Sean Whitfield - NURS 3540 Module 13 Active Learning Guide PDF

NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Module 13 Active Learning Guide - Chapters 32 & 33 Reading Focus Areas In the text, you will see essential boxes, such as Safety Alerts, which discuss issues related to the care of older adults. Research Highlights contain a summary of pertinent current research related to chapter topics. Resources for Best Practice provide suggestions for further information for chapter topics and tools for practice. Healthy People boxes refer to goals cited in Healthy People 2030. Clinical judgment and next generation NCLEX examination style questions are located at the end of every chapter. Please review these questions as they are good practice for the exam. I. Later Life Transitions in Relationships 1. Describe the role transitions that take place in late life. a. Retirement Issues of work and retirement for older adults are a cultural universal topic because every culture has mechanisms for retiring their older citizens. Although retirement patterns differ across the world, in industrialized nations, and in many developing nations, the expectation is that older workers will cease full-time career job employment and be entitled to economic support. However, whether that support will be adequate, or even available, is a growing concern worldwide. In the United States, many European countries, and Australia, problems are emerging as the generation born after World War II moves into retirement. Developing countries face similar issues with the growth of the older population combined with decreasing birth rates. Governments may not be able to afford retirement systems to replace the tradition of children caring for aging parents. Most countries are not ready to meet what is projected to be one of the defining challenges of the 21st century. Retirement, as we formerly knew it, has changed. The transitions are blurring, and the numerous patterns and styles of retiring have produced more varied experiences in retirement. Retirement is no longer just a few years of rest from the rigors of work before death. It is a developmental stage that may occupy 30 or more years of one’s life and involve many stages. Some individuals will be retired for longer than they worked. Retirees are living longer, and declining birth rates mean that there will be fewer workers to support them. Countries are scaling down retirement benefits and raising the age at which individuals can collect them. People are starting to retire later as they realize the obstacles that financial challenges or obligations present to successful retirement and future independence. Sixty-nine percent of baby boomers either expect to or are already working past age 65 years. There may be financial reasons for older adults to want to keep working, or it might be that they want to stay mentally alert. The most frequently cited retirement fear across generations is outliving savings and investments (Transamerica Center for Retirement Studies, 2019). The COVID-19 pandemic has affected retirement decisions and there has been an increase in retirement among adults ages 55 and older. As of the third quarter of 2021, 50.3% of U.S. adults 55 and older said they were out of the labor force due to retirement. It is unclear if the NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide pandemic-induced increase in retirement among older adults will be temporary or long-lasting. The Bureau of Labor Statistics is projecting large increases in labor force participation among older adults from 2020 to 2030 with nearly 40% of individuals 65 years to 69 years of age being in the labor force by 2030, up from 33% in 2020 (Fry, 2021). Special Considerations in Retirement The three-legged stool for retirement (Social Security, savings, and private pensions) has become one-legged for a sizable proportion of Americans because of limited personal retirement savings and a decline in pension plans (Morley, 2017). Older adults with disabilities, those who had less access to education or held low-paying jobs with no benefits, and those not eligible for Social Security are at increased economic risk during retirement years. Older minority women, never-married women, and divorced women are more likely to live in poverty and are less likely to receive Social Security. Prior to the legalization of same-sex marriage in the United States, individuals were denied access to Social Security survivor benefits. After legalization of same-sex marriage, married same-sex couples now have access to Social Security survivor benefits, Medicaid spend-downs, bereavement leave, and tax exemptions upon inheritance of jointly owned real estate and personal property. Inadequate coverage for women in retirement is common because their work histories may have been sporadic and diverse. Women often retire earlier than anticipated because of family needs. Whereas most men have always worked outside the home, it is only within the past 40 years that this has been the expectation of women. Therefore large cohort differences exist. Traditionally, the variability of women’s work histories, interrupted careers, the residuals of sexist pension policies, Social Security inequities, and low-paying jobs created hazards for adequacy of income in retirement. The scene is gradually changing in many respects, but the gender bias remains (Chapter 5). Retirement Planning Current research suggests that retirement has positive effects on life satisfaction and health, although this may vary depending on the individual’s