Hostname: page-component-78c5997874-mlc7c Total loading time: 0 Render date: 2024-11-05T04:15:12.808Z Has data issue: false hasContentIssue false
  • English
  • Français

Sexuality in institutionalized elderly persons: a systematic review of argument-based ethics literature

Published online by Cambridge University Press:  24 August 2011

Lieslot Mahieu  and
Chris Gastmans
Lieslot Mahieu*
Affiliation:
Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
Chris Gastmans
Affiliation:
Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
*
Correspondence should be addressed to: Lieslot Mahieu, Research Associate, Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 35/3, B-3000 Leuven, Belgium. Phone: +32-16-33-29-23; Fax: +32-16-33-69-52. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Admission to a nursing home might challenge the way in which individuals experience their own sexuality, but it does not automatically diminish their need and desire for sexual fulfillment. Despite the fact that sexuality proves to be an intrinsic part of human existence, the sexual expression of geriatric residents remains a sensitive subject for many caregivers and family members. It evokes a variety of ethical issues and concerns, especially when dementia patients are involved. The overall objective of this review was to examine the ethical arguments and concepts about the debate on sexuality within a nursing home environment.

Methods: We conducted a systematic search for argument-based ethics literature focusing on sexuality in institutionalized elderly people. Twenty-five appropriate studies were identified.

Results: A thematic analysis of the included literature led us to distinguish two major groups of ethical arguments: (i) principles and (ii) care. Ethics arguments on sexuality in institutionalized elderly are particularly guided by the principle of respect for autonomy and the concomitant notion of informed consent. Arguments related to care were also apparent within the research literature although they received considerably less attention than the arguments related to the principles of respect for autonomy, beneficence, nonmaleficence and justice.

Conclusions: The lack of clarity in the conceptualization of the arguments referred to in the research literature indicates that there is a pressing need for a better defined, more fundamental philosophical-ethical analysis of the values at stake.

