Reviews

"Sexuality and Long-Term Care confronts ageism by helping to set the stage for abetter understanding that older people still experience love, seek intimacy, and are sexual.Administrators, staff, and family members who read this book will gain the recognition thatresidents in long-term care settings are clearly full human beings. If facilities embrace Doll'sbook, then older adults will gain recognition as individuals who can enjoy a sexual life waypast the time that society currently believes they should be doing so."-- (07/18/2012)

For all the innuendos and images surrounding sex in our society, it's a topic that many long-term caregivers are reluctant to bring up with residents and their family members.Sexuality is far more than being about sex, or as Freud might have put it, sometimes a cigar isn't just a cigar. As Gayle Doll explains in her new book, "Sexuality & Long-Term Care: Understanding and Supporting the Needs of Older Adults," sexuality encompasses many aspects of a resident's life. This includes the desire for companionship and intimacy, the need for privacy, and holding onto one's identity."Unfortunately, the only time many long-term care facilities address sexuality is when there is a 'problem, '" writes Peggy Brick, the president of the Sexuality and Aging Consortium at Widener University, in her introduction to Doll's book.That can mean anything from public inappropriate behaviors to an adult child flipping out upon finding a parent has a new girlfriend or boyfriend.So what can long-term care staff do to mitigate problems yet help residents still enjoy all parts of their lives? That's what is great about Doll's book: Rather than an academic treatise, "Sexuality & Long-Term Care" is a workbook, with activities and questions designed to help managers lead staff in creating a positive environment. Those questions can be basic, such as, "Does your organization have policies, which include consequences, to deal with employee or client complaints of discrimination or harassment, and is there a follow-up process?"Other activities and self-assessments will open up sticky psychological wickets for staff based on one's personal values and background. How does a staff member handle a resident viewing pornography, same-sex residents holding hands, or a dementia patient falling in love? Doll doesn't provide the answers, but she does provide a framework for respecting resident's sexual needs while protecting him or her from harm.If you've been down this road and have thoughts to share, please leave them in the comments below. To sweeten the deal, a commenter will be chosen at random to receive a copy of Doll's book.-- (01/24/2012)

