Maggie L. Syme

Predicting Sexual Decline and Dissatisfaction Among Older Adults: The Role of Partnered and Individual Physical and Mental Health Factors

OBJECTIVES To target improvement in older adult sexuality by understanding how a myriad of partnered and individual physical and mental health factors, often associated with aging, affect sexual unwellness. METHOD Data from the Wisconsin Longitudinal Study were used to conduct a case-control study on the risk factors for sexual unwellness (i.e., lack of sexual satisfaction, inability to maintain the sexual relationship) in older adults aged 63-67. RESULTS Higher risk for lack of sexual satisfaction was associated with poor spousal health, a history of diabetes, and fatigue symptoms. In addition, being of male gender, being satisfied with marital support, and having better spousal health reduced the risk of being unsatisfied sexually. Also, higher risk for being unable to maintain the sexual relationship was independently associated with a higher education level, poorer self-rated health, better spousal health, a history of diabetes, prostate cancer, fatigue, sexual pain, and a history of depression. DISCUSSION Results show the impact of several physical and mental health risk factors on the development of sexual unwellness in older adults. A gendered pattern also emerged, suggesting that women tend to be less sexually satisfied, as compared to their male peers, who tend to report sexual unwellness that is associated with individual health.

Sexuality among wounded veterans of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND): Implications for rehabilitation psychologists.

OBJECTIVE The sexual lives of returning Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans have only been discussed minimally in the psychological literature. Given the nature of military social and cultural contexts, the potential for exposure to combat-related stressors that may lead to posttraumatic stress disorder (PTSD), and the risk of traumatic brain injury secondary to physical injury, the potential for significant psychological and relational ramifications exists. This article focuses on the intimate relationships and sexuality of returning OIF/OEF/OND veterans within the context of their personal cultural variables and the diverse experience of being a part of military life. CONCLUSIONS Culturally competent assessment and evidenced-based treatment approaches are highlighted to offer clinicians initial strategies to begin treatment of sexuality issues within the returning Veteran population. These clinical tools are discussed within a positive psychology approach that emphasizes healthy sexuality as a part of overall satisfactory quality of life.

Sexual Health and Well-Being After Cancer Applying the Sexual Health Model

Sexual quality of life after cancer is an integral component of well-being for many survivors. However, the experience of cancer presents significant challenges to sexual health and well-being, often requiring survivors to negotiate the many physical, psychological, social/relational, and cultural factors that impact psychosexual functioning. By embracing a sex-positive approach to conceptualization, assessment, and treatment, psychologists can better serve the unique psychosexual needs of survivors and assist in enhancing sexual and intimate expression that promotes adaptation and flexibility. This article will (a) present a positive conceptualization of sexual health and well-being for cancer survivors and (b) discuss culturally competent treatment strategies to promote the sexual health and well-being of cancer survivors.

Sexual Self-Esteem and Psychosocial Functioning in Military Veterans After Cancer

Little is known about the sexual well-being of male Veteran cancer survivors, or the relationship of sexual concerns to psychosocial adaptation postcancer. This study examined the association between sexual self-esteem and psychosocial concerns in male Veteran cancer survivors. Forty-one male survivors were recruited from a Veterans Affairs (VA) hospital to participate in a pilot study addressing cancer survivorship care for Veterans. Sixty- to 90-minute interviews were conducted, assessing sociodemographic, medical, stress/burden (cancer-related posttraumatic stress disorder [PTSD], depression), and resource (social support, post-traumatic growth) variables. Twenty-one (51.2%) Veteran cancer survivors reported lowered sexual self-esteem as a result of cancer, which corresponded to significantly higher levels of depression and cancer-related PTSD. The lowered sexual self-esteem group also indicated significantly lower social support. Veteran cancer survivors with lowered sexual self-esteem tend to have higher levels of stress and lower levels of resources, putting them at risk for lowered quality of life. This increased risk highlights the importance of addressing sexual well-being in the survivorship care of Veterans.

A Comparison of Actual and Perceived Sexual Risk Among Older Adults

Sexual risk among older adults (OAs) is prevalent, though little is known about the accuracy of sexual risk perceptions. Thus, the aim was to determine the accuracy of sexual risk perceptions among OAs by examining concordance between self-reported sexual risk behaviors and perceived risk. Data on OAs aged 50 to 92 were collected via Amazon.com’s Mechanical Turk. Frequency of sexual risk behaviors (past six months) were reported along with perceived risk, namely, sexually transmitted infection (STI) susceptibility. Accuracy categories (accurate, underestimated, overestimated) were established based on dis/concordance between risk levels (low, moderate, high) and perceived risk (not susceptible, somewhat susceptible, very susceptible). Approximately half of the sample reported engaging in vaginal (49%) and/or oral sex (43%) without a condom in the past six months. However, approximately two-thirds of the sample indicated they were “not susceptible” to STIs. No relationship was found between risk behaviors and risk perceptions, and approximately half (48.1%) of OAs in the sample underestimated their risk. Accuracy was found to decrease as sexual risk level increased, with 93.1% of high-risk OAs underestimating their risk. Several sexual risk behaviors are prevalent among OAs, particularly men. However, perception of risk is often inaccurate and warrants attention.

