Section: 2-1

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Geriatrics – Assessment of Sexual Health in Older Adults
Strength of Evidence Level: 3
SECTION: 21.02
__RN__LPN/LVN__HHA
PURPOSE:
To provide an opportunity for nurses to solicit
information and provide support for disruptions in sexual
health related to normal and pathologic changes in the
older adult.
3.
CONSIDERATIONS:
1. Sexuality is important to older adults as for many, it
is an expression of passion, affection, esteem and
loyalty.
2. Of Americans between the age of 57 and 64 years,
73% were sexually active.
3. Of Americans between the age of 65 and 74 years,
53% were sexually active.
4. Of Americans between the age of 75 and 85 years,
26% were sexually active.
5. Cognitively impaired adults still retain sexual desire
however, they may exhibit sexually inappropriate
behavior as an expression of interest.
6. As women age, a loss of estrogen at menopause
may decrease vaginal lubrication.
7. As men age, they experience less frequent and
weaker ejections.
8. Ethnic and cultural background need to be
considered prior to asking sexual health questions.
9. Depression, cardiovascular diseases and diabetes
affect sexual function.
10. Medications can affect sexual function and at times,
compliance with taking medications may be
impacted by the unwanted side affects, including
decreased libido and erectile dysfunction. Common
medications that impact sexual functioning include:
a. Antihypertensives, including angiotensin converting enzyme inhibitors, [alpha]-blockers,
[beta]-blockers, calcium channel blockers and
thiazide diuretics.
b. Antidepressants, including selective serotonin
reuptake inhibitors, tricyclic antidepressants and
monoamine oxidase inhibitors.
c. Cholesterol-lowering medications - statins and
fibric acid derivatives.
d. Antipsychotics (phenothiazines and the atypical
antipsychotics risperidone.
e. Seizure medications (carbamazepine) and H2
blockers (cimetidine).
5.
EQUIPMENT:
Quiet private area in the home
Environment of open communication
Nonjudgmental attitude
PLISSIT model
PROCEDURE:
1. Permission (P) – ask permission to discuss sexual
health.
2. Ask open ended questions and let the patient
describe issues and/or concerns.
4.
6.
Involve partner if patient gives permission and
wants to discuss unmet needs.
Provide limited information (LI) – after identifying
concerns, provide information related to normal and
pathologic age-related changes in sexual
health/function and how it relates to the patient.
Offer specific suggestions (SS) – help identify
potential medication and treatment regimen,
changes, environmental changes or privacy issues
as well as alternative forms of sexual expression
which promote sexual health and fulfillment.
Intensive Therapy (IT) – warranted for those
requiring more intensive services beyond nursing
care, e.g., those that are sexually inappropriate,
hyperactive or aggressive or with abuse history
should be referred to other healthcare specialist
who specialize in these areas.
AFTER CARE:
1. Follow-up with primary care practitioner to identify
potential specialists, if referrals are needed, and
address medication or treatment regimen changes
needed which are impacting sexual function.
2. Follow-up with primary care practitioner for
medication or devices to address erectile
dysfunction or other conditions.
3. Follow-up with primary care practitioner for
medication or lubrication to address vaginal dryness
and pain during intercourse or other conditions.
4. If patient is in a home shared with caregivers,
discuss the importance of privacy and need for
healthy sexual activity of patient.
5. Document in patient's record:
a. Assessment and response to PLISSIT
approach.
b. Patient education and instructions given to
patient regarding normal and pathogenic
changes, medication and disease which impact
sexual function and interventions to address
sexual health needs.
c. Contact to primary care practitioner and his/her
response regarding patient’s sexual health
concerns.
REFERENCES:
Wallace, M. A. (n.d.). How to Try This: Assessment of
Sexual Health in Older Adults. AJN: American Journal of
Nursing. Retrieved July 13, 2010, from
http://www.nursingcenter.com/library/JournalArticle.asp?
Article_ID=800532
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