Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly
Sexuality and Intimacy Assessment
Sexuality is a core dimension of life that incorporates notions, beliefs, facts, fantasies, rituals, attitudes, values, and rights with regard to gender identity and role, sexual acts and orientation, and aspects of pleasure, intimacy, and reproduction (WHO, 2008).
Influenced by biopsychosocial, economic, cultural, religious, and spiritual factors, the expression of sexuality and desire for intimacy is complex, no less so for an older adult than for a teenager.
The notion of sexual health, as with physical health, is not simply the absence of sexual dysfunction or disease but, rather, a state of sexual well-being that includes a positive approach to a sexual relationship and anticipation of a pleasurable experience without fear, shame, violence, or coercion(Calamidas EG, 1997).
Sexual activity is associated with health (Laumann EO, 2005).
Illness may considerably interfere with sexual health (Schover LR, 2000).
A massive and growing market for drugs and devices to treat sexual problems targets older adults.
Driven in part by the availability of drugs to treat erectile dysfunction, the demand for medical attention and services relating to sexual health is increasing.
Most women and men maintain sexual and intimate relationships and desire throughout their lives (Nicolosi A, 2004 A).
Physiologic changes can affect the sexual response of men and women and may inhibit or enhance sexual function as people age (Rosen RC, 2005).
Age and poor health are negatively associated with many aspects of sexuality (Camacho ME, 2005).
Sexual problems may be a warning sign or consequence of a serious underlying illness such as diabetes, an infection, urogenital tract conditions, or cancer (Isselbacher KJ, 1994).
Undiagnosed or untreated sexual problems, or both, can lead to or occur with depression or social withdrawal (Nicolosi A, 2004 B).
Patients may discontinue needed medications because of side effects that affect their sex lives, and medications to treat sexual problems can also have negative health effects, yet physician–patient communication about sexuality is poor (Gott M, 2004).
It is suggested that intimacy consists of 5 distinct components (Moss BF, 1993) :
emotional intimacy (includes caring, positive regard),
cognitive intimacy (includes thinking about the other; shared values), and
physical intimacy (ranging from closeness to intercourse)
Intimacy is a process which develops and fluctuates over time. Intimacy is an unstable state, it cannot be "achieved," it must be worked on to be maintained (Olson DH, 1975).
The Personal Assessment of Intimacy in Relationships (PAIR) questionnaire is a validated tool for the measurement of the 5 components of intimacy.
Intimacy and privacy
Viewed from the perspective of privacy, intimacy cannot be forced upon a person even if all the signs indicate that he or she is craving human contact.
Rooted in the ethical principle of respect for person, privacy is a personal right (Mattiasson AC, 1999).
Caregiving (e.g., assistance with activities of daily living) straddles the space between privacy and personhood. It is a kind of intimacy that cannot be avoided because it istask related.
However, caregivers should not assume that a person likes or wants to be touched. Non-task-related “affective” touching, such as simply stroking a person’s cheek or holding his or her hand may be viewed as assaultive, erotic, comforting, or presumptuous, depending on a person’s cultural background, relationship with the one touching, and personal comfort zone.
Appropriate and sensitive questioning, especially following cues of distress, is essential to assess intimacy related desire, fears and /or distress.
Relationship between Sexuality and Intimacy
The relationship between intimacy and adequacy of sexual functioning may be particularly important in older individuals, since older people have a higher likelihood of experiencing difficulties with sexual functioning (Hyde JS, 1990).
Several standardized measures of sexuality have been developed. Few, however, incorporated sexual satisfaction and functioning.
The Golombok-Rust Inventory of Sexual Satisfaction (GRISS). is a validated tool for the measurement of specific areas of sexual functioning. It includes questions pertaining to specific sexual dysfunctions (i.e., erectile disorder, anorgasmia) as well as subscales measuring sexual satisfaction and communication.
Defensiveness in Response to Measures of Relationship Satisfaction
Social desirability can be thought of as a tendency to respond to items in such a way that one appears in a favourable light (Jemail JA, 1982).
In test situations, people often respond in a way that will create a favourable impression, regardless of how they actually think, act, or behave. Cosequently, items which are considered socially desirable are endorsed, and those which are considered socially undesirable are denied (Carstenson LL, 1983).
The possibility of socially desirable, or defensive responding must be taken into account when utilising tools such as PAIR and GRISS (Patton GR, 1979).
Personal Assessment of Intimacy in Relationships
Measure of relationship intimacy.
The Sexuality and Intimacy Assessment is one of 8 domains of the
Comprehensive Geriatric Assessment (CGA)
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Golonbok-Rust Inventory of Sexual Satisfaction Male
Measure of speific areas of male sexual functioning and satisfaction.
Golonbok-Rust Inventory of Sexual Satisfaction - Female
Measure of speific areas of female sexual functioning and satisfaction.