Sexuality in the nursing home,part 1: attitudes and barriers to sexual expression

Sexuality is a basic human need that begins at birth and continues throughout life. The sexual needs of the elderly are similar to those of the young, but with variations in frequency, intensity, and mode of expression. Regardless of age, every individual has a need for love, intimacy, and companionship. Unfortunately, however, stereotypical thinking, ignorance, and prejudice dominate Western society's view on sexuality in the elderly. In a youth-oriented culture, sexuality is attributed to the young, healthy, and beautiful, and the myth that the elderly are asexual beings predominates. Consequently, the sexual needs of the elderly are frequently overlooked and ignored. Nowhere is this more emphatic than in the nursing home setting. This article explores barriers to sexual expression in the nursing home setting and discusses strategies to overcome them.     

End-of-life experiences and the dying process in a Gloucestershire nursing home as reported by nurses and care assistants

This article presents an interim study into the end-of-life experiences of elderly residents in a Gloucestershire nursing home as reported by nurses and care assistants. It draws comparisons between the experiences of an end-of-life experiences pilot study conducted with the Camden Palliative Care Team in the United Kingdom with those of the nursing home staff to consider whether the dying experience of elderly nursing home residents is the same as those whose lives are foreshortened through terminal illness. It draws the conclusion that elderly residents have end-of-life experiences similar to those described in the Camden pilot study. It also examines the effect that end-of-life experiences have on the carers and reflects on possible needs for specialized training and support to deal with such existential issues.     

Sexual and institutional issues when one spouse resides in the community and the other lives in a nursing home

Later life marriages often include one partner caregiving another. In some situations, institutionalization of a mate may become a viable option. One issue requiring attention when one mate resides in a nursing home and the other lives in the community is that of sexuality between the couple. Four issues are discussed: intimacy/sexual needs of the nursing home resident and the communitydwelling spouse, sexually inappropriate behaviors as related to sexuality between a nursing home resident and his/her spouse, and the role of the nursing home in facilitating relationships between these couples. Clinical implications of these issues are also explored.     

The need for training in gerontology and geriatrics among the staff providing services at a geriatric care institution

The purpose of this qualitative study was to explore and identify the basic training needs of nursing home staff, in terms of attitudes, knowledge and skills required to work effectively with geriatric patients. Three focus groups were performed, two groups of employees, and a group of elderly residents of the institution, in order to explore issues pertaining to the following topics: personal attributes required to work with geriatric patients, basic knowledge and skills needed to provide effective services. Group discussions were transcribed and themes were extracted through consensus reached by the investigators. Results indicated that the interviewed staff lack of formal preparation or continuing education in gerontology or geriatrics. Needs identified were the following: the aging process, caring behaviors, management of common health conditions, administration of medications, transference and mobility of residents, among others. Finding were use to design an educational program aimed in assisting nursing home staff in providing an effective service to their geriatric patients.     

Everyday doings in a nursing home – described by residents and staff

Objective: For many groups of elderly people it is important to be active, which can be hindered by disabilities that come with age. Research has progressed in this area but mostly concerns the elderly living at home. The aim of this study was to examine how residents and staff at a nursing home described the residents’ everyday doings. Methods: A nursing home was selected in which 15 of the residents and six of the staff were interviewed about the residents’ activities during an ordinary day and week. Results: The material was analysed using qualitative content analysis in which two categories emerged: shared doings and individual doings. The shared doings were important for supporting the residents in their social and physical activities, but participation in these was often hampered by reduced functions. The individual doings, where the residents’ own interests can be promoted, were also hampered by their disabilities. Being able to be active and having something to do were emphasized, either continuing with previous activities or participating in shared activities at the nursing home. Conclusions: Receiving care and being forced to adjust to the context at the nursing home had a significant impact on the residents’ daily doings. Most of the residents needed help to be able to continue performing their activities or to find new ones. The social environment consisting of other residents and staff also influenced the residents’ activities.     

Outbreak of Chlamydia pneumoniae infection in a Japanese nursing home, 1999-2000.

