Abstract
Background: Sexuality and intimacy are two basic psychosocial aspects of older adults' (65 years and older) lives that are rarely addressed in aged residential care (ARC). There are limited guidelines for best practice available internationally that could be adapted in the New Zealand (NZ) ARC context for facilitating older adults' expression of sexuality and intimacy. However, this has not occurred, nor does it appear that there are available NZ best practice guidelines.
Aim: The aim of this integrative review was to explore and synthesise the best evidence available in addressing and supporting the sexuality and intimacy needs of older adults over 65 years in ARC.
Methodology: A search of electronic databases was undertaken for all literature (journal articles, grey literature, government documents) utilising the PRISMA flowchart (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses). Literature underwent quality appraisal using the appropriate Joanna Briggs Institute (JBI) tools. Included literature was analysed using the processes of data reduction, data display, data comparison, conclusion drawing, and verification outlined by Whittemore and Knafl. The thematic analysis method by Braun and Clarke was used to facilitate identification of themes from data findings. The definitions of sexuality and intimacy were also extracted and tabulated from included studies.
Findings: There were twenty-seven studies included in the review. The majority of the articles represented grey literature from Australia, United States of America and United Kingdom with year of publication ranging from 2008-2021. The definitions of sexuality and intimacy were also identified in the included studies. The two overarching themes identified from findings were Organisational dichotomy and Ethical conundrum. Each theme described a significant result from collating all articles depicting best practice in the review. The first theme was Organisational dichotomy which explored the aged care organisation as a home for the older adults at the same time, a workplace for the staff. There were three subthemes identified in the first theme which are; Older adult sexuality and intimacy wishes and care requirements, Staff governance and Facility environment. The second theme was Ethical conundrum which described the ethical dilemma of the ARC organisation in its role in ensuring the safety of the older adults while promoting their rights to sexuality and intimacy activities. There were three subthemes identified which were Resident rights, Staff responsibility and Aged residential care facility policies. The findings also highlighted the different areas of nursing practice that can be improved through further research in relation to sexuality and intimacy needs of older adults in ARC.
Conclusion: Sexuality and intimacy are two important concepts that are essential for any human need and continues throughout an individual's life. Older adults in ARC facilities have sexuality and intimacy needs which currently remain unrecognised and underprioritized. The findings identified that a shared definition of sexuality and intimacy is required for these needs to be acknowledged. The findings highlighted the two overarching themes of Organisational dichotomy and Ethical Conundrum as representation of the findings. Wider literature is explored in line with the results from the findings. Organisational culture, nursing leadership and aged residential care policies have a significant effect in addressing older adults' sexuality and intimacy needs. The need for a shared definition of sexuality and intimacy, facility staff education, modifications in the aged residential care environment, organisational policies and empowerment of nurse leaders are recommended to fully address older adults' sexuality and intimacy needs in ARC.