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