OBJECTIVE: To identify risk factors for infection and severe illness due to Chlamydia pneumoniae. METHODS: To identify risk factors for infection, we conducted a case-control study among nursing home residents who had onset of symptoms during December 1, 1999, to February 20, 2000. To identify risk factors for severe illness among nursing home residents, we conducted a retrospective cohort study. SETTING: A nursing home providing long-term and day care services for elderly patients in Japan.Participants. Fifty-nine residents and 41 staff members of a nursing home. RESULTS: The attack rates for respiratory illness were 53% (31 of 59) among residents and 22% (9 of 41) among staff. Infection was confirmed in 15 resident and 2 staff case patients by isolation of C. pneumoniae from nasal swab specimens. Fifteen resident case patients developed severe illness (ie, bronchitis, pneumonia, and hypoxia); one case patient died. The median age of resident case patients was 87 years. We could identify neither the source of the outbreak nor significant risk factors for infection and severe illness in residents. However, residents with a higher level of physical activity were more likely to become infected, whereas older residents (aged more than 85 years) and those with a lower level of physical activity were more likely to develop severe illness (P>.05). Contact with residents was a risk factor for infection in staff (relative risk, undefined; P=.04). CONCLUSIONS: C. pneumoniae can cause large outbreaks of infection and severe illness among elderly persons, and its transmission is likely to be enhanced by close contacts among people in nursing homes. Therefore, early detection of an outbreak by means of better surveillance, and subsequent isolation of patients, may be effective control measures.     

Caring behaviours perceived by elderly residents and their associated factors in nursing homes in Zhengzhou City of China: A qualitative study

Caring is an evidence-supported behaviour or activity which can meet nursing home residents' needs. China has an ever-increasing number of care-dependent individuals in nursing homes. It is important to explore the caring behaviours and to understand the factors associated with the caring behaviours perceived by elderly residents in nursing homes. This will contribute to an evidence-based approach with which to assist healthcare services. This study aims to explore the perceived caring needs, associated behaviours, and their associated factors identified by elderly residents in nursing homes. Fourteen semi-structured interviews were conducted with elderly residents from five nursing homes in three districts across Zhengzhou City, China. Interviews were transcribed verbatim and analysed using the Colaizzi phenomenological method. Five themes and fourteen sub-themes were identified. The availability of health services, a livable environment, and social communication were the main caring needs identified. Nursing assistant factors and resident factors were the main influencers. This study provides valuable information on the need to carry out standardised training of nursing assistants and how to adjust the goal of care in nursing home residents. The medical support, psychological counselling, livable environment, recreational and cultural services as well as caring literacy about nursing assistants in the nursing homes, however, need to be further enhanced to meet the residents' diversified caring needs.     

Sexuality and Intimacy Behaviors in the Elderly with Dementia: The Perspective of Healthcare Professionals and Caregivers

This paper discusses sexuality and intimacy behaviors of the elderly with dementia living in residential care. The study explores this thematic from the perspectives of healthcare professionals and family caregivers. The methodology used is based on a qualitative method approach. The research was conducted in Portugal, using semi-structured face-to-face in-depth interviews. Thirty-two people participated in this study. The qualitative data was analyzed using thematic analysis to help identify repeated patterns of meaning in the dataset. The following key findings emerged: (1) participants identified the presence of sexuality, intimacy and sexual behavior in elderly people with dementia, primarily due to the physiological needs of individuals; (2) sexuality was mostly considered as an important manifestation of love, affectivity and proximity; (3) social and cultural beliefs influenced participant’s perception of the issue, some considering it a taboo subject; (4) participants expressed the need for these behaviors be considered natural and acceptable as sexuality and intimacy are inherent in humans and contribute to an individual’s quality of life hence they should also be dealt with in a practical manner; (5) a general limitation in training and institutional guidelines was identified; (6) decision-making in the area of sexuality should be determined by the elderly if they maintain the ability to manifest what their wishes are. As life expectancy increases along with dementia cases, a better understanding of sexuality in dementia, is of great importance as it could potentially help increased the quality of life for these individuals.

     

Investigating the educational needs of licensed nursing staff and certified nursing assistants in nursing homes regarding end-of-life care

Nursing homes care for people at the end of life (EOL). There is evidence to suggest, however, that nursing staff in these settings is often unprepared to provide a high level of EOL care. This article reports the findings from three preliminary studies that investigated the needs of licensed staff and certified nursing assistants in nursing homes regarding EOL care. The studies involved needs assessment surveys, focus group interviews with staff members, and telephone interviews with nursing home administrators. Data show that the major needs included a lack of knowledge and skills in symptom management; communication difficulties; conflicts with families and physicians; and emotional distress in dealing with time constraints and attachment to residents. Implications for nursing home staff education are described.     

