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Sexuality and Dementia- Identifying good practice in care home settings, with regard to issues of competency

Sexuality and Dementia- Identifying good practice in care home settings, with regard to issues of competency

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An essay for the 2011 Undergraduate Awards Competition by Robyn Lennox. Originally submitted for Social Work at Queen’s University Belfast, with lecturer Bernadette Kelly in the category of Social Studies
An essay for the 2011 Undergraduate Awards Competition by Robyn Lennox. Originally submitted for Social Work at Queen’s University Belfast, with lecturer Bernadette Kelly in the category of Social Studies

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Published by: Undergraduate Awards on Aug 29, 2012
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10/27/2013

 
Evidence Based Project
Sexuality and DementiaIdentifying good practice in care home settings, with regard to issues of competency
 AimI plan to explore how care homes currently manage relationships and establish existingpolicy and procedure used to guide practitioners in relation to issues surroundingcompetency in this area. Through exploration of procedures I will identify best practice indealing with sexuality and dementia in care homes and propose guidelines for practitioners.Relevance to PracticeMy practice learning opportunity (PLO) was within an Integrated Care Team, where Iworked in care management for older people. Whilst working with older people who live ina care home it became apparent that relationships is an integral aspect of home life. Thisseemed to be widely accepted by staff, however when a resident actively displayed sexualbehaviour it became an issue. Care home staff seemed to be unsure of how to managethe situation and as a result arranged a multi-disciplinary meeting including the socialworker or care manager. During meetings issues regarding competency were prevalentand common solutions included separating the residents.Intervening with separation was a method used in a case where an older lady andgentleman with dementia had established a relationship; however staff were concernedthat the relationship may develop. They also were unsure if the woman was trulyconsenting as she believed the gentleman was her husband. A meeting was held, whichincluded the care manager for both individuals and the staff nurse. Issues of competencywere discussed and the best practice to safeguard both individuals. The solution was tomove the lady to the opposite side of the care home, as this would be less detrimental for medical reasons than moving the gentleman. Before she was moved the situation wasexplained to her husband and permission was sought.I was surprised at the lack of knowledge of policy guidance and legislation surrounding
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Evidence Based Project
the topic and the general in-consistence in staff responses. The example highlights that itis necessary to protect those who are vulnerable because of their cognitive impairment,however I also believe that it is important to promote autonomy and choice, which was notpromoted by separation. Nonetheless the woman's husband was consulted and anintervention was implemented in relation to what was perceived as the best interests of theservice users. The situation raised many ethical dilemmas and encouraged me to exploremy own feelings towards sexuality and dementia and how I would address this type of situation in practice.IntroductionOlder people were once perceived as a marginal concern however their growing numbershave made them one of the largest groups within society. Statistics from the NorthernIreland Statistic and Research Agency (2008) state that people aged 65 and above issuspected to increase to 356,000 by 2023. The high number of older people in societymeans that issues impacting upon them is a priority for the Trusts thus making dementiacare a pivotal concern for social workers, with two in three care home residents sufferingfrom dementia (Denning and Mathews 2002, PSSRU 2007).Sexuality is not a word often associated with old age. Ward et al (2005:3) agree with this,as they state that older people are often perceived as “sexless”. This perception isincorrect as for many older people sexuality is an integral aspect of their life. It is thereforerecognised that despite preconceived misconceptions, sexuality does not disappear withage (Bortz et al 1999).Despite the general agreement within literature that sexuality is existent in old age societalattitudes have not changed. The sexual needs of older people remain marginalised withinsociety (Bouman 2006). This has led to ignorance regarding the topic meaning thatsexuality is often viewed as problematic, especially in relation to individuals with dementia(Rheaume and Mitty 2008, Kuhn et al 1998).Ignorance in relation to sexuality in older people is what Ford (1998) describes as apertinent aspect of ageism, which is something that social workers have a responsibility towork against and to decrease through anti-oppressive practice. At present anti-oppressivepractice in relation to the topic is absent in the social work process, particularly in care
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Evidence Based Project
home settings where diversity in sexuality is not recognised (Callan 2006).Roach (2004:2) states that “
nursing homes mark the end of many types of freedoms for older people
”, thus anti-oppressive practice means promoting the individual's reamingfreedoms including sexuality. Encouraging sexuality and relationships is not only essentialfor anti-oppressive practice but also essential for the general health and well-being of older people, particularly those with cognitive impairment. This is acknowledged by Roach(2004), who suggests that a lack of intimacy can have adverse effects on mental health.Current Care Home StrategiesThe literature surrounding the subject, highlighted that there were common methods of intervention used across the UK and internationally, however many of the methods werenot effective or in keeping with other policies such as person centred practice.To manage the sexual needs of an older person with dementia, it would be assumed thattheir needs would be assessed, just as other needs are assessed when entering a home.During my PLO none of the assessments used, including the Northern Ireland Single Assessment Tool, specifically addressed sexuality. Assessment of sexual needs was alsoabsent in all of the research literature I found. These surprising findings were also found byWeeks (2002) who asserts that needs are ignored in assessment even though sexuality isrecognised as an integral part of good health in later life.Other areas which are usually included in the assessment process such as spiritual needscan assist in the management of sexual expression. This point is asserted by Ward et al(2005) as they suggest that assessment of spiritual needs can assist in ensuring that thepersons' values and dignity is respected. Thus it can assist staff in detaching their ownbeliefs from the situation and in intervening in a way which meets the service user needs,as opposed to their own.Insufficient assessment of a situation can lead to responses which are not in the bestinterests of the service user. Some staff respond to sexual expression using humour dueanxiety or lack of knowing how else to react. Although it is a small study of only fiveworkers in Australia, Buver and Geran (1999) found that staff used humour inappropriately.The use of humour can embarrass the service user; however it may be the only option for staff that are unaware of another response. Heymanson (2003) agrees with this as he
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