Page 122 - GHES-3-3

Global Health Economics and
Sustainability
The challenges of caring

concerning consent in dementia care. Cognitive decline staff education, research, and creating a supportive
raises critical questions about an individual’s capacity environment. Comprehensive policies addressing sexuality
to make informed decisions regarding sexual activity. in dementia care are essential. These policies should define
Inconsistent legal frameworks and vague institutional guidelines for consent and capacity assessment, allow
policies often leave caregivers and healthcare providers for the accommodation of couples within care facilities,
uncertain about their roles and responsibilities. While the including shared rooms and flexible visitation hours, and
use of sexual surrogates has been explored in other medical explore the feasibility of sexual surrogacy programs or
contexts, such as for patients with spinal cord injuries or equivalent supportive measures (Grigorovich et al., 2022;
multiple sclerosis, its application in dementia care remains Grigorovich & Kontos, 2020).
largely unexplored (Grigorovich & Kontos, 2020; Wiskerke Education and training for staff are also crucial.
& Manthorpe, 2019).
Training programs should equip staff with the necessary
3.2. Professional dimension skills and knowledge to address residents’ relational
and sexual needs with empathy and professionalism.
Continuous staff training is essential for addressing the Evidence suggests that targeted education can
sexual needs and behaviors of dementia patients (Ehrenfeld significantly improve staff confidence and competence in
et al., 1999). Individualized care plans that incorporate this area (Bauer et al., 2014).
discussions about sexuality can improve the quality of care
(Richter et al., 1998). Further research is warranted to better understand
the prevalence and nature of sexual expressions among
3.3. Family dimension individuals with dementia. Longitudinal studies and
The family dimension underscores the urgent need for qualitative research can provide valuable insights into
clear policies and training to support both caregivers and residents’ needs and help inform the development of
residents in addressing these sensitive issues effectively. tailored interventions (De Medeiros & Rubinstein, 2018;
Involving families in discussions about sexual rights Hatzidimitriadou & Phellas, 2020).
and behaviors can create a supportive care environment Finally, creating a supportive environment within care
(Benbow & Beeston, 2012). Staff often face moral facilities is essential. This involves providing private spaces
dilemmas regarding intimacy and sexuality in aged care, for intimacy, offering counseling services for residents and
highlighting the need for ethical education and policies families, and encouraging open dialogue about sexuality
that support open discussions (Cook et al., 2022). and relationships (Mahieu et al., 2017). These strategies
Constructive staff-family relationships can mitigate power collectively aim to enhance the quality of care and respect
imbalances and improve collaborative care approaches residents’ rights and needs in relation to intimacy.
(Haesler et al., 2007).
4. Limitations
3.4. Organizational dimension
While there is a growing acknowledgment of the
Institutional barriers also play a significant role. Many care importance of intimacy in care settings, challenges remain
homes lack comprehensive policies addressing intimacy in implementing effective policies and practices that
and sexuality, leading to inconsistent practices. These range
from the outright prohibition of intimate relationships respect residents’ rights and needs.
to permissive approaches that fail to provide adequate While this article provides valuable insights into
support or guidance. Studies reveal a notable gap in staff the role of nurses in addressing intimacy and sexuality
training, with many care providers expressing discomfort concerns for individuals with dementia in long-term care
or a lack of knowledge when managing residents’ sexual settings, it is essential to acknowledge certain limitations.
expressions (Grigorovich & Kontos, 2020; Horne et al., The generalizability of the findings is restricted, as the data
2021). Clear organizational guidelines are necessary to were derived from a limited number of narratives and
facilitate the best practices in supporting intimacy in institutional contexts, which may not represent the diversity
care settings. Organizations should foster a culture that of practices and policies present in other regions or care
normalizes discussions around sexuality in dementia care facilities. Moreover, the reliance on qualitative data poses
(Ehrenfeld et al., 1999). challenges in drawing broader inferences. The absence
of longitudinal analysis also limits the ability to capture
3.5. Support strategies for improvement changes over time in nurses’ approaches or institutional
Proposed strategies for improving the management of policies. Future research should aim to address these
sexuality in dementia care focus on policy development, limitations by incorporating a more extensive and diverse

Volume 3 Issue 3 (2025) 114 https://doi.org/10.36922/ghes.5130