“Sexuality is a human right”: Normalising sexuality in aged care

Clinical sexologist and psychologist Dr Nathalie Huitema says it’s time to normalise sexuality in older adults, reinforcing that any beliefs over it being a “complex” issue are only that way because society makes it so.

Dr Huitema will be in Sydney this week for the International Dementia Conference as a keynote speaker, but before she takes to the stage for Sex on the brain – the battleground of consent, privacy and personal rights, she spoke to Hello Leaders.

“In reality, intimacy and sexual health are positive, increase well-being, reduce feelings of loneliness, and benefit overall quality of life. Sexual behaviour itself is normal and not inherently complex; it is our perception that makes it seem otherwise,” Dr Huitema shared.

“We make them complex because people tend to be shocked by the idea of sexuality and ageing, which are often considered oxymorons. Sexuality is simply a human right, yet when it pertains to ageing, it is often seen as complex. 

“Sexual ageism has perpetuated the notion that older adults are asexual beings, a message deeply embedded in our Western society. As a result, when older adults are admitted to aged care settings and display any sexual behaviour, it is often quickly labelled as inappropriate or abnormal.”

Dr Huitema has been working in aged care and assisted living settings for over 25 years, helping care teams work through awkward or uncomfortable situations where nursing staff don’t know how to best support an older person with sexual behaviour and expression.

This includes situations where a resident may express sexual excitement in the shower, moments of inappropriate touching of staff or consensual intimacy among residents. 

Her work also focuses on people living with dementia. Dr Huitema advocates for universal sexual consent guidelines for people living with dementia in long-term care so their needs and wants are better recognised and supported. 

“Sexuality guidelines in aged care will enable individuals to express themselves sexually (which, of course, includes hand-holding, kissing, masturbation, as well as intercourse) and feel a connection or closeness to others,” she explained. 

“These guidelines allow individuals to have experiences that enhance their quality of life. And an increase in quality of life is what we wish for all older adults in aged care.”

Staff training is integral to the implementation of sexuality guidelines, Dr Huitema added. She said aged care providers should also form sexual health committees to support a more person-centred, sexuality-friendly environment where sexual rights are promoted and quality of life improved.

Navigating consent and inappropriate conduct

Unlawful sexual contact or inappropriate sexual conduct is the fourth most reported incident in residential aged care under the Serious Incident Response Scheme. With at least 50 sexual assaults reported in aged care homes each week, it’s a concerning statistic.

Dr Huitema believes a significant proportion of incidents may be consensual with limited staff training and understanding a contributing factor to the high rates. 

“Sexual assault is a very strong term. I can’t help but wonder when sexual behaviour is classified as sexual assault, have the staff received any training on sexuality to understand how their own sexual ageism, norms, and values influence their perception of sexual expression in older adults with dementia?” she said.

There is no blame game on staff, though, with reporting regulations often creating a more reactive response when certain behaviours are witnessed.

Dr Huitema said a lack of training and unclear policies can create negative attitudes toward sexuality in older adults with cognitive impairment as staff aren’t supported enough to take a person-centred approach. As a result, many staff will err on the side of caution. 

“When the focus is solely on safety and protection, we tend to overlook autonomy, sexual rights, and the promotion of well-being. Sexual consent then becomes an all-or-nothing phenomenon, meaning that older adults with cognitive impairment are either viewed as asexual or accused of sexual assault,” she added. 

“For staff to effectively balance safety and autonomy, training is essential. Such training will help staff interpret sexual expression from the resident’s perspective and foster a more supportive and positive attitude toward sexuality. 

“In general, aged care should aim to be a support system for its residents, rather than acting as an alternative decision-making authority.”

Moving forward, she would also like to see sexuality courses embedded in higher education learning, plus person-centred care combined with a salutogenic approach (focused on health and well-being) to normalise sexuality in aged care. 

Dr Huitema will speak and lead a panel discussion at IDC2024 on September 5, Day 1 of the two-day international conference in Sydney.