Sexuality Assessment for Older Adults

Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing New York University, College of Nursing Issue Number 10, Revised 2007

Series Editor: Marie Boltz, MSN, APRN, BC, GNP

Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP New York University College of Nursing
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WHY: Although it is commonly believed that sexual desires diminish with age, several researchers have identified that sexual patterns persist throughout the life span. The landmark study by Masters and Johnson (1986) indicates that older adults continue to enjoy sexual relationships throughout each decade of their lives. The expression of sexuality among older adults results in a higher quality of life achieved by fulfilling a natural desire. Although the need to express sexuality continues among older adults, they are more susceptible to many disabling medical conditions such as cardiac problems and arthritis, as well as normal aging changes that may make the expression of sexuality difficult. In addition, the treatments used for medical conditions may also hinder the older adult’s sexual response. Nurses are in an ideal position to assess these normal aging changes, as well as disabling medical conditions and medications, and to intervene at an early point to prevent or to correct sexual problems.

BEST TOOL: The PLISSIT model has been used to assess and manage the sexuality of adults (Annon, 1976). The model includes several suggestions for initiating and maintaining the discussion of sexuality with older adults. Suggested questions to guide the discussion of sexuality are also provided.

TARGET POPULATION: The PLISSIT model and the questions suggested on the reverse page may be used with older adults in a variety of clinical settings. The goal of the assessment is to gather information that allows the client to express his or her sexuality safely and to feel uninhibited by normal or pathologic problems. It is common for healthcare professionals to feel uncomfortable with assessing the sexual desires and functions of all clients. Regardless, a sexual assessment should be performed as a routine part of the nursing assessment. Knowledge, skill, and a sense of one’s own feelings and sexuality will provide the comfort necessary for the nurse to assess the sexuality of older adults.

VALIDITY AND RELIABILITY: Despite the findings that sexuality continues throughout all phases of life, little material, scientific or otherwise, exists in the literature to guide nurses toward assessing the sexuality of older adults. Consequently, validity and reliability to support the PLISSIT model or the suggested questions are not available. Further research in the area of sexuality among older adults is imperative.

STRENGTHS AND LIMITATIONS: The PLISSIT model and suggested discussion questions are not diagnostic in any manner but rather provide guidance for further work-up or referral. As sexuality is discussed, the model and questions provided help initiate and maintain discussions of sexuality.

MORE ON THE TOPIC: Best practice information on care of older adults: GeroNurseOnline.org. Annon, J. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of sex education and therapy, 2(2), 1-15. Butler, R.N., & Lewis, M. I. (2002). The new love and sex after 60 (Revised ed.). NY: Ballantine Books. Drench, M.E., & Losee, R.H. (1996). Sexuality and sexual capacities of elderly people. Rehabilitation Nursing, 21(3), 118-123. Ginsberg, T.B., Pomerantz, S.C., & Kramer-Feeley, V. (2005). Sexuality in older adults: Behaviours and preferences. Age and Ageing, 34(5), 475-480. Johnson, B. (1997). Older adults’ suggestions for healthcare providers regarding discussions of sex. Geriatric Nursing, 18(2), 65-66. Wallace, M. (2003). Sexuality in Long Term Care. Annals of Long Term Care, 11(2), 53-59. PLISSIT MODEL P obtaining Permission from the client to initiate sexual discussion LI providing the Limited Information needed to function sexually SS giving Specific Suggestions for the individual to proceed with sexual relations IT providing Intensive Therapy surrounding the issues of sexuality for that client This article originally appeared in the “Journal of Sex Education and Therapy”, a publication of the American Association of Sexuality Educators, Counselors and Therapists (AASECT).

QUESTIONS TO GUIDE SEXUALITY ASSESSMENT AMONG OLDER ADULTS

•Can you tell me how you express your sexuality?

•What concerns or questions do you have about fulfilling your continuing sexual needs?

•In what ways has your sexual relationship with your partner changed as you have aged?

•What interventions or information can I provide to help you to fulfill your sexuality?

Adapted from Wallace, M. (2000). Intimacy and sexuality. In A. Lueckenotte (Ed.). Gerontological nursing (Revised ed.). St. Louis: Mosby Year Book, Inc. Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that The Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronic format, including PDA format. Available on the internet at www.hartfordign.org and/or GeroNurseOnline.org. E-mail notification of usage to: hartford.ign@nyu.edu.