Unit 1: Communication around sexuality

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).

  Introduction

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).

More importantly perhaps, it is widely recognised that older adults will not usually initiate conversations about their sexual health. Nonetheless, when prompted older adults are often open to discussing their sexual health needs and concerns.  Health and social care practitioners therefore need to have a proactive attitude to discussing the sexual health needs of their older clients and best practice guidelines recommend that health and social care practitioners should bring up the topic at an opportune time during routine healthcare checks (Farrell & Belza 2012; Hughes, Rostant & Curran 2014; Kotz 2005; Kuehn 2008).

 

  Key messages

  • Sexual activity has many benefits for health and well-being
  • There are many barriers to health and social care practitioners communicating with their older clients around matters of sexuality and sexual health
  • Often older people will not initiate discussion, but when asked, many will value the opportunity to discuss their situation, queries and concerns with health and social care professionals
  • Routine healthcare checks provide an excellent opportunity for health and social care practitioners to prompt discussion surrounding sexual matters with their clients

  Learning outcomes 

At the end of this unit students are expected to:

  1. Be able to recognise barriers to promoting discussion around sexual health matters that can confront older people and social and health care practitioners
  2. Be aware of communication strategies and approaches for engaging older people in conversations around sexuality and sexual health
  3. Be aware of ways in which to empower older people through appropriate communication approaches

   Content

 

Empowerment, communication and the PLISSIT model.

In order for this to happen an individual must be well informed as to the conditions that are necessary for achieving optimal health and wellbeing. By improving communication between the health and social care practitioner and the client, a practitioner can help empower a client to take control over their sexual health by involving them in the decision-making process in order to address and fulfil their sexual needs and to maintain their sexual health generally. As such, beginning the conversation is a crucial first step. Developed in the late 1970s, the PLISSIT model offers an approach to initiating and engaging in a conversation with a client about their sexual health. 

The PLISSIT model has four interconnected parts – Permission, Limited Information, Specific Suggestions, Intensive therapy.

 

The PLISSIT Model

 

P

Permission-  ask permission from the client to speak to them about their sexual health.

LI

Limited Information-  give the client limited information on sexual health issues that might apply to the older adult.

SS

Specific Suggestions-  provide the client with specific suggestions on how to improve their sexual health.

IT

Intensive Therapy-   offer a referral to a specialist if the client’s problem goes beyond the scope of the health and social care practitioner.

 

 

For more information about the PLISSIT model and to view a video by Meredith Wallace PhD and the Hartford Institute for Geriatric nursing on the management and assessment of the sexual health of older clients visit: https://consultgeri.org/try-this/general-assessment/issue-10 .

 

Factors that can facilitate using the PLISSIT model to engage in discussion with an older person.

  • Ensure that the space in which the conversation is taking place is private and reassure the client that all information is strictly confidential.
  • Adopt an open-minded and non-judgmental manner and, utilise neutral non-gendered language- for example, partner instead of husband or wife.
  • Ensure that one’s own beliefs and attitudes do not impinge on the discussion, for example, refrain from showing surprise.
  • Be mindful that there may be possible cultural and gendered differences in attitudes towards sex. If the client/patient has a cultural background that is different to the health and social care practitioner and the practitioner is unsure of what may or may not be appropriate, the simplest solution is to ask the client in a respectful and sensitive manner.

  

Role play

Practise using the PLISSIT model with a colleague or friend, using the following hypothetical case studies:

Mrs. Black is a 65 year old married woman who has come to visit her GP for her annual check-up. Mrs. Black has been on hormone replacement therapy for eight years. This has helped her with problems she previously encountered with lack of lubrication. However, over the past year she has been taking a low dose (20mg) of a selective serotonin reuptake inhibitor (SSRI), citalopram, for mild depression. Since starting these anti-depressants, she has been experiencing a decrease in her libido and is concerned about how this is affecting her marriage.

Mr. White is a 68 year old divorced man. He self-identifies as gay, having come out 15 years ago after the break-up of his marriage. He has been with his current partner for five years. He used to take anti-anxiety medication (Xanax) but discontinued using it around four years ago. He is currently taking statins (Lipitor) to control his cholesterol, but otherwise is in good health. He occasionally experiences erectile dysfunction.

 

Questions for facilitating the role plays
  • If it’s alright with you Mrs. Black, I’d like to ask you a few questions about your sexual health?
  • Many patients have issues with their sexual health as they get older, would it be ok if I asked you some questions about how your sexual health has been?
  • Some of the medications you are currently taking can affect your sexual health, would you mind if I asked you some questions about your sexual health? 
  • What concerns have you about your sexual health?
  • How has your sexual function changed since your diagnosis with...?
  • How have your sexual feelings changed since starting your new treatment regime?
  • Can you tell me how you express your sexuality?
  • What concerns or questions do you have about fulfilling your continuing sexual needs?
  • In what ways has your sexual relationship with your partner changed as you have aged?
  • What interventions or information can I provide to help you fulfil your sexuality?

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This project has been funded with support from the European Commission. This publication reflects the views only of the author, and the Commission cannot be held responsible for any use which may be made of the information contained therein