Attitudes Toward Sexuality Among Nursing Home Residents

There is a paucity of data regarding sexuality among nursing home residents. The aim of the present study was to evaluate sexual attitudes in a group of independent residents in a large urban nursing home. Ten items covering different aspects of sexual attitude were scored by two board certified psychiatrists following a semistructured interview. The study was undertaken at a large 1,200-bed nursing home providing services to both healthy independent elderly as well as geriatric patients. Subjects were 31 volunteers: 15 men and 16 women (mean age: 82.4 and 74.1 years, respectively), who consented to participate. Participants were cognitively intact and living independently at the nursing home. Exclusion criteria were: a) current major psychiatric morbidity, b) drug or alcohol abuse, c) Geriatric Depression Scale (short version) score 5, and d) Clinical Dementia Rating >0. A hierarchy of basic functions was constructed wherein each function was graded on a 5-point Likert-like scale reflecting its endorsed importance. The majority (23/31) felt that sexuality should be openly discussed with the elderly by health professionals. Twenty-one of 31 expressed willingness to receive medical consultation and treatment for sexual dysfunction as needed and 20/31 expressed a similar attitude if their partner so needed. The hierarchy of needs was rated by the participants (men and women, respectively) as follows: Mood (4.4; 4.3), Memory (4.2; 4.2), Sleep (3.8; 3.9), Sex (3.5; 2.8), and Appetite (2.8; 2.6). Sex is graded as moderately important among nursing home residents, more so in males. The majority of residents expressed positive attitudes towards open discussion of sexual matters and willingness to accept therapeutic interventions when needed.     

Caring for the institutionalised elderly: how easy is it?

In the light of long-standing criticism of nursing homes an assessment of staff's ability to provide care was required. By creating a profile of nursing home staff it may be possible to explain and predict difficulties in providing care. One hundred and five staff from 15 nursing homes and 18 hostel staff were interviewed to examine demographic characteristics, attitudes to the job and to the elderly, as well as sources of stress in the workplace. Staff were predominantly female, with children, and had a strong sense of altruism and desire to nurture. They foster an atmosphere of care and protection and may unwittingly encourage dependence. This may preclude challenge and rehabilitation for nursing home residents. Constraints such as staff shortages, stress (35.3 per cent cases on the General Health Questionnaire), lack of training, conflict among staff and lack of support may hamper care. These problems could be addressed by additional training and incentives for staff, increased staff cooperation and communication. Medical practitioners and other health professionals have a significant role to play in assuming greater responsibility for supporting the caregivers in nursing homes.     

宝安区西乡街道桃源居社区居家老人护理需求研究

目的调查分析桃源居社区居家老人对社区护理服务需求的现状,为开展居家护理服务和制定内容规划提供依据。方法编制居家老人护理需求评估表,通过专业人员对240名老年人的健康功能状况和居家护理服务需求进行入户评估。结果67.08%的居家老人有居家护理服务,年龄、文化程度、自理能力是影响老年人护理需求的影响因素。结论开展居家护理能够有效提高老年人的自我保健意识和能力,对保障老年人的健康生活具有重要意义。     

社区失独家庭慢性病老人居家护理直接成本调查与分析

目的调查重庆市某主城区失独家庭慢性病老人居家护理服务直接成本,为社区护理服务成本管理提供参考。方法采用案例调查法和访谈法,以重庆市某主城区3个社区382名失独家庭老人和3个社区卫生服务中心124名护理人员为研究对象,确定失独家庭慢性病老人居家护理服务项目和成本构成要素,核算护理服务项目直接成本。结果共确定了22项护理服务项目,其中,糖尿病8项、高血压4项、冠心病5项、其他疾病5项;生命体征测量项目直接成本最低（1.5元）,糖尿病伤口换药项目直接成本最高,在22.8元～57.0元之间。失独家庭慢性病老人居家护理服务项目中血糖监测、PICC维护及引流管护理盈利,其他项目处于亏损状态。结论护理服务项目计价标准较低,未能体现社区护理人员劳动价值;失独家庭扶助金标准较低,难以减轻居民经济负担;社区护理人员学历、职称不高,难以满足失独家庭慢性病老人心理需求。建议动态调整居家护理服务项目物价标准,提高失独家庭老人救助金标准,加强“互联网+社区护理”体系建设,完善人才队伍结构,有效利用社会资源。     

