THE EXPRESSION OF SEXUALITY BY PEOPLE WITH DEMENTIA AS PART OF THE PERSON FOCUSED CARE APPROACH
Richard Chesterton and Michael Bender (Understanding Dementia: The Man with the Worried Eyes, 2003), inform us that the main meanings of ‘person-focus’ in the understanding of dementia are to focus:
On the person with dementia, not their diseased brain
On their emotions and understandings, not memory losses
On the person within the context of a marriage or a family
Within a wider society and its values
On this pretence, nurses, carers and clinicians must adopt a holistic approach to care and interventions.
In order to develop a positive care plan based on the expression of sexuality (identified as AOL 10 on Roper, Logan and Tierney), it would be useful to work within the person focused framework. This, along with the person centred approach, must underpin all care interventions whether proactive or reactive.
The expression of sexuality is a basic human right. I doubt that anybody would be able to counter argue that point. However, what happens if we then include old age, habitation in a long term care environment and dementia? Is this still seen in the same way? Or is it an aspect of care that some members of our care teams find difficult to handle? The team are likely to consider it as a complex area made up of ethical, legal, psychological and practical issues.
I would encourage all our care teams to consider the expression of sexuality in great detail when writing care plans. It might be a good idea for teams to run their own in-house training session where discussions and suggestions can be considered (Dementia Services Development Centre at the University of Stirling produce a useful teaching aid called Sexuality and Dementia). This will encourage you to consider more than whether a person wishes to wear make-up or nail polish, perfume or after shave, etc.
If there are complex issues based around this aspect of care, the following Framework for Action may be of use:
DESCRIPTION OF BEHAVIOUR:
Is there a problem?
(What is the problem?)
If the answer is no, evaluate and monitor
If the answer is yes, for whom is there a problem?
(Organization/staff/carer/person with dementia/
other house mates?):
WHAT ACTION WILL YOU TAKE FOR:
(Organization/staff/carer/person with dementia/
other house mates?
ALWAYS RECORD, EVALUATE AND MONITOR
Summary:
ØExpression of sexuality is a basic emotion and human right – this does not change because of age and dementia
ØAlways consider, address and care plan for this aspect of care
ØConsider in-house training sessions on a regular basis
ØFollow the Framework For Action when addressing complex issues
References:
Understanding Dementia: The Man with the Worried Eyes, Cheston and Bender
Sexuality and Dementia, A Guide, Dr Carole Archibald, University of Stirling