Examining aging sexual stigma attitudes among adults by gender, age, and generational status

Objectives: Stigma related to later life sexuality could produce detrimental effects for older adults, through individual concerns and limited sexual health care for older adults. Identifying groups at risk for aging sexual stigma will help to focus interventions to reduce it. Accordingly, the purpose of this study was to examine cross-sectional trends in aging sexual stigma attitudes by age group, generational status, and gender. Method: An online survey was administered to a national sample of adults via a crowdsourcing tool, in order to examine aging sexual stigma across age groups, generational status, and gender (N = 962; 47.0% male, 52.5% female, and .5% other; mean age = 45 years). An aging sexual stigma index was formulated from the attitudinal items of the Aging Sexual Knowledge and Attitudes Scale. Results: This sample reported moderately permissive attitudes toward aging sexuality, indicating a low level of aging sexual stigma. Though descriptive data showed trends of stigma attitudes increasing with age and later generations, there were no significant differences between age groups or generations in terms of aging sexual stigma beliefs. Men, regardless of age and/or generation, were found to espouse significantly higher stigmatic beliefs than women or those reporting ‘other’ gender. Conclusions: Aging sexual stigma beliefs may not be prevalent among the general population as cohorts become more sexually liberal over time, though men appear more susceptible to these beliefs. However, in order to more comprehensively assess aging sexual stigma, future research may benefit from measuring explicit and implicit aging sexual stigma beliefs.

Sexual Consent Capacity Assessment with Older Adults

Many healthcare providers have a limited knowledge of sexual and intimate expression in later life, often due to attitudinal and informational limitations. Further, the likelihood of an older adult experiencing cognitive decline increases in a long-term care (LTC) setting, complicating the ability of the providers to know if the older adult can make his or her own sexual decisions, or has sexual consent capacity. Thus, the team is left to question if and how to support intimacy and/or sexuality among residents with intimacy needs. Psychologists working with LTC need to be aware and knowledgeable about sexual consent capacity in older adulthood to be prepared to conduct evaluations and participate in planning care. Limited research is available to consult for best practices in sexual consent capacity assessment; however, models of assessment have been developed based on the best available evidence, clinical judgment, and practice. Existing models will be discussed and an integrated model will be illustrated via a case study.

Somali Perspectives on Physical Activity: PhotoVoice to Address Barriers and Resources in San Diego.

Background. Although many immigrants enter the United States with a healthy body weight, this health advantage disappears the longer they reside in the United States. To better understand the complexities of obesity change within a cultural framework, a community-based participatory research (CBPR) approach, PhotoVoice, was used, focusing on physical activity among Muslim Somali women. Objectives. The CBPR partnership was formed to identify barriers and resources to engaging in physical activity with goals of advocacy and program development. Methods. Muslim Somali women (n = 8) were recruited to participate, trained and provided cameras, and engaged in group discussions about the scenes they photographed. Results. Participants identified several barriers, including safety concerns, minimal culturally appropriate resources, and financial constraints. Strengths included public resources and a community support system. The CBPR process identified opportunities and challenges to collaboration and dissemination processes. Conclusions. The findings laid the framework for subsequent program development and community engagement.

Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development

We examined public opinion of sexual expression and dementia to inform nursing home policy and practice.

Recommendations for sexual expression management in long‐term care: a qualitative needs assessment

AIMS To conduct a qualitative needs assessment of Directors of Nursing regarding challenges and recommendations for addressing sexual expression and consent. BACKGROUND Sexual expression management among long-term care residents is a complex issue for nursing home staff. Little guidance is available for those wanting to follow a person-centred approach. Policies and procedures are needed, and must be usable across long-term care settings. DESIGN Qualitative design for in-depth exploration. METHODS Semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013, representing a range of regions, facility sizes and resident populations. Interview questions prompted them to identify recommendations that address challenges to improving sexual expression management in long-term care settings. RESULTS Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories. DISCUSSION Directors of Nursing report several challenges to sexual expression management in their facilities, and perceive their current methods to be ad hoc. A proactive approach to policy and procedure development is needed.