The Use of Humor in Addressing the Sexuality of Elderly Nursing Home Residents

This paper is drawn from a large phenomenologically based study which investigated the nursing home carers' experiences of elderly residents' sexuality. Joking and teasing with the residents was an acknowledged way for staff to deal with sexuality in the nursing home. Whilst humor can be used in a therapeutic way to establish and maintain rapport, as well as to deal with incidents which are uncomfortable, joking is also known to be an effective way to manipulate and control people. Teasing can be used as an effective strategy to discourage certain types of behavior.     

Partnership working by default: district nurses and care home staff providing care for older people

Older people residents in care homes that only offer residential care rely on primary healthcare services for medical and nursing needs. Research has investigated the demands that care homes staff and residents make on general practice, but not the involvement of other members of the primary healthcare team. This paper describes two consecutive studies completed in 2001 and 2003 that involved focus groups and survey methods of enquiry conducted in two settings: an England shire and inner London. The research questions that both studies had in common were (1) What is the contribution of district nursing and other primary care services to care homes that do not have on‐site nursing provision? (2) What strategies promote participation and collaboration between residents, care home staff and NHS primary care nursing staff? and (3) What are the current obstacles and aids to effective partnership working and learning? A total of 74 community‐based nurses and care home managers and staff took part in 10 focus groups, while 124 care home managers (73% of the171 surveyed) and 113 district nurse team leaders (80% of the 142 surveyed) participated in the surveys. Findings from both studies demonstrated that nurses were the most frequent NHS professional visiting care homes. Although care home managers and district nurses believed that they had a good working relationship, they had differing expectations of what the nursing contribution should be and how personal and nursing care were defined. This influenced the range of services that older people had access to and the amount of training and support care home staff received from district nurses and the extent to which they were able to develop collaborative and reciprocal patterns of working. Findings indicate that there is a need for community‐based nursing services to adopt a more strategic approach that ensures older people in care homes can access the services they are entitled to and receive equivalent health care to older people who live in their own homes.     

Tuberculosis among institutionalized elderly in Alberta, Canada.

Previous studies in the US have suggested that the risk of tuberculosis is increased among elderly residents of nursing homes. This registry-based study determined and compared the tuberculosis incidence rate for the elderly in nursing homes and community dwellings in Alberta, Canada, over the 5-year period 1979-1983. Rate ratios (RR) using the community elderly rate as baseline, were estimated for all notified cases and for culture positive cases only. Adjustment was made for the variables age, sex, and ethnicity. The nursing home elderly in Alberta did not have an increased risk of tuberculosis: adjusted RR = 1.09, 95% CI : 0.38-1.80.     

Linking young and old institutionalized people.

A proprietary nursing home for the elderly in the State of North Carolina succeeded in pairing itself for joint activities of residents with an institution for the young mentally retarded. The young and old residents of the two homes were thus enabled to help each other, and thereby to help themselves as well. For the nursing home residents, this program provided an opportunity to engage in respected volunteer work and to regain a meaningful role in the community. It is believed that indications drawn from this demonstration of interaction between a nursing home and a home for the mentally retarded can aid in farther planning of such arrangements and in identifying research needs and potentials. Although only relatively few of the mildly impaired elderly in the nursing home volunteered for the joint activity, the ripple effect of the project extended beyond the direct participants. Since residents of the two institutions alternated visits, nonparticipants had a chance to observe and even participate in the activities for short periods. Even those who chose not to participate at all shared in the enriched conversation that resulted from this experience. The project was obviously a source of satisfaction and pride to residents of the nursing home, and the activity was eagerly received by the mentally retarded youngsters. The program demonstrates that aged persons in nursing homes can be tapped as a resource for providing service to institutionalized mentally retarded children and that a mutually beneficial relationship between the two institutions can accompany such service. Many leads for worthwhile research emerge from this pilot project.