Addressing sexuality of older people is a neglected area and has received insufficient attention in residential care practice. This paper presents an urgent need to address this sensitive, potentially embarrassing but important health issue. It concludes that much work is still needed in this area, particularly to understand sexuality from older peoples' perspectives and how their sexual needs and concerns can be addressed by those caring for them in residential care homes. Not until we truly know what older people want and understand what sexuality means to them can it be possible to plan individualized care that will meet their specific sexual need.
As the number of older people moving to residential care home continues to increase, there is a growing expectation that the care they receive will be of the highest quality. Yet to actively engage in discussion about how older people live in residential care homes conjures up unpleasant images that may make people uneasy and prefer not to think about it (Kane, 2000). Then what about broaching the subject of sexuality of older people in residential care homes? It is important, no doubt, but also sensitive and potentially embarrassing.
Even though sexual health has been acknowledged as an important component of quality of life for many older people (Miller, 2004), it has not been easy to either encourage or respond to older people expressions of sexual interest, attitudes, activity and satisfaction. Not surprisingly, there appears to be scant knowledge on how best to address the sexual needs of older people in residential care homes. As such, sexuality of older people is a neglected area that has received insufficient attention in residential care practice. In a selective review of the literature, this paper aims to offer insights into how sexuality of older people is expressed and addressed in residential care homes. It also suggests that more work should be undertaken to promote awareness of sexuality in residential care, particularly understanding what sexuality means from older people's own perspectives. In this way, they may be supported to express their sexuality in appropriate forms across culturally diverse societies.
Sexuality is a complex and multi-dimensional concept covering the desire for sex, the sexual act and values, and beliefs about sex (Kaiser, 1996). Sexuality also involves the whole experience of a person's sense of self, and includes a person's ability to form relationships with others, feelings about themselves, and the impacts of the physiological changes of ageing on their sexual functioning (Kamel, 2001; Russel, 1998). Other dimensions of sexuality such as a person's level of self-esteem, type of clothing worn, type of sexual activity one chooses to engage in and with whom, and the nature of the sexual act may also be considered (Peate, 1999). This suggests that a person's sexual experience and their ability to enjoy it is very personal and individualized, and is related to age and degree of disability or ill-health (Russell, 1998). It would seem that when effort is put into promoting an understanding of a person's sexuality, numerous benefits such as having a healthy self-image, psychological refueling and re-energizing, an outlet for personal anxieties, and a means of preventing social disengagement and avoiding depression results (Heath, 1999). Engaging in a sexual relationship can also bring love, intimacy and closeness that can further improve older people's general well-being (Wallace, 1992). It is therefore important to promote sexual awareness of older people.
Many sexual myths and stereotypes work against older people and challenge whether the expression of sexuality in old age is appropriate. Despite studies reporting that older people can be potentially sexually active into later life (Marsiglio & Donnelly, 1991), the society still continues to devalue older people's sexuality with humor, ridicule and distaste (Spurgeon, 1994).
One major challenge is trying to change people's attitudes towards sex in later life and to outgrow the deeply embedded beliefs that sexuality is only the province of a youthful society (MacRae, 1999). As people age it is generally believed that they no longer look physically attractive and thus do not have sexual needs and, if they have any, they would need to suppress them. This is somewhat consistent with findings from older people who reported that they no longer felt physically attractive and thereby felt sexually unattractive (Richardson & Lazur, 1995). This commonly held misconception has unnecessarily coerced and socialized sexual older people into becoming asexual beings--who have lost their physical attractiveness, have no sexual needs, thoughts or desires to engage in any forms of sexual behavior (Kessel, 2001)--in order to comply with societal expectations and social values.
Few would deny victimizing older people for their overt sexual behaviors and labeling them as socially unacceptable. Indeed, such assumptions would deny older people the right to express their true sexual feelings verbally and behaviorally, for fear of being labeled as disgusting with unrestrained indulgence of lust (Archibald, 1998). Until these ingrained and longstanding myths are dispelled, older people's sexuality will continue to be concealed, viewed with shame, and discouraged from the freedom of sexual expression by those caring for them (Bauer, 1999). So instead of working towards accepting older people's sexuality as an indispensable part of human existence (Nay, 1992), society has further diverted needed attention to understand older people's sexual needs and rendered their sexual behavior as insignificant.
Sexuality of older people in residential care
Despite some progress made to challenge the prominent sexual myths of older people in residential care homes, supporting and allowing older people to freely express sexuality in acceptable forms is still a challenge for residential care home staff. The following will discuss different ways in which older people express their sexuality, and how residential care staff respond, understand and interpret older people's sexual acts.