circumstances. Decisions to retire are often based on financial resources, attitudes toward work, family roles and responsibilities, the nature of the job, access to health insurance, chronological age, health, and self-perceptions of ability to adjust to retirement. Retirement planning is advisable during early adulthood and essential in middle age. However, people differ in their focus on the past, present, and future and their realistic ability to “put away something” for future needs. Retirement confidence continues to be closely related to having a retirement plan. Retirement preparation programs are usually aimed at employees with high levels of education and occupational status, those with private pension coverage, and government employees. Thus the people most in need of planning assistance may be those least likely to have any available, let alone the resources for an adequate retirement. Individuals who are retiring in poor health, minorities, women, those in lower socioeconomic levels, and those with the least education may experience greater concerns in retirement and may need specialized counseling and targeted education efforts (Fischer, 2021). NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 2. Explain the issues involved in adapting to both the expected and unexpected transitions and role changes in later life. a. Widowhood Death of a Spouse or Life Partner Losing a spouse or other life partner after a long, close, and satisfying relationship is the most difficult adjustment one can face, aside from the loss of a child. This loss is a stage in the life course that can be anticipated but seldom is considered. Spousal bereavement in later life is a higher probability for women due to differences in life expectancy, and while less common among men, it is still a significant event. Among those 75 years or older who had ever married, 58% of women and 28% of men had experienced the death of a spouse in their lifetime (US Census Bureau, 2021). Among individuals 75 to 84 years old, 14.7% of men and 42.9% of women are widowed; among those older than 85 years, 35.3% of men and 71.9% of women are widowed (Biddle et al., 2020). Older women are substantially more likely to be widowed (and not remarried) than older men (37% vs. 13%), and the majority of these older widowed women live alone. The number of widows has declined, especially for women whose spouses are now living longer. The decline in widowhood in recent decades also results from the rising share of divorced older adults, particularly among those ages 65 to 74 years. Although change in marital status is accepted as a normal life experience, the death/life partner of a spouse is a significant life event for older adults. With the loss of the intimate partner, several changes occur simultaneously in almost every domain of life and have a significant impact on well-being: physical, psychological, social, practical, and economic. Individuals who have been self-confident and resilient seem to fare best. Having frequent contact with family and friends is key to resilience in handling the loss. The transitional phase of grief, if handled appropriately, leads to the confirmation of a new identity, the end of one stage of life, and the beginning of another. Gender differences on widowhood are found in the literature. Bereaved husbands may be more socially and emotionally vulnerable. Suicide risk is highest among men older than 80 years of age who have experienced the death of a spouse (Chapter 30). Widowers adapt more slowly than widows to the loss of a spouse and often remarry quickly. Loneliness and the need to be cared for are factors influencing widowers to pursue new partners. Having associations with family and friends, being members of a church community, and continuing to work or engage in activities can all be helpful in the adjustment period following the death of a wife. Common bereavement reactions of widowers are listed in Box 32.2 and should be discussed with male clients. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 3. Interview a newly retired older adult. What are his/her beliefs about retirement (e.g., does he or she view retirement as a good thing, a bad thing, etc.)? What does he/she miss about his or her previous work role(s)? What plans has he or she made for his/her retirement (e.g., financial, residence, part-time work, etc.)? What worries does he/she have about retirement? What goals does he or she have for retirement (e.g., travel, reading, hobbies, spending time with family, volunteering, etc.)? (maybe call your parents or grandparents and ask them the above questions) 1. A Time for Relaxation and Freedom Many retirees view retirement as a well-earned break after decades of work. They look forward to having freedom from the daily grind and the opportunity to relax, pursue hobbies, travel, and spend time doing things they couldn't while working. 2. Opportunity for New Ventures Retirement is often seen as a second chance to explore new interests or revive old passions that were set aside during their working years. This might include starting a new business, picking up new skills, or engaging in volunteer work. 3. Concerns About Financial Security Financial security is a significant concern. Some retirees feel well-prepared and confident about their financial planning, while others might be anxious about outliving their savings, managing health care costs, or the ability to maintain their lifestyle without a steady income. 