Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 136

Sexuality does not necessarily cease on entry into a nursing home. However, there are multiple barriers to sexuality within the nursing home, including lack of privacy, lack of a partner, and staff, family, and resident attitudes and knowledge concerning sexuality.⁷ There has been a movement toward permissive attitudes among nursing home staff regarding sexual activity of residents through staff education and incorporation of sexual policies into residents’ rights documentation at many facilities.⁴⁹ Despite this, for some partners of people in nursing homes, a perceived lack of privacy may make sexual activity undesirable.⁷

For residents with dementia, careful and repeated evaluation and documentation of capacity to consent to sexual activity may be necessary to preserve residents’ sexual autonomy. During such an assessment, it is important to consider whether the resident’s current desires are consistent with their lifelong behaviours and values and to assess whether they understand the consequences of sexual activity; unfortunately, no standard assessment tool exists.⁴⁹ Suggested criteria for capacity for sexual consent include voluntariness (or lack of coercion), safety (from physical or emotional harm), lack of exploitation, lack of physical or psychological abuse, the ability to verbally or nonverbally say ‘no’, and social appropriateness (i.e. understanding that there is a time and place for sexual activity).⁴⁷

Healthcare providers in long‐term care facilities have a duty to facilitate healthy sexual expression and protect residents from unwanted sexual activity. Resident‐to‐resident sexual aggression is defined as ‘sexual interactions between long‐term care residents that, in a community setting, at least one of the recipients would be likely to construe as unwelcome and that have high potential to cause physical or psychological distress in one or both of the involved residents’.⁴⁹ In long‐term care, this may be in the form of malicious sexual aggression, as well as sexually inappropriate behaviours in people with dementia. Residents with dementia may feel lonely and seek intimacy with other residents; some may mistake the other resident for a spouse. In these situations, barriers such as seating residents far away from each other during activities may be appropriate to avoid unwanted sexual activity. Sexual abuse of people living in residential and long‐term care settings by caregivers and staff constitutes less than 1% of all reports to Adult Protective Services, but researchers and clinicians warn that the actual incidence may grossly outnumber the reported cases.⁶⁰ Victims may suffer physical injury, STIs, and psychosocial trauma and may not report abuse due to many factors, including dementia, stigma, the possibility of retribution, and fear of not being believed. Providers working in long‐term care settings should be observant of signs of sexual abuse in residents, such as new anxiety, fear, hypervigilance, and perceived danger with personal care, in addition to genital trauma.⁶¹