Portal de Periódicos da CAPES

Policies Regarding Sexual Expression in Spanish Long‐Term Care Facilities for Older People

2018; Wiley; Volume: 66; Issue: 5 Linguagem: Inglês

10.1111/jgs.15345

1532-5415

Montserrat Celdrán, Feliciano Villar, Rodrigo Serrat, Josep Fabà, Teresa Martínez,

Intergenerational Family Dynamics and Caregiving

Journal of the American Geriatrics SocietyVolume 66, Issue 5 p. 1044-1045 Letter to the EditorFree Access Policies Regarding Sexual Expression in Spanish Long-Term Care Facilities for Older People Montserrat Celdrán DPsy, Montserrat Celdrán DPsy orcid.org/0000-0003-3606-1975 Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorFeliciano Villar DPsy, Feliciano Villar DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorRodrigo Serrat DPsy, Rodrigo Serrat DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorJosep Fabà DPsy, Josep Fabà DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorTeresa Martínez DHealthSci, Teresa Martínez DHealthSci Social Services and Rights Department, Principado de Asturias, Asturias, SpainSearch for more papers by this author Montserrat Celdrán DPsy, Montserrat Celdrán DPsy orcid.org/0000-0003-3606-1975 Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorFeliciano Villar DPsy, Feliciano Villar DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorRodrigo Serrat DPsy, Rodrigo Serrat DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorJosep Fabà DPsy, Josep Fabà DPsy Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, SpainSearch for more papers by this authorTeresa Martínez DHealthSci, Teresa Martínez DHealthSci Social Services and Rights Department, Principado de Asturias, Asturias, SpainSearch for more papers by this author First published: 12 March 2018 https://doi.org/10.1111/jgs.15345Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL In the last few years, there has been increasing interest in the sexual rights and sexual expression of older people living in long-term care facilities (LTCFs).1-4 Although many of these studies conclude that institutions should implement explicit policies designed to deal with residents' sexual rights,5 little is known about the frequency with which these policies are implemented and what kinds of policies are the most popular. The few studies published to date, all coming from Anglo-Saxon countries, suggest that these policies are rarely implemented, which may represent a barrier to residents' sexual expression. For instance, one study found that, although most facilities claimed to have a general policy regarding dignity and respect for residents' rights, just 10% of the 198 participant nursing homes specifically mentioned sexuality within these rights.6 Similarly, another study found that two-thirds of 366 nursing homes surveyed did not have a policy regarding residents' sexual expression, even though most of them recognized that there had been problems regarding residents' sexual expression in their facilities.7 We conducted a study to explore the presence and nature of sexual expression policies at LTCFs in Spain. We contacted directors of nursing (DONs) at LTCFs in different Spanish autonomous communities to explain the objectives of the study and to outline the procedure for data collection. Of the 245 who agreed to participate, 152 returned the completed questionnaire (62% response rate). The University of Barcelona ethics committee approved and supervised the entire process. Participants completed a self-administrated 26-item inventory, each item addressing a sex-related policy and selected from the SexAT questionnaire.8 Specifically, 4 experts (1 DON, 1 psychologist working at a LTCF for older people, 1 head of a regional social service agency in charge of supervising LTCFs, 1 member of the research team) rated each SexAT item in terms of its importance for protecting residents' sexual rights and its relevance in the Spanish context. The 26 items (of the original 69) that consistently presented the highest scores were included in the final version of the inventory. These items were grouped into 4 areas (explicit rights guaranteed, staff practices and behavior, facilitating resources and materials, training and information) according to their content, and their order was randomized. For each item, participants were asked to indicate whether the policy was implemented at their LTCF. We calculated the percentage of institutions at which each policy was included in the inventory, as well as the mean percentage of policies implemented, for each content dimension and in total. We found greater diversity between policies (Table 1). Although at least 8 of 10 LTCFs implemented some (particularly those related to the explicit recognition of sexual rights and sexual diversity), others were hardly present at all in 40% of centers, such as availability of sexual aids or policies related to training and information. There were important differences in the frequency of items included under each dimension. So, although the presence of sexual behavior policies at Spanish LTCFs seems to be higher than reported in previous studies, it is an area in which institutions need