Aged Care Insite Issue 103 | Oct-Nov 2017 | Page 27

clinical focus
You used a webinar training program to improve understanding among health professionals across various care settings . What did the webinar focus on ? The content of the webinar was based on an education resource I developed in 2013 through the Dementia Training Study Centre , which is now called Dementia Training Australia . It ’ s an education resource that focuses on sexuality and dementia , and although it ’ s specific to health professionals , it ’ s easy for anyone who picks it up to understand .
The content of the webinar focuses on improving the awareness and understanding of intimacy and sexuality , and how these are reflected in the behaviour of people with dementia . And how they might express their sexuality or some of the so-called ‘ challenging , inappropriate or improper ’ behaviour that sometimes staff perceive , which could simply be a reflection of unmet needs by people with dementia .
So it ’ s getting staff to look at ways in which they can more positively and more supportingly respond when an older person in care with dementia is expressing their sexuality .
The webinar also deals with some ethical and legal considerations when it comes to supporting people with dementia in their expression of sexuality . So there ’ s quite a range of coverage in terms of this topic for healthcare professionals .
How should health professionals or aged care providers respond if someone in their care with dementia wishes to express themselves sexually ? Well , first , I ’ d like to clarify that we ’ re not saying all older people with or without dementia want to express their sexuality . But with those that do , we as care providers need to be supportive , to acknowledge it , and not ridicule or laugh or try to curtail , restrict or discourage them in their expression of sexuality .
And care providers or care organisations can start looking at some form of policy that can provide guidance for care staff when it comes to responding to those behaviours . Often , care providers and even care staff don ’ t know what they ’ re expected to do . How does that fit with their organisation policy ? What are they supposed to do ? Is it okay to support them ? Having some clarity from the top down is important .
Training and educating staff is also important to get them to recognise this issue and how their personal attitudes should not manifest in their care practices .
And also , when it comes to supporting , we ’ re talking about being respectful and acknowledging the needs of those in care . For example , if a particular gentleman is found masturbating in a common area in a care or nursing home environment , rather than saying , “ Oh , look at that dirty old man . He ’ s sitting there masturbating again . We need to stop it ”, how about thinking the behaviour , masturbating , is not an issue ?
Sometimes it ’ s the context within which that behaviour is occurring that is the issue . So rather than stopping the behaviour , could it be possibly that this gentleman may have an unmet need ? He may not be aware of the environment he ’ s in as a result of his dementia . Could we bring him back to the privacy of his own room ? Perhaps close the door , give him some privacy , put a ‘ do not disturb ’ sign on his door so he can continue doing what he ’ s doing rather than stopping that behaviour altogether . So that ’ s one area .
And also , talking to family . You may have watched a documentary called Scarlet Road , which was made by an organisation called Touching Base that does actually provide services for people with a disability , including those with a cognitive disability or cognitive impairment like dementia .
So for older people with dementia residing in a care home , if they have expressed that they do have an unmet need , or they do perhaps want to have sex and they have expressed it to family or even care staff , could they be supported looking at other avenues ?
And also , if older people in nursing homes have an existing spouse that is also residing in the same facility , is it possible to look at having a shared room , instead of separating them in different wards or different areas ?
Care organisations and care homes are actually doing some of these things . In the last few years , since I ’ ve started working in this area , there has been a lot of improvement through conversations I ’ ve been having with care homes and aged care workers as well .
You tested the effectiveness of six weekly 1.5-hour live webinar sessions with more than 100 aged care and health professionals . What impact did the webinars have on workers ’ views about sexual expression among people living with dementia in aged care ? We did this webinar research last year , and we found that there were significant improvements in the knowledge and attitudes of participants who had been involved in a study . They were found to have a better understanding , awareness and knowledge of this particular topic . In terms of their attitude , they were found to be more permissive in terms of this area when it came to people with dementia .
On top of that , besides assessing their knowledge and attitude , we were also keen to find out if , after attending this education training program , there were any changes in their practices . Through anecdotal evidence , through talking to our participants three to six months after they had finished their training or education webinar , we learned that many of them highlighted that it was important for workers in this sector to have this training .
They also said that through this training they had learned how they could improve communication with residents when dealing with their sexual expression , and it also made them more aware that this is very much a part of life and not a switch that is turned off just because someone is 65 , or has dementia , or has entered into a nursing home environment .
What else do you hope health professionals or the public keep in mind when it comes to sexual expression in people living with dementia ? I hope we continue to have this conversation with residents , rather than just ignore this aspect of care . It would be good if organisations and care staff , as part of their care provision , could acknowledge that this is an issue , and perhaps initiate a conversation with older people , including those with dementia , about this aspect of care , and ask if there are any needs they would like addressed .
I ’ m not saying they would get clear information from the start , but it ’ s about telling older people that they recognise that this is an aspect of care , and that they are here to address it and to listen to the needs they have , and that they should feel comfortable expressing their needs to their care provider .
What we hope is that through education , training and awareness , staff will realise that this is a neglected aspect of care that they should be addressing . And that it ’ s about having a conversation with older people , including those with dementia in the nursing home . ■ agedcareinsite . com . au 25