4. Health and Well-being There is often a belief that retirement will provide more time to focus on health through exercise, better eating habits, and managing medical issues. However, some might also worry about declining health and its impact on their ability to enjoy retirement fully. 5. Social Relationships Many retirees believe that retirement will allow them more time to invest in their personal relationships, including with their spouse, family, and friends. Conversely, some may worry about losing a social network connected to their job, leading to feelings of isolation or loneliness. 6. Identity and Purpose Retirement can lead to significant shifts in identity and purpose. Some retirees struggle with the loss of professional identity and look for new ways to define themselves. Others embrace the change, finding new sources of fulfillment and purpose outside the professional sphere. 7. Adjustment Period There is often an acknowledgment that adjusting to retirement can take time. Retirees might expect an initial honeymoon phase followed by a period of adjustment where they have to find a new routine and deal with the psychological impacts of major life changes. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 8. Longevity and Legacy With increasing life expectancies, many retirees consider how they will spend potentially several decades in retirement. This can bring beliefs centered around leaving a legacy, whether through family, community work, or other contributions. 9. Mixed Emotions Retirement is frequently seen with mixed emotions. The anticipation of freedom often comes with apprehensions about the unknowns. Many express a bittersweet feeling about leaving their career behind. 10. Desire for Active Engagement There is a strong belief in staying active and engaged to keep one’s mind and body healthy. Retirees often plan to engage in physical activities, continue learning, and maintain a social calendar to stay vibrant. 4. What questions should one consider when deciding whether to continue working or to retire? 1. Financial Considerations: Evaluate your financial preparedness for retirement, including savings, investments, pension plans, and potential sources of income post-retirement. 2. Health and Well-being: Assess your physical and mental health status, considering any medical conditions that may impact your ability to work or enjoy retirement fully. 3. Lifestyle Preferences: Reflect on your desired lifestyle in retirement, such as travel, hobbies, or spending time with family, and how continued work or retirement aligns with these aspirations. 4. Social Connections: Consider the social aspects of work, such as interactions with colleagues and a sense of purpose, versus the opportunities for social engagement in retirement. 5. Personal Fulfillment: Reflect on whether your current job provides fulfillment and satisfaction or if pursuing other interests in retirement would bring greater personal happiness. 6. Long-term Goals: Align your decision with your long-term goals and aspirations, considering how working or retiring may impact your overall life plan. 7. Health Insurance and Benefits: Review the availability of health insurance and other benefits through work versus retirement options to ensure comprehensive coverage. 5. What are the components of financial security in retirement? 1. Retirement Savings: Accumulating sufficient savings through retirement accounts such as 401(k), IRAs, or other investment vehicles to cover living expenses during retirement. 2. Social Security Benefits: Utilizing social security benefits as a source of income in retirement, which can provide a foundation of financial support. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 3. Pension Plans: For individuals with pension plans through their employers, these can serve as an additional source of income during retirement. 4. Healthcare Coverage: Securing adequate healthcare coverage, including Medicare or supplemental insurance, to address medical expenses in retirement. 5. Debt Management: Managing and reducing any outstanding debts before retirement to minimize financial burdens in later years. 6. Estate Planning: Establishing wills, trusts, and other estate planning tools to ensure assets are distributed according to your wishes and to potentially minimize tax implications. 7. Diversified Investments: Building a diversified investment portfolio that balances risk and return to generate income and preserve capital throughout retirement. Describe factors that place one at economic risk during retirement years. In retirement, several factors can contribute to economic risk. One significant factor is inadequate savings and investments. If individuals have not saved enough or made poor investment choices during their working years, they may face financial difficulties in retirement. This can result in a lower standard of living or even running out of money altogether. Another factor is healthcare costs. As people age, healthcare expenses tend to increase, especially for long-term care or chronic conditions. Without proper planning or insurance coverage, these costs can quickly deplete retirement savings and assets. Furthermore, unexpected events such as a market downturn, inflation, or personal emergencies can also pose economic risks during retirement. A lack of contingency plans or emergency funds can leave retirees vulnerable to financial instability in such situations. Moreover, relying solely on social security benefits without additional sources of income can also increase economic risk. Social security may not provide enough to cover all expenses, especially as life expectancy increases and healthcare costs rise. To mitigate these risks, individuals should focus on building a diverse portfolio of savings and investments, considering factors like risk tolerance, time horizon, and inflation protection. Planning for healthcare expenses through insurance or savings accounts is crucial. Additionally, having a comprehensive retirement plan that includes emergency funds and contingencies can help buffer against unexpected events. Why are women at greater risk than men in terms of financial security in retirement? Analyzing the question, we see that you are interested in understanding the factors that can put individuals at economic risk during their retirement years. This is a crucial topic as financial security in retirement is a major concern for many people. