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Global Health Economics and
Sustainability
The challenges of caring

obligation to provide care. Recognizing and supporting sexual behavior in residents, which may be due to societal
the intimate needs of patients is crucial, as is ensuring taboos or inadequate preparation in their training
that these needs are respected (Mattiasson & Hemberg, (Roelofs et al., 2019).
1998). Assessing the competency of patients for intimate Nursing perspectives on intimacy and sexual behavior
relationships is challenging due to the lack of standardized in long-term care settings reveal the complexities
guidelines (Lichtenberg & Strzepek, 1990).
of addressing these needs. While supporting sexual
2. Nurses’ perspective expression can significantly enhance the well-being of
residents, nurses often face moral dilemmas and systemic
Nurses play a critical role in supporting the intimate barriers that make it difficult to provide this support
and sexual needs of individuals with dementia in long- effectively. Developing clear guidelines, offering targeted
term care, yet they often face significant challenges in training, and fostering a supportive organizational culture
doing so. Intimacy is perceived by nurses as a complex are essential steps toward improving the care of individuals
concept, encompassing not only physical closeness but with dementia in this regard.
also emotional vulnerability, dependency, and trust. These
elements are crucial in building meaningful relationships 3. Key dimensions for supporting sexuality
between caregivers and residents. However, systemic and intimacy
constraints, such as institutional policies, limited resources,
and rigid role expectations, can hinder nurses’ ability to Addressing sexuality in dementia care presents numerous
fully address these aspects of care (Williams, 2001). challenges rooted in societal stigma, ethical complexities,
and institutional barriers (Figure 1). Sexuality among older
One of the primary ethical challenges that nurses face adults is often met with discomfort or denial, a response
is balancing respect for patient autonomy with the moral that becomes even more pronounced in the context of
obligation to provide care. Autonomy, a fundamental dementia. Research highlights the role of societal stigmas
principle in healthcare ethics, involves recognizing the in marginalizing the sexual needs of individuals with
residents’ right to express their intimate and sexual needs cognitive impairments, often leading to the suppression of
while ensuring these desires are honored in a manner natural expressions of intimacy and the pathologization of
that does not cause harm. This is particularly difficult in behaviors perceived as inappropriate (D’cruz et al., 2020;
dementia care, where cognitive decline may affect a patient’s Horne et al., 2021).
ability to communicate or make informed decisions about
their intimate relationships. Nurses must often make 3.1. Ethical dimension
complex judgments about residents’ competency to engage Balancing autonomy and protection is a critical concern,
in intimate behavior, but the absence of clear guidelines particularly when assessing the consent capacity of
complicates this process (Mattiasson & Hemberg, 1998).
residents (Benbow & Beeston, 2012). Ethical frameworks
Another key issue is the lack of structured protocols or should guide caregivers in respecting residents’ sexual
training for assessing sexual consent and capacity among autonomy while ensuring their safety. Ethical and legal
dementia patients. Nurses may struggle with determining dilemmas further complicate this issue, particularly
whether a resident can give consent to sexual activity
or intimate behavior, which raises significant ethical
concerns. Without clear policies and adequate support,
nurses are left to navigate these gray areas on their own,
often relying on personal judgment, which can vary greatly
among caregivers (Lichtenberg & Strzepek, 1990).

The literature also highlights the importance of
understanding and supporting sexual expression as part
of person-centered care. When nurses can recognize
and support residents’ sexual and intimate needs, they
contribute to the overall quality of life for those in their
care. However, this requires not only professional training
but also a cultural shift within institutions to normalize
conversations about sexuality and intimacy in older
adults, particularly those with dementia. Many nurses Figure 1. Key dimensions for nurses to address intimacy in individuals
express discomfort or uncertainty when dealing with with dementia in long-term care

Volume 3 Issue 3 (2025) 113 https://doi.org/10.36922/ghes.5130