Sexual rights compromised in aged care

Intimacy and sexuality are often ignored or actively discouraged in residential aged care settings, La Trobe University research has found.   

“Everyone has their own morals around sexuality and expression of sexuality. Staff don’t have much guidance around what to do about it,” co-lead author Professor Deirdre Fetherstonhaugh – from La Trobe University’s Australian Centre for Evidence Based Care – told Australian Ageing Agenda.

Alongside research fellow Dr Linda McAuliffe, Professor Fetherstonhaugh led a national survey of almost 3,000 aged care homes to determine what factors influence staff decisions to intervene over matters of a consensual sexual nature.

“It provided us with some insight into how residential aged care staff make decisions regarding the intimacy and sexuality of older people and how personal views and values might guide practice when there is an absence of formal policy,” said Professor Fetherstonhaugh.

Their research found that only:

• 55 per cent of aged care facilities have a written policy on sexuality
• 17 per cent have a policy around sexual health
• 34 per cent have a policy addressing sexual behaviour.

“The net result is that resident sexuality is at best overlooked and at worst actively discouraged,” said Professor Fetherstonhaugh.

A number of barriers prevent residents from enjoying intimacy and expressing their sexuality. While some of those barriers are environmental – such as a lack of privacy – other barriers include ageist views held by staff.

“People seem to think that people don’t have sexual relationships when they are older, which is not true,” Professor Fetherstonhaugh told AAA. “Therefore, [facilities] don’t have policies around that in aged care.”

It’s important, said Professor Fetherstonhaugh that – as Australia’s ageing population grows and the need for residential aged care increases – older people’s sexual rights are acknowledged and respected.

“Intimacy contributes to our wellbeing and extends into older age, despite cognitive or physical impairment. However, unlike their community-dwelling peers, who continue to enjoy their right to sexual freedom, aged care residents often find that their right to sexual freedom is hampered.”

Capacity to consent

The La Trobe research centred around a case study of a fictional couple – Norm and Carol – who develop a close, intimate relationship while in residential aged care.

Senior staff were initially asked whether they would intervene in such a relationship. More than 90 per cent of respondents said no, with just 10 per cent saying they would.

However, when the case study was varied to indicate Norm was expressing distress in Carol’s presence, 89 per cent of respondents said they would intervene to end the relationship.

Level of intimacy was also found to influence staff intervention, with 47 per cent of respondents indicating that they would be more likely to intervene if the couple engaged in acts of a physical sexual nature.

But even when viewed positively, sexuality in residential aged care was still found to pose a challenge to staff with 29 per cent of respondents saying they’d intervene if a resident had cognitive impairment. “You want to make sure that if one person has dementia, that they are able to give consent to that relationship,” said Professor Fetherstonhaugh.

Currently, in such cases, staff negotiate a “delicate balance” between a resident’s sexual rights and a professional duty of care. “The consent issue is difficult because there is no hard and fast way to determine capacity,” said Professor Fetherstonhaugh.

Overall the survey findings published in BMJ Journal of Medical Ethics showed a wide variation in current staff responses to sexual behaviour and that those responses are likely to be influenced by personal morals rather than formal policies.

“There are still quite a few facilities that don’t have policies in this area,” said Professor Fetherstonhaugh. “Further research could be directed towards developing comprehensive yet flexible, person-centred policies to guide staff.”

Next month, Professor Fetherstonhaugh and Dr McAuliffe are holding a session on intimacy in residential aged care at a workshop addressing unwanted sexual behaviour in residential aged care. The interactive workshop – which is an initative of the Australian Centre for Evidence Based Care and Residential Aged Care Communiqué – features a lineup of experts including Professor Joseph Ibrahim.

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