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide There are several key factors that can contribute to economic risk during retirement. One of the primary factors is inadequate savings and planning for retirement. Many individuals may not have saved enough money or invested wisely to support themselves during their retirement years. This lack of financial preparedness can lead to difficulties in meeting living expenses, healthcare costs, and other essential needs. Another factor that can increase economic risk in retirement is unexpected health expenses. As individuals age, they may face increased medical costs due to age-related health issues or chronic conditions. These expenses can quickly deplete savings and strain financial resources, especially if they are not adequately covered by insurance or other means. Additionally, changes in the economy and financial markets can also impact one's financial stability in retirement. Fluctuations in the stock market, inflation, and other economic factors can affect the value of investments and pensions, potentially reducing income and assets available for retirement. Furthermore, longevity risk is another important factor to consider. With increasing life expectancy, individuals may need to support themselves financially for a longer period of time in retirement. This requires careful planning to ensure that savings and income sources will last throughout one's lifespan. To mitigate these risks, it is essential for individuals to engage in comprehensive financial planning, including saving early and consistently, diversifying investments, obtaining adequate insurance coverage, and staying informed about economic trends that may impact their retirement finances. 6. How do you think retirement differs for men and women? Analyzing the question, it revolves around the comparison of retirement experiences between men and women. The user is seeking insights into the potential differences in retirement for these two genders. Retirement experiences can indeed differ significantly between men and women due to various factors. One key aspect is the gender pay gap, where women typically earn less over their careers compared to men. This results in lower savings and pension funds for women, impacting their financial security in retirement. According to data from the U.S. Census Bureau, women's median annual earnings are around 82% of men's earnings, contributing to a retirement savings gap. Additionally, women often have interrupted careers due to caregiving responsibilities for children or elderly parents, which can further impact their ability to save for retirement. This can lead to lower Social Security benefits for women compared to men who have had continuous employment. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Furthermore, women tend to live longer than men on average, which means they may need to stretch their retirement savings over a longer period. This longevity risk poses a challenge for women in terms of managing their finances and ensuring they have enough resources for a comfortable retirement. In terms of investment behavior, studies have shown that women tend to be more risk-averse than men when it comes to investing, which can impact their investment returns and overall wealth accumulation for retirement. Many men who retire develop a chronic illness or die after retirement. Can you find a source to legitimize this comment? https://www.nber.org/bah/2018no1/mortality-effects-retirement 7. Describe the nurse’s role in caring for the spouse of a patient who has recently died. First and foremost, nurses offer compassionate care and a listening ear to the grieving spouse. They provide emotional support by acknowledging their feelings, validating their grief, and offering a safe space for them to express their emotions. Nurses also help the spouse understand the grieving process, normalize their reactions, and provide coping strategies to manage their grief effectively. In addition to emotional support, nurses assist the spouse in practical matters such as making funeral arrangements, accessing resources for bereavement support, and connecting them with counseling services if needed. They may also provide information on legal matters, financial considerations, and community resources to help the spouse navigate through this challenging time. Furthermore, nurses collaborate with other healthcare professionals, such as social workers, chaplains, and psychologists, to ensure comprehensive care for the grieving spouse. By working as part of a multidisciplinary team, nurses can address the physical, emotional, and spiritual needs of the spouse holistically. It is essential for nurses to approach their care with sensitivity, empathy, and cultural competence when caring for the spouse of a