Intimacy in the Long-Term Care Setting

The sexual needs of elderly individuals are similar to those of the young, but with variations in frequency, intensity, and mode of expression. Intimacy may take the form of affection, romance, companionship, touch, and the need to feel attractive, even in the absence of overt sexual behavior. Social connection and human touch are essential ways of avoiding the depression and loneliness that often occur when an elderly individual becomes isolated by losses or illness in advancing age. In many long-term care facilities, a communal atmosphere, the caregiving role, emphasis on disease management, and concern regarding cognitive impairment often lead to inappropriate restrictions on intimacy and sexual expression. The individual with dementia is often perceived as “being in need of” protection from his or her own impaired memory and judgment. Normal sexual behaviors are often considered “problematic” by staff. Many residents and staff have little experience with lesbian, gay, bisexual, and transgender (LGBT) individuals, and this may contribute to the isolation these individuals experience as they transition from their supportive communities. Clearly written policies, staff education, and a non-biased interdisciplinary sexual history at the time of admission can help the facility and family to best meet the individual needs of each resident.