Page 120 - GHES-3-3

Global Health Economics and
Sustainability
The challenges of caring

Regional variations highlight differences in dementia 1.1. Importance of sexual expression and intimacy
prevalence worldwide. In India, the prevalence among in older adults
those aged 60 and above is estimated at 2.8%, affecting Sexuality plays a vital role in life satisfaction, even among
approximately 3.9 million people (Farina et al., 2024). In older adults, including those with dementia (Richter et al.,
Bangladesh, the prevalence is higher at 8.0% among older 1998; Roach, 2004). Despite common misconceptions that
adults, with significant variations linked to factors such sexual interest diminishes with age, research indicates that
as age, sex, and education (Naheed et al., 2023). In Brazil, many older adults continue to seek emotional and physical
dementia prevalence is reported at 5.8%, with an additional intimacy.
8.1% for cognitive impairment with no dementia. Overall,
the prevalence rate is notably higher among older adults Intimacy in the elderly encompasses emotional,
(Bertola et al., 2023). physical, and social dimensions, significantly impacting
their quality of life. Research highlights the evolving nature
Gender differences are evident across studies, with of intimacy as individuals age, emphasizing the importance
females generally demonstrating a higher prevalence of of addressing their needs within various care contexts.
dementia compared to males. For example, in Brazil, Intimacy remains vital for older adults, particularly in
prevalence rates are 6.8% in females versus 4.6% in males assisted living, where emotional, intellectual, spiritual, and
(Bertola et al., 2023). Similarly, global analyses confirm physical dimensions intertwine (Fitzroy et al., 2022).
higher prevalence rates among women (Cao et al., 2020).
Sexual intimacy is recognized as a natural aspect
Age-related trends demonstrate a significant increase in of aging, with barriers, such as societal attitudes and
dementia prevalence with advancing age. In Bangladesh, health status, influencing experiences (Garrett, 2021). In
the odds of dementia are 9 times higher in individuals aged residential care, agism and restrictive policies often limit
90 and above compared to those aged 60 – 69 (Naheed et al., opportunities for intimacy, necessitating a person-centered
2023). This trend is consistent globally, with prevalence approach to care that fosters intimate relationships (Cook
doubling approximately every 5 years (Cao et al., 2020). et al., 2022).
While these studies provide valuable insights into Variations in intimacy experiences exist across cultures,
dementia prevalence, they also underscore the challenges with a shift towards intimacy-oriented sexual expressions
of underdiagnosis and the need for standardized noted among older adults in post-communist countries
diagnostic criteria. The variations in prevalence (Gore-Gorszewska & Ševčíková, 2023).
across regions and demographic groups highlight the
importance of tailored public health strategies to address While intimacy is crucial for well-being in later life,
the growing global burden of dementia, especially in systemic barriers often hinder its expression, highlighting
the need for supportive environments that promote
long-term care.
intimate connections.
The tension between respecting residents’ autonomy
and ensuring their safety is a recurring ethical challenge 1.2. Staff training and attitudes
in dementia care. Nurses, as primary caregivers, are at the Care staff’s perceptions of sexuality are often influenced
forefront of navigating these complexities, often without by their comfort levels and the organizational culture
adequate training or guidelines. This gap in practice they operate within. To foster a supportive environment,
and policy underpins the need for targeted research and targeted training is essential to promote an open attitude
discussion. toward sexual expression (Roach, 2004; Roelofs et al.,
This article aims to explore the ethical but also 2019). In addition, caregivers need a moral framework
professional, family, and organizational dimensions of that emphasizes respect for residents’ wishes (Mattiasson
supporting intimacy and sexuality in long-term care for & Hemberg, 1998).
individuals with dementia. By examining these aspects Emotional intimacy is particularly important for
from a nursing perspective, it seeks to propose actionable caregivers, as a lack of intimacy before dementia can lead
recommendations for improving care practices. to increased caregiver strain (Morris et al., 1988). Physical
Addressing sexuality and intimacy in dementia care is intimacy, including sexual behavior, is often overlooked.
essential for advancing person-centered care practices. By Institutionalized patients may express a wide range of
focusing on this often-neglected aspect of care, this article sexual behaviors, which can provoke varied responses
contributes to the broader discourse on the quality of life from staff and families (Ehrenfeld et al., 1999).
for elderly individuals with dementia and the role of nurses Nurses must navigate complex ethical concerns, balancing
in promoting their well-being. respect for patient autonomy with their professional

Volume 3 Issue 3 (2025) 112 https://doi.org/10.36922/ghes.5130