Keywords

agingelderlydementianursing homesethicsdecision making
Type
Review Article
Information
International Psychogeriatrics , Volume 24 , Issue 3 , March 2012 , pp. 346 - 357
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anonymous (2001). Legal and ethical considerations of cognitive impairment and sexual expression in the long-term care setting. Canadian Nursing Home, 12, 13–14.Google Scholar
Archibald, C. (1998). Sexuality, dementia and residential care: managers report and response. Health and Social Care in the Community, 6, 95–101. doi: 10.1046/j.1365-2524.1998.00104.x.CrossRefGoogle ScholarPubMed
Archibald, C. (2003). Sexuality and dementia: the role dementia plays when sexual expression becomes a component of residential care work. Alzheimer's Care Quarterly, 4, 137–148.Google Scholar
Baier, A. (1986). Trust and antitrust. Ethics, 96, 231–260.CrossRefGoogle Scholar
Beauchamp, T. L. and Childress, J. F. (2009). Principles of Biomedical Ethics. New York: Oxford University Press.Google Scholar
Berger, J. T. (2000). Sexuality and intimacy in the nursing home: a romantic couple of mixed cognitive capacities. Journal of Clinical Ethics, 11, 309–313.CrossRefGoogle ScholarPubMed
Casta-Kaufteil, A. (2003–2004). The old and the restless: mediating rights to intimacy for nursing home residents with cognitive impairments. Journal of Medicine and Law, 8, 69–86.Google Scholar
Christensen, K., Doblhammer, G., Rau, R. and Vaupel, J. W. (2009). Ageing populations: the challenges ahead. Lancet, 374, 1196–1208. doi: 10.1016/S0140-6736(09)61460-4.CrossRefGoogle ScholarPubMed
Dornberg, M. (1992). Sexualität und Suizidalität. Ethische Überlegungen aus der Sicht der Geriatrie. Wiener Medizinische Wochenschrift, 142, lxix–lxxi.Google Scholar
Ehrenfeld, M., Tabak, N., Bronner, G. and Bergman, R. (1997). Ethical dilemmas concerning sexuality of elderly patients suffering from dementia. International Journal of Nursing Practice, 3, 255–259. doi: 10.1111/j.1440-172X.1997.tb00110.x.CrossRefGoogle ScholarPubMed
Everett, B. (2007). Ethically managing sexual activity in long-term care. Sexuality and Disability, 25, 21–27. doi: 10.1007/s11195-006-9027-3.Google Scholar
Everett, B. (2008). Supporting sexual activity in long-term care. Nursing Ethics, 15, 87–96. doi: 10.1177/0969733007083937.CrossRefGoogle ScholarPubMed
Feldkamp, J. K. (2003). Legal landscape. Navigating the uncertain legal waters of resident sexuality: residents' rights to sexual expression can create complicated issues for facilities and family members. Nursing Homes: Long Term Care Management, 52, 62–66.Google Scholar
Glass, J. C. and Webb, M. L. (1995). Health care educators' knowledge and attitudes regarding sexuality in the aged. Educational Gerontology, 21, 713–733. doi: 10.1080/0360127950210801.CrossRefGoogle Scholar
Glass, J. C., Mustian, R. D. and Carter, L. R. (1986). Knowledge and attitudes of health-care providers toward sexuality in the institutionalized elderly. Educational Gerontology, 12, 465–475. doi: 10.1080/0380127860120506.Google Scholar
Gordon, M. and Sokolowski, M. (2004). Sexuality in long-term care: ethics and action. Annals of Long-Term Care, 12, 45–48.Google Scholar
Groenhout, R. E. (2004). Connected Lives. Human Nature and the Ethics of Care. New York: Rowman & Littlefield.Google Scholar
Hajjar, R. R. and Kamel, H. K. (2003). Sex and the nursing home. Clinics in Geriatric Medicine, 19, 575–586. doi: 10.1016/S0749-0690(02)00099-X.CrossRefGoogle ScholarPubMed
Harris, L. and Wier, M. (1998). Inappropriate sexual behavior in dementia: a review of the treatment literature. Sexuality and Disability, 16, 205–217. doi: 10.1023/A:1023099109976.CrossRefGoogle Scholar
Higgins, A., Barker, P. and Begley, C. M. (2004). Hypersexuality and dementia: dealing with inappropriate sexual expression. British Journal of Nursing 13, 1330–1334.Google Scholar
Hodson, D. and Skeen, P. (1994). Sexuality and aging: the hammerlock of myths. Journal of Applied Gerontology, 13, 219–235. doi: 10.1177/073346489401300301.CrossRefGoogle Scholar
Howe, E. G. (2000). At the bedside: improving treatment for patients who are elderly and have dementia. Journal of Clinical Ethics, 11, 291–303.Google Scholar
Illhardt, F. J. (1992). “Ich will zu meinem Peterle.” Anthropologische und ethische Überlegungen zu Sexualität und Suizidalität im Alter. Wiener Medizinische Wochenschrift, 142, lxvi–lxviii.Google Scholar
Kamel, H. K. and Hajjar, R. R. (2004). Sexuality in the nursing home: part 2. Managing abnormal behavior – legal and ethical issues. Journal of the American Medical Directors Association, 5, S49–S52. doi: 10.1016/S1525-8610(04)70094-8.CrossRefGoogle ScholarPubMed
Kuhn, D. (2002). Intimacy, sexuality, and residents with dementia. Alzheimer's Care Quarterly, 3, 165–173.Google Scholar
Kuhn, D. R., Greiner, D. and Arseneau, L. (1998). Addressing hypersexuality in Alzheimer's disease. Journal of Gerontological Nursing, 24, 44–50.CrossRefGoogle ScholarPubMed
Lichtenberg, P. A. (1997). Clinical perspectives on sexual issues in nursing homes. Topics in Geriatric Rehabilitation, 12, 1–10.Google Scholar
Lichtenberg, P. A. and Strzepek, D. M. (1990). Assessments of institutionalized dementia patients' competencies to participate in intimate relationships. The Gerontologist, 30, 117–120. doi: 10.1093/geront/30.1.117.CrossRefGoogle ScholarPubMed
Lingler, J. H. (2004). Ethical issues in distinguishing sexual activity from sexual maltreatment among women with dementia. Journal of Elder Abuse and Neglect, 15, 85–102. doi: 10.1300/J084v15n02_05.Google Scholar
Loue, S. (2005). Intimacy and institutionalized cognitive impaired elderly. Care Management Journal, 6, 185–190.Google ScholarPubMed
Mattiasson, A. and Hemberg, M. (1998). Intimacy – meeting needs and respecting privacy in the care of elderly people: what is a good moral attitude on the part of the nurse/carer? Nursing Ethics, 5, 527–534. doi: 10.1177/096973309800500607.CrossRefGoogle ScholarPubMed
McCullough, L. B., Coverdale, J. H. and Chervenak, F. A. (2004). Argument-based medical ethics: a formal tool for critically appraising the normative medical ethics literature. American Journal of Obstetrics and Gynecology, 191, 1097–1102. doi: 10.1016/j.ajog.2004.06.060.CrossRefGoogle ScholarPubMed
McCullough, L. B., Coverdale, J. H. and Chervenak, F. A. (2007). Constructing a systematic review for argument-based clinical ethics literature: the example of concealed medications. Journal of Medicine and Philosophy, 32, 65–76. doi: 10.1080/03605310601152206.CrossRefGoogle ScholarPubMed
Metzger, E. D. and Gillick, M. R. (2002). Ethics corner: cases from the Hebrew rehabilitation center for aged. Sex in the facility. Journal of the American Medical Directors Association, 3, 390–392. doi: 10.1016/S1525-8610(04)70533-2.CrossRefGoogle ScholarPubMed
Miles, S. H. and Parker, K. (1999). Sexuality in the nursing home: iatrogenic loneliness. Generations, 23, 36–43.Google Scholar
Noddings, N. (1984). Caring: A Feminine Approach to Ethics and Moral Education. Berkeley: University of California Press.Google Scholar
Post, S. G. (1995). Alzheimer disease and the “then” self. Kennedy Institute of Ethics Journal, 5, 307–321.CrossRefGoogle Scholar
Post, S. G. (2000). Commentary on “Sexuality and intimacy in the nursing home”. Journal of Clinical Ethics, 11, 314–317.Google Scholar
Post, S. G. (2001). Ethics. Care for the caregiver: the issue of sexual intimacy. Alzheimer's Care Quarterly, 2, 82–84.Google Scholar
Tabak, N. and Shemesh-Kigli, R. (2006). Sexuality and Alzheimer's disease: can the two go together? Nursing Forum, 41, 158–166. doi: 10.1111/j.1744-6198.2006.00054.x.CrossRefGoogle ScholarPubMed
Tenenbaum, E. M. (2009). To be or to exist: standards for deciding whether dementia patients in nursing homes should engage in intimacy, sex, and adultery. Indiana Law Review, 42, 675–720.Google Scholar