Jennifer L. Hillman

Sexual issues and aging within the context of work with older adult patients.

Recent studies suggest that the majority of older men and women maintain moderate or high levels of sexual interest well into their 70s but often experience sexual dysfunction. Given the burgeoning of the older adult population, psychologists are increasingly likely to find older patients in their practice with questions or concerns about sexuality. The goal of this article is to provide psychologists with current information regarding sexuality and aging, including general prevalence data, age-related biological changes (e.g., menopause), incontinence, erectile dysfunction, prostate changes, male performanceenhancing drugs (e.g., Viagra), medications’ sexual side effects, and sexually transmitted diseases, including HIV/AIDS. Practice guidelines endorse a biopsychosocial perspective, in which stereotypes, gender, partner availability, socioeconomic status, ethnicity, religious beliefs, and sexual orientation are examined. Clinicians’ potentially negative countertransference also should be recognized and worked through. Case examples illustrate many of these concepts, and directions for future research and patient care are offered.

Grandparents of Children with Autism: A Review with Recommendations for Education, Practice, and Policy

One in 166 grandparents will become grandparent to a child with autism. A review of empirical studies suggests that these grandparents experience significant role confusion. They provide the autistic childs parents—who are more likely to be depressed, single, or divorced—with both burden (e.g., conflict regarding behavioral symptoms) and emotional and instrumental support (e.g., childcare; financial assistance; advocacy). Unique stressors of autism upon families include social isolation and financial burden. Custodial grandparents face additional stressors. Opportunities for education, practice, and policy that are designed to help grandparents redefine their role, share in the diagnosis and treatment of autism, and obtain social support are advanced.

Knowledge and Attitudes About HIV/AIDS Among Community-Living Older Women: Reexamining Issues of Age and Gender

ABSTRACT Although older women face unique risks related to HIV/AIDS, little empirical data is available regarding HIV/AIDS among women over the age of 65. In the present study, 160 community-living older women and men completed questionnaires regarding knowledge and attitudes about HIV/AIDS. Findings showed that although older women were less likely to talk to their physician about HIV than men, they maintained greater knowledge and generally dispelled myths about viral transmission. However, most older women believed that HIV/AIDS had limited personal relevance, possessed virtually no knowledge of age and gender specific risk factors, and professed HIV-associated stigma. These findings highlight the need for gender and age specific prevention programs.

Knowledge, Attitudes, and Experience regarding Hiv/Aids among Older Adult Inner-City Latinos

Although Latinos, now the largest minority group in the U.S., comprise 13% of the population, they represent 18% of all new HIV and AIDS cases. This disproportionate representation also appears among older adult Latinos. Semi-structured interviews with 45 inner-city Spanish speaking older adult Latinos provide new data regarding HIV/AIDS among this largely ignored but at risk population. Findings indicate that approximately two thirds of the sample ascribed to at least one myth regarding viral transmission (e.g., via mosquito bites; using public toilets) and less than half were aware of age and gender specific risk factors (e.g., increased mortality and side-effects from antiviral medication; greater risk of contracting HIV through intercourse among older women). Women were significantly less likely to have experience with condoms than men, and machismo, lack of perceived risk, and perceived ineffectiveness were identified as potential barriers to condom use. Recommendations are offered for the design of culturally sensitive, primary prevention programs for this older Latino population.

SUPPORTING AND TREATING FAMILIES WITH CHILDREN ON THE AUTISTIC SPECTRUM: THE UNIQUE ROLE OF THE GENERALIST PSYCHOLOGIST

Research findings indicate that intensive behavior therapy (e.g., applied behavioral analysis, or ABA) represents an effective treatment for autistic spectrum disorders. Unfortunately, children with autism represent an underserved patient population. Parents often make treatment decisions with insufficient information and report problems in establishing and maintaining treatment programs. This practice review asserts that psychologists, including those without professional certification or coursework in ABA, are in a unique position to assist affected children and their families. Psychologists can provide critical information about evidence-based treatment; offer assistance in overcoming barriers to intensive treatment, including personnel selection; and provide ongoing support to family members. Case examples also illustrate how psychologists can help families address specific barriers to intensive treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Sexual Consent Capacity: Ethical Issues and Challenges in Long-Term Care

ABSTRACT More than two million Americans live in nursing homes and other long-term care facilities. Available research suggests that the majority of older nursing home residents, including those with some degree of cognitive impairment, place significant value upon a variety of sexual activities. With nearly half of all residents suffering from dementia, psychologists and other mental health professionals often face significant challenges in the assessment of their patients’ sexual consent capacity. A primary ethical issue is to balance an individual resident’s rights to autonomy and privacy with a facility’s need to protect residents from harm. Sexual consent capacity functions on a continuum across time and behavior. It also cannot be predetermined by proxy, in which an individual prepares legal documents ahead of time to identify a surrogate decision maker; sexual consent capacity must be determined by information obtained in the present moment. In this paper, an approach to the assessment of residents’ sexual consent capacity, encompassing knowledge, reasoning, and voluntariness, along with a brief overview of sexual activity among long-term care residents, will be presented. A case example is offered to illustrate complex clinical dilemmas involving staff attitudes, residents’ rights, and family dynamics.

HIV/AIDS among Older Adults

The oldest person to have a documented case of HIV infection was an 88-year-old white widow. She is believed to have been exposed to the AIDS virus through sexual contact with her husband, a recreational intravenous drug user (Rosenzweig & Fillit, 1992).

The Experience, Contributions, and Resilience of Grandparents of Children With Autism Spectrum Disorder

ABSTRACT Autism Spectrum Disorder (ASD) affects 1 in 68 children in the United States and has been associated with significant stress on nuclear families. Little is known about the grandparents of these children, however, including their first-person, intergenerational experience and potential family contributions. A national, online survey of 1,870 grandparents of grandchildren with ASD revealed that they make significant monetary contributions toward therapeutic needs and frequently play an essential caregiving role. Forty-three percent of the grandparents reported making personal sacrifices such as drawing upon their retirement funds or putting off retirement, and 25% of the grandparents moved or combined households to support a grandchild on the autism spectrum. Consistent with resilience theory, the majority of grandparents reported that they were coping fairly or very well in relation to their grandchild’s ASD, although they did express significant worry for their adult son’s or daughter’s well-being. However, 12% of grandparents reported that they were coping poorly. Recommendations for future research and public health policy are provided.

Grandparents’ Experience of Autism Spectrum Disorder: Identifying Primary Themes and Needs

Limited information is available regarding the first person perspective of grandparents of children with Autism Spectrum Disorders (ASD). In the present study, 1870 grandparents of a child with ASD participated in a nationwide, online, anonymous, 30-minute survey and responded to open-ended questions including their “greatest challenges and greatest joys” as the grandparent of a child on the autism spectrum. A grounded theory approach to qualitative analysis revealed four overarching categories: a Desire for Connection, Barriers to Care, Celebration of Progress, and Personal Reactions. Despite the presence of significant challenges grandparents often experienced positivity in their role, and engaged in radical acceptance of their grandchild as well as transformative insight and advocacy. Specific recommendations are offered to help address grandparents’ needs and capitalize upon their resilience.

Understanding Care Disparities Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults: Recommendations for Culturally Competent Care

LGBT adults represent a growing, aging population. LGBT elders face significant health care disparities, and are often fearful of disclosing their sexual orientation or gender identity to practitioners. As a result, many older LGBT adults fail to receive appropriate screening or treatment. Various recommendations can be offered to help health providers offer more culturally competent, LGBT and age-affirming care.