to improve. Table 1. Percentages, Dimension Mean Percentages, and Total Mean Percentages of the Inventory on Sexual Policies (N = 152) Inventory % Explicit rights guaranteed (6 items) 25. Explicit recognition and acceptance of residents' sexual diversity 86.2 1. Explicit recognition and support of residents' right to sexual expression 82.9 17. Residents' sexual rights prioritized over relatives' opinions 75.0 6. Homophobic, sexist, or ageist language explicitly banned 64.5 7. Explicit recognition of residents' right to have sexual relations with nonresidents in their rooms 42.8 11. Outreach materials available including information about residents' right to express their sexuality 31.6 Dimension mean percentage 63.8 Staff practices and behavior (5 items) 5. Staff knock on the door before entering residents' rooms 72.4 23. Physical and chemical restrictions are used only in critical situations 75.0 3. Residents' sexual needs are taken into account in personalized caring plans 53.3 22. Availability of a written procedure to identify, prevent, and act in case of sexual abuse 50.0 10. Information regarding medication side effects is provided to residents 40.1 Dimension mean percentage 58.2 Facilitating resources and materials (7 items) 19. Double rooms available for residents willing to share room 93.4 2. Residents allowed to have sexual images or materials in their rooms 67.8 21. Measures available to warrant privacy for those who share a room but are not a couple 62.5 18. Individual rooms available for those who decide to live alone 48.0 15. Sex aids and materials available for residents 32.9 20. Double beds available for couples 32.9 4. "Do not disturb" signs available in residents' rooms 30.3 Dimension mean percentage 52.5 Training and information (8 items) 16. Information available regarding who to address in case of sexual abuse or discrimination 64.5 24. Trained staff available to assess the capacity of residents with dementia to consent 63.2 14. Trained staff available to advise residents, families, and other professionals on matters of sexuality and sexual diversity 53.9 8. Training regarding residents' sexual needs and rights provided to staff 46.1 26. Activities available to promote residents' tolerance and acceptance of sexual diversity 44.1 9. Training and advice regarding residents' sexual needs and rights provided to residents and their families 39.5 12. Written information regarding residents' sexual issues provided to staff 37.5 13. Written information regarding sexual issues provided to residents 30.9 Dimension mean percentage 47.5 Total mean percentage 55.5 Any interpretation of the results of the present study should take into account its limitations. First, our sample was obtained using a nonprobability procedure and from a single country, which limits the generalizability of the results. Second, the presence or absence of policies was derived from DONs' reports and not from objective measures; the potential influence of social desirability, which may have caused respondents to overestimate the implementation of policies, should be taken into account. Our findings suggest that, although formal recognition of sexual rights and diversity seems to be the norm, specific policies are still not generalized in Spanish LTCFs, so there is still much room for improvement in this field, particularly in areas such as training and availability of resources and materials. The inventory used in this study could be useful for management and staff to establish which policies are implemented and how practices in this area might be improved. Acknowledgments Conflict of Interest: The authors declare that they have no conflict of interest. Author Contributions: All authors have contributed significantly to the research on which this paper is based, and they are all in agreement over its contents. Sponsor's Role: No sponsor support this research. References 1 Rowntree MR, Zufferey C. Need or right: Sexual expression and intimacy in aged care. Aging Stud 2015; 35: 20– 25. 2 Tarzia L, Fetherstonhaugh D, Bauer M. Dementia, sexuality and consent in residential aged care facilities. J Med Ethics 2012; 38: 609– 613. 3 Bauer M, McAuliffe L, Nay R. Sexuality, health care and the older person: An overview of the literature. Int J Older People Nurs 2007; 2: 63– 68. 4 Lichtenberg PA. Sexuality and physical intimacy in long term care. Occup Ther Health Care 2014; 28: 42– 50. 5 Doll GM. Sexuality in nursing homes: Practice and policy. J Gerontol Nurs 2013; 39: 30– 37. 6 Shuttleworth R, Russell C, Weerakoon P et al. Sexuality in residential aged care: A survey of perceptions and policies in Australian nursing homes. Sex Disabil 2010; 8: 187– 194. 7 Lester PE, Kohen I, Stefanacci RG et al. Sex in nursing homes: A survey of nursing home policies governing resident sexual activity J Am Med Dir Assoc 2016; 17: 71– 74. 8 Bauer M, Fetherstonhaugh D, Tarzia L et al. Supporting residents' expression of sexuality: The initial construction of a sexuality assessment tool for residential aged care facilities. BMC Geriatr 2014; 14. Citing Literature Volume66, Issue5May 2018Pages 1044-1045 ReferencesRelatedInformation