such as Human Immunodeficiency Virus (HIV) compared with younger people (Bouman et al, 2006).

Presently there is no definite area in which government policy reflects the true nature of sexuality in middle aged and older individuals. The overall perception and prejudices of the elderly being a sexual, disguising or simply laughed at tends to hold. (Department of Health, 2010).Such findings are in direct dispute with those of Lindau et al, (2007) who maintain that older people adore an active sex life despite having to face certain issues or concerns in attaining it. Lindau et al (2007) further considers that this taboo topic is not readily accepted by healthcare professionals and in particular nurses (Royal College of Nurses [RCN] 2011) who may be denying older people opportunities to express their sexuality and to enjoy an active sex life. In this respect it could be argued that nurses are failing to effectively explore, diagnosed, treat or uphold sexual well being and health in the older population (Lindau et al, 2007).

Furthermore Lindau et al (2010) considers that there is a gender disparity with older age groups and sexuality, 41.2% of males aged between 75 and 85 stating that they still had an interest in sex in comparison with only 11.4% of females. These findings could be the result of menopause in women with associated problems of urogenital atrophy which is vaginal itching, soreness, dryness and pain during sex. Such symptoms may not only have an effect on sexual functioning, but on the emotional well-being, interpersonal relationships activities of daily living and on body image. (Huang et al, 2009).This affect of aging in women can be successfully treated with hormone creams that will counteract vaginal dryness and irritation.

While sexual activity usually tends to decline with age interests and issues still remain with regards to sexual desires and capacity. (Allen et al. 2009). Despite such findings Barrett and Cantwell (2007) suggests that in society older people are all too often considered not to have any sexual feelings towards each other. Barrett and Cantwell (2007) undertook research onto the perceptions of college students on issues of gender and sexuality. Students were not clear on the image of gender and stereotyped older people as not having any sexual desire or interest.
In a similar research undertaking Arnold et al, (2008) found that 62% of young people perceived older women as being non-sexual and sexually inactive compared with 62% of elderly gentlemen. These findings are supported by Kane (2006) who considers there is an understanding that older gentle men tend to engage in sexual conduct while older women who do so are frowned upon and perceived in a more negative and unacceptable manner.

Furthermore Kane (2006) considers that the public’s perceptions of older people sexual activity are generally perceived as being negative and totally unacceptable despite the fact that many older people enjoy a very productive sex life while others wish to but experience problems in this regard. Indeed Brooke (2011) reports that reports of the rise in sexually transmitted disease in the elderly (Broody et al 2008, Von Simpson and Kulasegaran 2012) in the United Kingdome (UK) were met with shock and bewilderment by journalists which adds weight to finding by Taylor et al (2011) that sexuality in the elderly is considered in one of three ways, amusement in the frail and elderly, largely non existent and possibly abnormal. Robinson et al (2008) stresses that such perceptions have a negative knock on affect on older people who begin to view themselves through the eyes of others. Jones et al (2010) calls for contesting and counteracting such negative perceptions and nurses are best placed to raise these issues and concerns with patients and to deliver holistic sexual health care and well being in accordance to NMC (2012) guidelines. In light of such findings there is a need for healthcare professionals and in particular nurses to accept the fact that older people may enjoy sex just as must as younger people and that many of the problems associated with the younger generation are just as relevant for the older age group. However until such time as this taboo topic is addressed it is unlikely that sexual health and sexual problems will be dealt with and treated effectively. (Lindau et al, 2007). There are issues of embarrassment and awkwardness in health care professionals in dealing with the issue of sexuality in the elderly for example Hyland et al, (2013) maintains that occupational therapists find it extremely difficult to deal with sexuality during rehabilitation, even though this issue has been addressed by occupational therapists working in various other areas. (Hyland et al, 2013).

Aged UK (2014) reminds that more people in the UK are living longer and Langer (2009) that we are born as sexual beings and will die as sexual beings and much can be done to ensure that older people are given the opportunity of time and privacy to express their feelings for one another such as the use of private rooms, protective times and do not disturb signs on doors (Delamater, 2012).

In order to do so more research is requires (Amber et al 2012) and Helmes and Cahman (2011) recommend that all healthcare professionals, including nurses have the facts and information about sexuality in the older population as they have a responsibility to ensure that these issue is dealt with. Higgins et al, (2012) maintains that this is achieved through training education programmes such as Permission, Limited, Information, Specific Suggestions and Intensive Therapy (PLISSIT) (RCN 2009) for assessing and evaluating an individual’s sexual wellbeing. (Post et al, 2008). Furthermore Skultety (2007) also believes that healthcare professionals need to overcome their own issues in regards speaking about and discussing sexual matters that can be culturally conditioned.

Despite such recommendations Watters and Boyd, (2009) believes that not enough is being done to tackle this issue by healthcare professionals. Even though nurses are the first line of contact patients may pick up the nurse’s feelings and attitude and this could weigh heavily on the outcome of the consultation. (Peate, 2004). Thus the beliefs and attitudes of health professional are vital in handling sexual health concerns and fears with older people and offering tests for sexually acquired diseases to older people (Ward and Bytheway, 2008).

