A major fear of the dying is that of loneliness, of dying alone. The barriers that the nursing home places to the development and nourishment of intimacy become pro foundly important as residents near the end of their lines. As death approaches, it is too late to find or acquire the intimacy required to ease the transition and achieve a peaceful death.
In this paper, we address what is known about sexual expression as a form of physical and emotional intimacy among residents of nursing homes.
The human need for touch, intimacy and physical contact has been clearly demonstrated in classic studies of the harm to babies raised without this essential form of support. Physical and emotional affection is sought and necessary at all stages of human development. A profound and almost totally ignored source of suffering in the frail elderly is the loss of physical and emotional intimacy that typically accompanies widowhood, medical illnesses, or institutionalization. Indeed, expressions of physical intimacy are widely viewed as abnormal or inappropriate behaviors in the elderly, and many nursing homes actually prohibit cohabitation by residents of the opposite sex. If humane care is the goal, health professionals and longterm-care institutions caring for the elderly must begin to acknowledge the normalcy, indeed the essential nature, of the human need for intimacy.
Like all of us, residents of nursing homes flourish best when diverse needs for intimacy are recognized, respected, and met. Sexuality is one dimension of intimacy. This paper proposes a hypothesis synthesizing research pertaining to nursing home sexuality with research pertaining to loneliness and intimacy. We do not review the aging, pathophysiology, evaluation, or management of sexual function in elderly persons (see, for example, Rowland et al., I993, and Richardson, I995). We suggest a new path for research on sexuality in nursing homes that may point to ways to make the nursing home a more humane, and human, place to live (LoPiccolo, 1991).
There is little research on sexual intimacy between nursing home residents, as a search using Medline (1966-1998) and BioethicsLine (1973-1998) revealed. Only 200 of the 30,000 Medline articles referring to sexuality or sexual behavior refer to people over 80 years old, and less than 3 percent of these refer to people in nursing homes. Oddly, most of the research is on the male minority of residents, suggesting a taboo on older women's sexuality. What research exists is of unsatisfactory quality. Most focuses on interest in or frequency of sexual behaviors rather than on the experience and meaning of sexual intimacy. Most studies are methodologically weak, with such problems as ungeneralizable single-facility studies (ubiquitous and unavoidable), small samples (we discarded studies with fewer than twenty-five subjects, though we do cite some case accounts), self-selected respondents or participants (we discarded surveys of people choosing to attend sexuality classes but kept studies that had some refusals in a randomly selected population), among others. Papers rarely described how interviewers were trained to obtain valid responses on this sensitive topic. For these reasons, though we cite the basis for our descriptive statements and tried to use multiple studies where possible, normative statements should be read as a sense of the impressions from this body of work rather than as a firmly established description of nursing home populations.
LONELINESS AND INTIMACY
The concepts of"loneliness" and "intimacy" are a foundation for interpreting the experience of sexual relationships and thereby provide a basis for examining the potential importance of sexuality to efforts to humanize nursing homes.
Loneliness is the unpleasant feeling of being qualitatively or quantitatively deprived of intimate relationships (Peplau and Perlman, I982). Ten percent of the older population (Creecy, Berg, and Wright, 1985; West, Kellner, and Moore-West, I986) say they are lonely, a percentage that increases with age (Berg, 1981). …