Ethical dilemmas concerning sexuality of elderly patients suffering from dementia

Abstract

This study endeavoured to clarify the ethical dilemmas concerning sexuality encountered by nurses caring for elderly patients suffering from dementia, and to assist the decision-making process of the nurses and staff who handle dilemmas of this nature. Many of the staff in geriatric institutions report difficulties, confusion, embarrassment and helplessness as well as negative responses and rejection when encountering sexual situations between patients of the same or different sex, patients and staff members or between patients and visitors. Embarrassment over sexuality is felt by staff members, visitors and family. This embarrassment may result in elderly patients being treated like children, and being separated from their partners. A response of this nature can provoke anger in the patients, sometimes leading to violence. The central dilemma on the subject of sexuality in a geriatric institution is the fact that staff are in conflict between the desire to protect the elderly patients and maintain their dignity and the patients' desire to fulfil their sexual needs. Since no single, definitive prescription can be provided for conduct acceptable to the staff, the patients and their families, it was decided to work with the staff on the basis of case studies to help them in selecting ways of coping.

Workplace errors and negative knowledge in elder care nursing

“…Regarding existing rules specific to any professional practice, it is not clear how purposefully these rules are paraphrased as 'dos and don'ts'. Even so, 'do and don't' phrases are quite common in nursing literature (Ehrenfeld et al 1997;McConnell 2002;Wentz, Karch, and Karch 2000). Despite the dualistic character of the expression, it mostly refers to non-dualistic concepts such as 'rules of thumb' that contain essential guidelines for work practice.…”

“Behind Closed Doors with open minds?”: A qualitative study exploring nursing home staff’s narratives towards their roles and duties within the context of sexuality in dementia

“…While residents may want their sexual desires to be acknowledged (Aizenberg, Weizman & Barak, 2002;Casta-Kaufteil, 2004;Lemieux et al, 2004), care home staff often report difficulties when encountering sexual situations for residents with dementia, due to their communication difficulties, declining decision making capacity and staff's own desire to protect and maintain the resident's dignity (Ehrenfeld et al, 1997;Tarzia et al, 2012). Resident and staff safety, risk of abuse, aggression and inappropriate sexual behaviours (ISB) are some of the key concerns of care home staff when responding to sexual relationships involving residents with dementia (ILCUK, 2011;Villar et al, 2014).…”

Intimacy and Institutionalized Cognitive Impaired Elderly

“…Ehrenfeld and colleagues reported from their observations of the interactions of 25 staff nurses with 48 institutionalized psychogeriatric patients over a period of 14 weeks that staff members often treated their elderly patients like small children (Ehrenfeld, Bronner, Tabak, Alpert, & Bergman, 1999). Nursing personnel often reported feeling confused, embarrassed, helpless, angry, and repulsed when they discovered that residents were having sexual activity in the facility (Ehrenfeld, Tabak, Bronner, & Bergman, 1997). In a survey study of 113 nursing home staff members located in three states, almost one half of the respondents indicated that even behaviors such as hugging and holding hands were difficult for them to deal with (Holmes, Reingold, & Teresi, 1997).…”