deceased patient. Every individual experiences grief differently, and tailoring care to meet the unique needs of each person is paramount in providing effective support during this vulnerable time. 8. Describe the various relationships that provide support to the older adult. Friendships Friends are often a significant source of support in later life. The number of friends may decline, but the majority of older adults have at least one close friend with whom they maintain close contact, share confidences, and can turn to in an emergency. The social network may narrow as one ages, with intimate personal relationships being maintained and the more instrumental NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide relationships discontinued. Research across the globe supports the value of friendship for older adults in promoting health and well-being. Friends play an important role in the lives of older adults. (By Michal Osmenda, Brussels, Belgium [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons.) Friendships are often sustaining in the face of overwhelming circumstances. Friends provide the critical elements of satisfactory living that families may not, providing commitment and affection without judgment. Personality characteristics between friends are compatible because the relationships are chosen and caring is shared without obligation. Trust, demonstrations of caring, and mutual problem solving are important aspects of the friendships. Friends may share a lifelong perspective or may bring a totally new intergenerational viewpoint into one’s life. Late-life friendships often develop out of changing situations, such as relocation to retirement or assisted living communities, widowhood, and involvement in volunteer pursuits. As desires and pursuits change, some friendships evolve that one never would have considered in one’s youth. Considering the obvious importance of friendship, it seems to be a neglected area of exploration and a seldom considered resource for professionals working with older adults. Because close friendships have such influence on the sense of well-being of older adults, anything done to sustain them or assist in building new friendships and social networks will be helpful. Internet access and social media offer new opportunities to interact with friends or even to form new friendships. Generally, women tend to have more sustaining friendships than do men, and this factor contributes to resilience, a characteristic linked to successful aging (Chapter 30). Nurses may include questions about the individual’s friendships and their importance and availability in their assessment of older adults. Although friendships do provide much support, they are also a further source of grief in old age. The loss of friends through death occurs often, and nurses must appreciate the nature of this loss. Encouraging intergenerational friendships and linking older adults to resources for social participation and meaningful activities are important interventions. FAMILIES Changing Family Structure The idea of family evokes strong impressions of whatever an individual believes the typical family should be. Because everyone comes from a family, these impressions have powerful symbolic meanings. However, in today’s world, the definition of family is in a state of flux. As recently as 100 years ago, the norm was the extended family made up of parents, their grown children, and the children’s children, often living together and sharing resources, strengths, and challenges. As cities grew and adult children moved in pursuit of work, parents did not always come along, and the nuclear family evolved. The norm in the United States became two parents and their two children (nuclear family), or at least that was the norm in what has been considered mainstream America. This pattern was not NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide as common among ethnically diverse families, where the extended family is often the norm. However, families are changing, and today the nuclear family is much less common. Changing family patterns pose significant challenges for the future of long-term care because 80% to 90% of all long-term care services and supports are provided by spouses, adult children, and other informal caregivers. Baby boomers are more likely to live alone than previous generations, and single-person households are increasing (Vespa & Schondelmyer, 2015). Other countries are also experiencing changes in family composition, and even values, as the numbers of older adults increase and the younger members of society become more mobile and move away from their homes. In China, the extended family is disappearing, and in 2013 the country enacted a new law mandating that family members must attend to the spiritual needs of older family members and visit them frequently if they live apart. Nearly half of the country’s seniors live apart from their children (Dong, 2016). A decrease in fertility rates has reduced family size, and American families are smaller today than ever before. The high divorce and remarriage rate results in households of blended families of children from previous marriages and the new marriage. The new modern family includes single-parent families, blended families, gay and lesbian families, domestic partnerships, and childless families. Older adults without families, either by choice or by circumstance, may create their own “families” through communal living with siblings, friends, or others. Indeed, it is not unusual for childless older adults residing in long-term care facilities