Module 4 - Professional practice and ethics

One of the greatest barriers to achieving good sexual health in later life is the lack of communication between health and social care practitioners and their older clients because of one or more of the factors mentioned above. In spite of an acknowledgement by many health and social care practitioners of the continued importance of sexuality to older clients/patients, this is an area of healthcare for older people that is frequently routinely overlooked in consultations (Gott et al. 2004). Indeed, this was highlighted in the Global Study of Sexual Attitudes and Behaviors, which found that only 9% of men and women had been asked about their sexual health during a routine visit to their health and social care practitioner in the previous 3 years (Moreira et al. 2005).

The free movement of people in Europe has been a core part of European Union policy since its inception and, with the signing of the Schengen Agreement in 1985, Europeans have been able to freely travel and work between countries in the Union. This, along with the effects of globalisation and post-colonialism mean that European societies have become increasingly more culturally diverse. In addition, in 2014 there were over 33.5 million non-EU nationals living in EU member states (Eurostat 2015). Thus, with a population of over 500 million people, Europe is one of the most linguistically and culturally diverse places on Earth. For instance, within EU borders there are 3 distinct alphabets, 24 official languages, 60 other European languages and an estimated 175 non-EU nationalities (EC 2015), each with their own varied cultural and linguistic heritage.

The intrinsic need and desire to express oneself sexually does not end at a particular age, nor does it necessarily end once a person has reached a stage of their life when they may need to enter into an assisted living or residential care facility or where they may suffer from an age-related cognitive impairment such as dementia or Alzheimer’s disease (Bach et al. 2013; Gott & Hinchliff 2003; Kontula & Haavio-Mannila 2009; Laumann et al. 2004; Lindau et al. 2007; Moreira et al. 2005). Although research in this area is still emerging, the existing literature suggests that facilitating the sexual expression of older adults in residential care has many health benefits, both physical and psychological, and can contribute to their overall well-being. For example, one study conducted in the United States amongst residents of a retirement community found that sexually active residents were more likely to be taking fewer medications, had a more active social life, where more physically active and reported higher levels of life-satisfaction and quality of life generally than residents who were sexually inactive. Indeed, sexually inactive residents were more likely to have bladder and bowel issues, mental ill-health concerns and higher risk levels for diabetes, hypertension, cardiovascular disease and dementia (Bach et al. 2013).

Older people, particularly those with dementia or those living in assisted care facilities can be particularly vulnerable to sexual violence. Problems with detecting sexual violence against older people and issues of under-reporting of sexual assault generally mean that this is a much under-researched area. The World Health Organisation defines sexual violence as: ‘any act, attempt to obtain a sexual act, unwanted sexual comments or advances...against a person’s sexuality using coercion, by any person...in any setting’ (WHO, 2015, p. 35).