There is a myth that sexuality vanishes with age. Gayle Appel Doll's book Sexuality andLong-Term Care: Understanding and Supporting the Needs of Older Adults does well attrying to change that attitude. Research has demonstrated that sexuality is a vital componentof well-being throughout the life span. Lindau et al. (2007) found that most of their samplein a study of 3,005 adults ages 57-85 thought that sexuality was an important part of life.The idea that the aging have significant desires and needs for intimate relationshipschallenges many people's belief systems. Furthermore, many find it even more implausibleto consider sexuality for older people in long-term care. In fact, if sexuality is acknowledgedor addressed, it is often seen as a problem in nursing homes rather than as a natural part ofthe developmental life cycle. Residents in long-term care are under constant surveillance andoften have their sexuality discounted or even forbidden.Redefining SexualityDoll, the director of the Center on Aging at Kansas State University, begins her book byredefining sexuality. According to Doll, sexuality is far more than sex; it is one's feelingabout oneself as a male or female, one's body image, and the desire for intimacy, connection, and touch. She defines intimacy and sexuality as acts that include complimentsand emotional acts of warmth, as well as sexual intercourse.The need to balance residents' desires for companionship and intimacy with otherswhile maintaining their integrity and privacy is critical in long-term care. Doll is convincedthat it is possible to create environments where individuals can still experience love, in all itsdiverse forms, in a residential health facility. Sexuality and Long-Term Care takes a personcenteredapproach to residents' sexuality in long-term care. Doll provides guidelines thataddress the rights and responsibilities of older adults and help long-term care facilities todetermine their own best practices in order to establish an environment that supportsresidents' sexual health and well-being.Long-term care staff, administrators, and family members have historically had muchdifficulty responding positively to older adults' sexuality in a residential setting. Dollengages the reader in a discussion of how residential facilities can balance the rights of theindividual resident with the concerns of the community as a whole. She provides strategiesfor teaching staff and administrators how to acknowledge the sexual and intimacy needs ofthe residents effectively, respectfully, and compassionately.In addition, Doll offers tools to teach staff, such as handouts and learning activitiesthat encourage staff and administrators to explore attitudes and biases about residents'sexuality. Staff members are encouraged to look at how they deal with the residents on thebasis of their own personal values and backgrounds. Doll provides a clear framework forrespecting a resident's sexual needs while protecting him or her from harm.Issues of Sexuality in Long-Term CareDoll's book provides ample scenarios to illustrate potential issues surrounding how to dealwith resident sexuality in long-term care settings. Readers will find that each case examplecreates opportunities for discussion about how the staff handled the situation, what worked, what failed to work, and what would have been a more effective way to deal with thesituation. Doll offers effective ways to resolve common dilemmas surrounding sexuality inlong-term care settings. Issues can include how the staff members handle residents viewingpornography, same-sex residents hugging, or a dementia resident falling in love.What makes Sexuality and Long-Term Care even more intriguing is that researchvalidates Doll's best-care practices for supporting resident sexuality. Simple ideas such asmaking "Do Not Disturb" signs available on doors and pushing beds together are potentialpossibilities. More important than any specific suggestion is the effort to help staff becomeaware that the residents are whole people and do not just need the staff to watch them and dotasks for them.The book grapples with the definition of normal sexual expression in old age. Dollacknowledges that the administrative team must intervene to prevent unsafe and abusiverelationships. She discusses how facility caregivers can recognize inappropriate sexualbehaviors and then suggests how to address them. Another complex issue that needs seriousconsideration involves a resident in a long-term care home developing a sexual relationshipwith another resident when he or she still has a living spouse. Doll also addresses howdementia affects sexuality. It is not difficult to let the residents who are cognitively intacthave meaningful intimate relationships; it is far more challenging to give the same freedomto individuals with dementia.Doll discusses how the losses associated with moving to a long-term care facility aremagnified for the LGBT community. Sexuality and Long-Term Care addresses the concernsthat lesbian, gay, bisexual, and transgendered residents have about moving into a long-termcare community (Stein, Beckerman, & Sherman, 2010). Often, after living openly, they haveto return to the closet to avoid discriminatory actions. Doll helps long-term care homesbecome more accepting to the LGBT community by creating antidiscrimination policies anddiscouraging heteronormative language.Doll addresses another hurdle regarding resident sexuality: residents' families. Inmany situations, long-term care facilities will choose to follow the directives of familymembers over the residents' expressed desires for intimacy. Doll suggests that long-termcare facilities can support families through education and counseling. Helping families toacknowledge the need for sexual expression may honor the person that the older individualhas become.Addressing Sexuality in Long-Term Care SettingsMany nursing homes and long-term health care facilities have not discussed residentsexuality or developed policies to address it other than possibly forbidding it. The researchand training tools included in Doll's book will help them start this discussion and developpolicies to create a positive environment related to residents' fundamental desires forintimacy and sexuality.Clearly, long-term health facilities need to protect themselves from unexpectedlawsuits. Spending time creating sexuality policies will go a long way toward reducing theese threats. Figuring out how to make policies regarding sexual expression that show acommitment to residents' quality of life is essential. Doll addresses the issue of whatconstitutes consent and/or competence in residents of a long-term health facility.There have always been needs and desires for intimacy and sexuality in residents oflong-term care, and there have always been and will always be residents who act on thoseneeds and desires. As a result of personal and societal discomfort with sexuality in the aging, support and compassion from administrators and staff of these facilities are sorely lacking.Sexuality is an area that most long-term caregivers are historically reluctant or unwilling tobring up or embrace.Although there are ample resources in Doll's book, the willingness of residentialfacilities to implement these approaches remains to be seen. Unfortunately, it will be a verydifficult task to get caregivers to deal with and resolve their discomforts with sexuality andto begin to see residents as sexual and intimate beings so that facilities can make use ofDoll's remarkable tools.Sexuality and Long-Term Care confronts ageism by helping to set the stage for abetter understanding that older people still experience love, seek intimacy, and are sexual.Administrators, staff, and family members who read this book will gain the recognition thatresidents in long-term care settings are clearly full human beings. If facilities embrace Doll'sbook, then older adults will gain recognition as individuals who can enjoy a sexual life waypast the time that society currently believes they should be doing so.ReferencesLindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W. L., O'Muircheartaigh, C., &Waite, L. J. (2007). A study of sexuality and health among older adults in the UnitedStates. The New England Journal of Medicine, 357, 762-774. doi:10.1056/NEJMoa067423Stein, G. L., Beckerman, N. L., & Sherman, P. A. (2010). Lesbian and gay elders and longtermcare: Identifying the unique psychosocial perspectives and challenges. Journal ofGerontological Social Work, 53, 421-435. doi:10.1080/01634372.2010.496478July 18, 2012, Vol. 57, Release 28, Article 4(c) 2012, American Psychological Association-- (07/18/2012)

"Gayle Doll bravely addresses the many barriers that currently deny the sexual needs and rights of many residents. [Her] pioneering book provides step-by-step guidelines for agencies ready to adopt a truly person-centered approach to sexuality."-- (04/14/2014)

"Rather than an academic treatise, "Sexuality & Long-Term Care" is a workbook, with activities and questions designed to help managers lead staff in creating a positive environment...Doll...provide[s] a framework for respecting residents' sexual needs while protecting him or her from harm."-- (01/24/2012)

"This book is long overdue. The sexuality of older adults living in long-term care facilities has been derided at worst and ignored at best. Gayle Appel Doll has finally brought this taboo topic out of the shadows and into the daylight where it belongs for a healthy discussion by all concerned."-- (04/14/2014)

"This is an excellent resource to help nursing home staff gain an understanding of sexuality in long-term care. It tackles this difficult and, for some, uncomfortable subject in such a simple way with chapters, sidebars, and activities that can be done with the nursing home staff or even students ... It is directed at long-term care staff at all levels ... [and] can be used as a tool to tailor discussions at any level from residents and their families to staff and physicians ... [to] promote group discussion and inner reflections for readers on their beliefs and opinions. The sidebars and activities greatly enhance the learning experience .... Grounded in research, but with very helpful practical applications, it covers the topic thoroughly, including providing sample facility policies that can be adapted to the individual facility."-- (04/14/2014)