Closeness and intimacy are basic aspects of the human experience.

Connection and the need for human contact matter. Not only do they make life worth living, but these ties also protect against depression and anxiety and offer us security, support and connectedness across our lifespan (Beyond Blue 2018).

With age, however, comes many significant changes to our lifestyle, such as the loss of a spouse or loved ones, physical decline and mobility issues, which mean maintaining social connections can become more difficult over time.

Thankfully, loneliness and social isolation are not an inevitable part of ageing (Miley 2019), and new and existing friendships and intimate relationships can flourish with the right support.

This article will guide you on how to best support the intimacy and sexuality of the older people in your care.

What are Intimacy and Sexuality?

• Intimacy: The emotional, affective and physical relationship between two individuals and how they connect (gentle touch, intellectual and emotional closeness, romance, intercourse, etc.)
• Sexuality: The way in which an individual experiences and expresses themselves as a sexual being (their biological sex, gender identity, sexual behaviours, sexual orientation, sexual activity, etc.)

(palliAGED 2024)

A common misconception is that older people are asexual; that they lack sexual appeal, sexual drive or desire. In reality, sexuality and intimacy remain important to adults over the age of 65 and can still provide physical and psychological benefits (palliAGED 2024).

It’s important to note that every person views sexuality and intimacy differently, so support should be individualised to reflect this. Some ways in which residents may express intimacy and sexuality include:

• Daydreaming or reminiscing
• Reading romantic/erotic literature
• Dressing up
• Witty, flirtatious remarks or compliments
• Hand holding
• Hugging
• Touching, stroking and caressing
• Kissing
• Fascination
• Masturbation
• Intercourse
• Oral sex
• Using sexual materials and services.

(palliAGED 2024)

Intimacy and Sexuality Under the Strengthened Aged Care Quality Standards

Standard 1: The Person - Outcome 1.1: Person-centred care (Action 1.1.3) of the strengthened Aged Care Quality Standards requires aged care providers and staff to recognise and respect the rights and autonomy of older people, including their right to express their sexuality and gender and experience intimacy (ACQSC 2024a).

Additionally, Standard 7: The Residential Community - Outcome 7.1: Daily living (Action 7.1.6) states that older people should be supported to maintain relationships of their choice (including intimate relationships) and engage in sexual activity without facing judgement (ACQSC 2024b).

Sexuality Assessment Tool (SexAT)

The Sexuality Assessment Tool (SexAT) was developed as an Australian Government initiative to help aged care facilities support their residents’ expressions of sexuality by identifying areas where further improvements may be needed (Bauer et al. 2013).

The SexAT guides practice to support the normalisation of sexuality in aged care and assists facilities in identifying where enhancements to the environment, policies, procedures and practices, information and education/training are required. The tool also enables facilities to monitor initiatives over time for further improvement (Bauer et al. 2014).

The areas of care assessed by the SexAT are:

1. Facility policies
2. Determining the needs of the older person
3. Staff education and training
4. Information and support for older people
5. Information and support for families
6. The physical environment
7. Safety and risk management.

(Bauer et al. 2014)

For more information, access the Sexuality Assessment Tool at: https://www.latrobe.edu.au/__data/assets/pdf_file/0006/1295790/ACEBAC-DCRC-Sexuality-Assessment-Tool-SexAT.pdf

Older People with Dementia

Dementia can affect how people think, behave and communicate. People living with dementia may still have feelings of intimacy and sexuality, and how they express this will vary across a wide spectrum, from normal to ‘problem’ sexual behaviour. It is important to be aware of this unpredictable nature and note that it may differ across individuals (palliAGED 2024).

Consent and Sexual Abuse

Consideration should be given to issues of consent and sexual abuse in residential aged care for the protection of older people, but also staff members, too.

The Aged Care Act 1997 and the Serious Incident Response Scheme (SIRS) have mandatory reporting provisions for unlawful sexual contact (i.e. non-consensual sexual activity involving residents in aged care facilities). If you witness any unlawful sexual contact, you have a duty to report it (palliAGED 2024; ACQSC 2022).

When a report is made, the capacity of the resident to consent to sexual activity may be considered. It will be based on an assessment by a health professional on a case-by-case basis (palliAGED 2024).

Non-judgemental Care

Unfortunately, older people often encounter ageist attitudes and stereotypes that impede their sexual expression. Sexuality in older age is commonly seen as a taboo topic, and consequently, older people may internalise this stigma and become less sexually active (Gewirtz-Meydan et al. 2018).

Remember that all care should be non-judgemental. It’s important that the values and beliefs of the care staff do not interfere with the rights of people in your care to express their sexuality when it does not harm others (Bauer & Fetherstonhaugh 2016).

Some practical ways for care staff to support the sexuality of older people in their care:

• Ask questions
• Review your policy around intimacy and sexuality (consider utilising the SexAT)
• Provide non-judgemental care
• Support older people to dress and groom themselves in the way they would like to
• Consider privacy (e.g. provide older people with ‘do not disturb’ signs and always knock before entering someone’s room)
• Refer older people to resources such as sexual health educational material and relevant health professionals
• Communicate with older people’s families
• Support sexuality through strategies such as providing double beds, connecting adjoining rooms and allowing overnight stays
• Use LGBTIQ+ inclusive language.

(Bauer & Fetherstonhaugh 2016; Health.vic 2016)