Nurses should be competent and confident in delivering sensitive and holistic sexual health promotion and well being to the elderly population both in hospital and community settings. In order to do this, nurses need ongoing and up to date education that is firmly based on research findings that guide best practice as outlined by NMC (2012).

Reference List
Age UK. 2014. Later Life in the United Kingdom. Available online at: http://www.ageuk.org.uk/Documents/EN-GB/Factsheets/Later_Life_UK_factsheet.pdf?dtrk=true Accessed on the 10th of April 2014.

Allen, R, S, Petro, K, N, Philips, L, L. 2009 Factors influencing adults’ attitudes and knowledge of late-life sexuality among older women. Ageing and Mental Health, 13(2), 238-245.

Ambler, D, R, Bieber, F, J, Diamond, M, P. 2012. Sexual function in elderly women: a review of current literature. Reviews in Obstetrics Gynecology.5(1): 16–27.

Arnold-Cathalifaud, M, Thumala, D, Urquiza, A, Ojeda, A. 2008 Young people's images of old age in Chile: Exploratory research. Educational Gerontology, 34(2), 105-123.

Barrett, A, E, Cantwell, L, E. 2007. Drawing on stereotypes: Using undergraduates' sketches of elders as a teaching tool. Educational Gerontology, 33(4), 327-348.

Bodley-Tickell, A, T, Olowokure, B, Bhaduri, S. 2008. Trends in sexuality transmitted infections (other than HIV) in older people: analysis of data from an enhanced surveillance system. Sex Transmitted Infections. British Medical Journal. 84(4). 312-317

Bouman, W, P, Arcelus, J, Benbow, S, M. 2006. Nottingham Study of Sexuality and Ageing: Attitudes Regarding Sexuality and Older People a Review of the Literature. Sexual and Relationship Therapy, 21(2). 149-161.

Brooke, C. 2011. The over 50’s having the time of their (loves) lives. Available online at : http://www.dailymail.co.uk/femail/article-1354354/The-50s-having-time-love-lives.html Accessed on the 21st of April 2014.
Department of Health, 2010. Better prevention, better services, better sexual health-the national strategy for sexual health and HIV.

De Lamater, J. 2012. Sexual expression in later life: a review and synthesis. Journal or Sex Research. 49(2). 125-141.

Helmes, E, Chapman, J. 2011. Education about sexuality in the elderly by healthcare professionals: a survey from the Southern Hemisphere. Sex Education, 12(1): 95-107.

Higgins, A, Sharek, D, Nolan, M. 2012. Mixed methods evaluation of interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability. Journal of Advanced Nursing, 68(11): 2559-2569.

Huang, A, J, Luft, J, Grady, D, Kuppermann, M. 2009. The day to day impact of urogenital aging, perspectives from racially/ ethnically diverse women. General Internal Medicine 25(1):45–51.

Hyland, A, Mc Grath, M. 2013. Sexuality and occupational therapy in Ireland a case of ambivalence? Disability and Rehabilitation 35(1): 73-80.
Jones, I, R, Higgs, P, F. 2010. The natural, the normal and the normative: contested terrains in ageing and old age. Social Science and Medicine, 71(8):1513-1519

Kane, M, N. 2006. Ageism and gender among social work and criminal justice students. Educational Gerontology, 32(10), 859-880.

Langer, N. 2009. Late life love and intimacy. Educational Gerontology, 35(8): 752-764

Lindau ST, Schumm P, Laumann E, Levinson W, O’Muircheartaigh C, Waite L. 2007. A study of sexuality and health among older adults in the USA. New England Journal of Medicine 357(8): 762–774.

Lindau, S, T, Gavrilova, N. 2010. Sex, health, and years of sexually active life gained due to good health: evidence from two US populations based cross sectional surveys of ageing. British Medical Journal 340: c810.

Nursing Midwifery Council, (2008). The Code: standards of conduct, performance and ethics for nurses and midwives. NMC. London.

Peate, I. 2004. Sexuality and Sexual Health Promotion for the Older Person. British Journal of Nursing, 13(4), 188-193

Post, M, M, Gianotten, W, Heijnen, L. 2008. Sexological competence of different rehabilitation disciplines and effects of a discipline- specific sexological training. Sexuality and Disability, 26 (1): 3-14.

Robinson, T, Gustafson, B, Popovich, M. 2008. Perceptions of Negative Stereotypes of Older People in Magazine Advertisements: Comparing the Perceptions of Older Adults and College Students. Ageing and Society, 28(2), 233-251.

Royal College of Nursing. 2009. Sexual health competencies: an integrated career and competence framework for sexual and reproductive health nursing across the UK, RCN: London.

Royal College of Nursing, 2011. Older people in care homes: sex, sexuality and intimate relationships. RCN: London.

Skultety, K, M. 2007. Addressing issues of sexuality with older couples. Generations 31(3): 31-37.

Taylor, A, Gosney, M, A. 2011. Sexuality in older age: considerations for healthcare professionals. Age Aging, 40: 538-543.

Von Simson, R, Kulasegaram, R. 2012. Sexual health and the older adult. Student British Medical Journal, 20:e688.

Ward, R, Bytheway, B. 2008. Researching age and multiple discriminations. No 8 in the Representation of Older People in Ageing Research series. The Centre for Ageing and Biographical Studies. The Open University and the Centre for Policy on Ageing. London.

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