Module 2 Discussion on Health assessment and Promotion
After reading an article in The Ney York Times by Ezekiel Emanuel on Jan 18, 2014 titled Sex and the Single Senior, I identified some of sexual issues experienced by residents in assisted living. This situation I related it with six to seven years ago, when my grandfather was living in assisted living facility. During one of our usual visits, he explained his liking to a ‘newbie’ in the facility. He talked lengthily for hours about the woman which occupied most of our time during the visit. During the second visit after that incident, he was eager to explain how he was in love with Lucil (not her real name). This was controversial where some family members thought it was normal while others thought it was an expression of problem behaviour. Upon consulting the management, I realized that sexual expression among the elderly is normal and they have rights to sexual feelings which requires expression.
Upon reading the article by Emanuel on Jan 18, 2014, I realized that there is need to introduce tools and information to address the aspect of sexual health as well as eliminating the barriers of intimacy in this population (Emanuel, 2014). Before formulating interventions and education programs effective for this group, it is first important to understand the diverse ways the residents express their sexuality. Another important aspect is the perception both for the residents and that of families which requires to be considered in the program. One of the major causes of controversy based on my example above is societal expectations. We grew understanding sex as a form of procreation in marriage and was associated with appearances of youths and physical activities. Because persons in assisted living care do not meet the youthful standards of attractiveness and beauty, any attempt of sexual relationships in this population evokes denial, disgust and distaste.
Another aspect to consider during the formulation of the program is tackling the attitudes of nurses. According to Rheaume and Mitty (2008), majority of nurses in assisted living have minimal understanding of the sexual need and sexuality of the elderly. To enhance continuity of sexual activities among the elderly requires changing the negative attitudes of nurses toward residents. one of the probable interventions is assessment using PLISSIT Model. Center on Aging (2003) defines a PLISSIT model as a tool to assess the aspect of sexuality among the elderly and provides a guideline for prevention mechanism of probable sexual related issues. PLISSIT stand for Permission, Limited Information, Specific Suggestions, and Intensive Therapy.
The first aspect of this model, permission, requires the health professional to either ask the elderly about their sexual issues. Nonetheless, this format may alleviate feelings of anxiety or guilty as they would be uncomfortable. The second component of permission is assuring the resident that their fantasies, feelings, and thoughts are normal as long as their behavior does not injure others. The second aspect of this model is providing limited information like the general physiology and anatomy in relation to age related changes as well as sexual functioning. This strategy according to Rheaume and Mitty (2008) eliminates any misconception that has the ability to impair sexual function. In this step, the health professional may guide and provide information to the resident on sexual related illness and way to prevent them by use of condoms.
A therapist or sex counsellor should formulate individualized intervention for the elderly couple. Some of essential aspects to include in this phase include practical advice on mutual pleasuring exercises, arousal techniques and safe sex procedures (like HIV testing and condom use). This phase is effective as it will prompt communication and reduce stress and anxiety levels of the resident. Nonetheless, Frankowski and Clark (2009) advise that if the issue is about the relationship rather than the sexual activity, an intensive therapy is required. However, based on the New York article, PLISSIT would be an effective program to reduce sexual transmitted diseases, misconception and attitudes of families and health professionals, and reducing stress and anxiety among residents. On the last aspect, we all know the medicinal value of companion and love, and do you think it will benefit the elderly?
Center on Aging. (2003). Pioneering Change Sexuality in Nursing Homes Education Module. State of Kansas Office Of Technology Services.
Emanuel, E. (2014). Sex and the Single Senior. The New York Times. Retrieved from https://www.nytimes.com/2014/01/19/opinion/sunday/emanuel-sex-and-the-single-senior.html?_r=0
Frankowski, A., & Clark, L. (2009). Sexuality and intimacy in assisted living: Residents’ perspectives and experiences. Sexuality Research and Social Policy, 6(4), 25-37. doi: 10.1525/srsp.2009.6.4.25
Rheaume, C., & Mitty, E. (2008). Sexuality and Intimacy in Older Adults. Geriatric Nursing, 29(5), 342-349. doi: 10.1016/j.gerinurse.2008.08.004
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