GRT 3110 Chapter Notes - Chapter chapter 14: Resource Access Control Facility, Ageism, Sex Education
11 Jan 2017
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Reading # 14: Dementia, sexuality and consent in residential aged care facilities
Guiding Questions:
1. Sexuality tend to be ignored in residential aged care facilities, ageism and the medias
association of youth and beauty with sexuality puts older adults in a sexless and undesirable
category, these negative attitudes can be held by staff and family of the residents, consequently
sexuality is not treated as a priority for care
2. Existing research suggest that residents want their sexual expression acknowledged, they
believed that their health professionals should ask them about their sexuality, sexual sensation
are among the last of the pleasure giving biological processes to deteriorate and are enduring
source of gratification at a time when pleasures are become fewer and fewer, Benefits: feeling
masculine or feminine, pleasurable, a way of communication, releasing tension, affirming life,
sharing affection and tenderness
3. Barriers to sexual expression in RACF
• Lack of privacy
• single bed rooms
• ageism and negative views of older adult sexuality by staff
• staff struggle to balance residents rights with their duty of care
• idea by staff of protecting patient but actually creating social control
• lack of inclusion of patient in decision making- health professionals and family members
choosing if relationship is positive or negative
• Lack of policy or training for staff
• Absence of formal guidelines and policies
• RACF have no intention to change the current culture and oversight
• Making a patient with dementia prove competent and capacity to make rational choices
(should be assumed until proven otherwise)
4. When relationship are based on mistaken identity
• Can be psychologically harmful – old memories may be stirred up leading to emotional
moments of relational recollection
• Arouse feelings of shame, regret as one become conscious of sharing intimate
relationship with a total stranger
5. Four criteria essential to determine decision-making capacity, 1- Ability to communicate a
choice, 2-Understand the relevant information, 3-Appreciate the situation and its consequences,
4-Display reasoning. Understanding of the concept of capacity: Whether a resident with
dementia can give or withhold consent to the formation of a relationship and physical intimacy,
Individuals with dementia may not always be able to verbalize their choices which makes
determining concern or refusal less straightforward
6. More relatable to ice cream flavors as the implications and consequences of the decision,
Different decisions require different levels of capacity (choosing flavor of ice cream or to get
surgery or not)- sexual behavior is closer to ice cream in terms of decision making
7. Double bedrooms, policies to support safe sexuality, education program for residents, education
and training for staff to deal with dementia and sexuality, encouraged staff and resident
communication and staff interpretation of communication whether verbal or non-verbal
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Summary:
• Sexual self-determination is a human right
• RACF struggle
o To balance residet’s rights with their duty of care
o With negative attitudes towards older people’s sexuality = can lead to sexual expression
being overlooked, ignored and discouraged
o Question of consent to sexual activity or physically intimate relationships
• Sexuality= ignored or poorly addressed by RACF in terms of policies and institutional frameworks
• Expression of sexuality through: kissing, hugging, touching, flirting, masturbation, intercourse
• Benefits: feeling masculine or feminine, pleasurable, a way of communication, releasing tension,
affirming life, sharing affection and tenderness
• Sexual sensation are among the last of the pleasure giving biological processes to deteriorate
• ARGUE:
o Formation of relationships, physical intimacy and the expression of sexuality are a basic
human right and a normal and healthy part of ageing
o Older people in RACF including those with dementia have the right to make and at very
least be involved in decisions
o Issues surrounding capacity of consent (dementia)
o Should not negate the right of sexual expression or the rights of residents to be involved
in decisions about their own sexuality
• Current legislation, policies and attitudes in residential aged care
o Older people tend to be viewed negatively (ageism)- in the media presenting older
people as sexless and undesirable
o Researchers argue that ageism is connected both with fear of death and a value system
focusing on productivity
o Research suggest that residents
▪ Want their sexual expression acknowledged
▪ Believe that health professionals should ask them about their sexual needs
o Most RACF do not have formal policy guidelines or training for staff to meet their
sexuality needs (issues are dealt with case by case)
o Problems with RACF
▪ Priay issue: doors do’t lok
▪ Only single bed rooms
▪ Dementia – sexuality inappropriate- anxiety about consent
▪ Decisions are made without resident on promotion or discouragement of
relationship
o Law does not offer guidance between promoting individual rights and protecting
vulnerable people when it comes to sexual expression
o Issue:
▪ absence of formal guidelines and policies
▪ RACF have no incentive to change the current culture of oversight
• Capacity and consent for residents with dementia
find more resources at oneclass.com
find more resources at oneclass.com
