Seniors and Sexuality

Salimah Walji-Shivji LLB, RSW, MSW, BSW

Vice President & General Counsel, Agecare
&
Patricia Mielcarek, MSW Student at U of C
 Table of Contents
• Video presentation
• Task at hand
• Literature review
• AgeCare Policy
• Stakeholder interviews
• Themes from literature search, scans and interviews
• Consent & capacity
• Checklists
• Recommendations
• Conclusion
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 Video:
Sex, Love and Intimacy in Later Life

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 A Conversation….
• The video helps us realize that we need
to start a conversation about sex and
aging
• Form of anti age discrimination
• Explore it from the older persons
perspective
• 50% of men and 33% of women over the
age of 70 are sexually active
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 Task at Hand…
• Literature search for best practices
related to sex and aging
• Policy and practice review within Agecare
• Interviews with stakeholders
• Assessed variation between sites
• Made recommendation for path forward
• Created a checklist for sites to use

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 Literature Review
• Discussion of sexual health and preferences
should be part of the care plan
• Space available for conjugal visits
• Discussions should be proactive rather in
response to activity or event
• Care teams should have education on how to
have discussions with residents about their
sexuality
• Access to contraceptive methods (disease
protection)
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Current Policy at AgeCare

 Policy is called: Privacy, Intimacy and Sexuality.

 Policy 7-Eh.200 is found under the nursing department.
 This policy had become effective as of June 2013.
 The policy explains its importance and guidelines to support the
right of resident’s sexuality and sexual expression (AgeCare,
2013).
 Includes definitions of sexuality, intimacy and abuse. Contains nine
policy statements emphasizing all residents as individuals with the
right to being treated with respect, and dignity (AgeCare, 2013).
 Although AgeCare has a policy in place regarding residents and
their sexuality their utilization is in question.

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Definitions from AgeCare’s Policy
Sexuality
 A central aspect of being human throughout life and encompasses sex,
gender identities and roles, sexual orientation, eroticism, pleasure, intimacy
and reproduction.
Intimacy
 “The experiences of being known understood and loved. It includes talking
loving words, kissing, hugging, and body contact. A sense of connection of
relationship” (MacCarthy, n.d.).
Abuse
 Abuse of a resident means any action or inaction or power and/or betrayal
of trust or respect by a person against a resident, that the person knew or
ought to have known, would cause (or could cause reasonably be expected
to cause harm to the resident’s safety or well-being.

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Interviews with Stakeholders
❖ Interviews were conducted with
Directors of Care using a modified
version of the the original SexAt tool by
Bauer et al., (2014) at all 5 AgeCare
sites.
❖ The results and overall scores of the
assessment of each facility fell under
the same scoring range of ‘good’
❖ This indicates the facilities are on the
right track but require improvement as
hypothesized.

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5 Themes from Literature Search,
Scan and Interviews
1) Facilities Sexual Policy:

❖ As AgeCare has a policy concerning sexuality, the main

gap identified using the assessment tool was the topic
of sexual behaviour.
❖ It was found that sex was usually not discussed at
intake with residents or during care conferences unless
there were concerns with sexual behaviour or a change
in behaviour which is perceived as negative.

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5 Themes from Literature Search,
Scan and Interviews

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5 Themes from Literature Search,
Scan and Interviews
3) Information and Support for Residents:
❖ This theme had the most ‘no’ responses and
inconsistencies.
❖ There is a lack of resources and information available
for older residents regarding sexual health, what
constitutes consent, what constitutes assault, STI
information and their rights to sexual expression and
access at aged care facilities.

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5 Themes from Literature Search,
Scan and Interviews
4) Physical environment:
❖ Four facilities had indicated that there are no double
beds available.
❖ Most facilities had private rooms available for all
residents, so privacy was not a concern.

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5 Themes from Literature Search,
Scan and Interviews
Safety and risk management:
❖ Training for staff is currently provided as needed and
staff use their discretion or consult with senior staff if
there are concerns of its residents regarding sexual
activity.
❖ Supportive Pathways is a training module available for
all general support staff but it unclear if all staff has
taken it and if this is enough or offer regularly.

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 Consent & Capacity
• Capacity
• Role of the agent/guardian
• Discussions with the resident – means involving the
resident irrespective of capacity
• consent is coming from partner – conflict and assessing
safety
• Resident past experiences and directions
• Contraception – safety from disease
• Disclosure of information to agent/guardian
• Closure with medical provider re: health assessment &
recommendations
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Intake Checklist

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 Checklist for Seniors & Sexuality
Inappropriate Sexual Behavior Checklist (Doll, 2012).

❏ Does the inappropriate behaviour happen frequently?

❏ Is there a pattern to the resident’s behaviour? If so when does it occur?
❏ Is the behaviour sexual or does it have another meaning?
❏ Does there appear to be a triggering incident?
❏ Have there been changes to the resident’s living environment?
❏ Has the resident’s medical condition changed and or has there been new medication
prescribed?
❏ Is the behaviour sexual or does it have another meaning?
❏ Has the resident forgotten the social rules about private behaviours?
❏ Why is the behaviour a problem?
❏ Is the behaviour an indication of a need for attention or due to boredom?
❏ For whom is the behaviour a problem? (staff, family member, resident, other residents)
❏ Is there a risk or benefit to the behaviour? Does the risk outweigh the benefit?
❏ Does the behaviour represent a psychosocial need to be part of the resident? (need to be
reassured due to fear of abandonment)
❏ Could caregivers be misinterpreting the behaviour?

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Checklist for Seniors & Sexuality

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Recommendations for Integration
into Practice
❖ Review of current policy for senior staff
❖ Training for all care staff
❖ Information on sexuality and sexual health for older
adults, families and staff available on site
❖ Contact local organization such as Calgary Sexual
Health Center for resources and information on sexuality
❖ To be proactive instead of reactive to older adults and
sexual activity it would be valuable to discuss sexuality
with residents during their initial intake to the facility

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Conclusion
❖ The topic of sexuality, and older adults in residential
aged care facilities is complex and has many
components to consider when creating a policy to
address this need.
❖ AgeCare has prided itself on being unique and providing
outstanding care and homes for older adults. By adapting
and updating its sexual intimacy policy to meet the needs
of its residents AgeCare will be innovative of other aged
care facilities that serve older adults.

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Questions:

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References
❖ Bauer, M., Fetherstonhaugh, D., Tarzia, L., Nay, R., & Beattie, E. (2014).
Supporting residents’ expressionof sexuality: the initial construction of a
sexuality assessment tool for residential aged care facilities. BMC
geriatrics, 14(1), 82. Retrieved from:
https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-14-82
❖ Doll, G. A. (2012). Sexuality & long-term care: Understanding and
supporting the needs of older adults. Baltimore, Md: Health Professions
Press.
❖ MacCarthy, B. (n.d.). No more puritanical sexuality in aged care: A hopeful
and positive approach to sexuality in dementia. Retrieved from:
https://www.dementia.org.au/sites/default/files/20070531_Nat_CON_McCa
rthySexuality.pdf
❖ Photographs by and Pixaby
❖ School of Social Science. (2017, September 15 ). Sex, Love and Intimacy
in Later Life. [Video file]. Retrieved from
https://www.youtube.com/watch?v=PWIcttU5BWE
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