to refer to the staff as their new “family.” Multigenerational Families The US Census Bureau defines multigenerational families as those consisting of more than two generations living under the same roof. One in four Americans live in a household with three or more generations. Multigenerational living has nearly quadrupled in the past decade, with the COVID-19 pandemic playing a strong role. However, record numbers of families were already living together in the United States before the pandemic. Multigenerational families are more common among Hispanic and Asian households but are growing among nearly all US racial groups, among all age groups, and among both men and women. Among those living in a multigenerational household, nearly 6 in 10 say that they started or are continuing to live together because of the COVID-19 pandemic. The pandemic created challenges, especially for those cohabitating with high-risk individuals. About 7 in 10 of those currently living in multigenerational households plan to continue doing so long term. Sixty-six percent say that the economic climate was a factor in their living arrangement. Other reasons include the need for eldercare or childcare; job loss, change in job status, or underemployment; health care costs for one or more family members; cultural and family expectations; and education or retraining expenses (Generations United, 2021). Although multigenerational living can be stressful at times, the overwhelming majority of Americans living in multigenerational homes say that their households function successfully. Benefits cited include enhanced bonds or relationships, ease of providing for care needs of one NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide or more family members, improved finances for at least one family member, positive impacts on personal mental and/or physical health, and making it possible for at least one family member to continue school or enroll in job training (Generations United, 2021). “Multigen” remodeling or new home building to accommodate intergenerational families is an increasing trend. Box 32.4 presents tips for planning to add an older adult to the household. Family Relationships Family members, however they are defined, form the nucleus of relationships for the majority of older adults and their support system if they become dependent. A long-standing myth in society is that families are alienated from their older family members and abandon their care to institutions. Nothing could be further from the truth. Family relationships remain strong in old age, and most older adults have frequent contact with their families. The majority of older adults possess a large intergenerational web of significant people, including sons, daughters, stepchildren, in-laws, nieces, nephews, grandchildren, great-grandchildren, and partners and former partners of their offspring. Families provide the majority of care for older adults. Changes in family structure will have a significant impact on the availability of family members to provide care for older adults in the future. Pets are a part of the family and are particularly beneficial to older adults. They provide companionship, comfort, and caring. (©iStock.com/michellegibson.) As families change, the roles of family members or expectations of one another also may change. Grandparents may assume parental roles for their grandchildren if their children are unable to care for them, or grandparents and older aunts and uncles may assume temporary caregiving roles while the children, nieces, and nephews work. Adult children of any age may provide limited or extensive caregiving to their own parents or aging relatives who may become ill or impaired. A spouse, sibling, or grandchild also may become a caregiver. Close-knit families are more aware of the needs of their members and work to resolve problems and find ways to meet the needs of members, even if they are not always successful. Emotionally distant families are less available in times of need and have greater potential for conflict. If the family has never been close and supportive, it will not magically become so when members grow older. Resentments long buried may crop up and produce friction or psychological pain. Long-submerged conflicts and feelings may return if the needs of one family member exceed those of the others. In coming to know the older adult, the gerontological nurse also comes to know the family, learning of their special gifts and their life challenges. The nurse works with the older adult within the unique culture of the adult’s family of origin, present family, and support networks, including friends. 9. Describe the role of fictive kin. Fictive kin are nonblood kin who serve as “genuine fake families,” as expressed by noted gerontologist Virginia Satir. These nonrelatives become surrogate family and take on some of the instrumental and affectional attributes of family. Fictive kin are important in the lives of NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide many older adults, especially those with no close or satisfying family relationships and those living alone or in institutions. Fictive kin includes both friends and often paid caregivers. Primary care providers, such as nursing assistants, nurses, or case managers, often become fictive kin. Professionals who work with older adults need to recognize the instrumental and emotional support, and the mutually satisfying relationships, that occur between friends, neighbors, and other fictive kin who assist older adults who are dependent. 10. Increasingly, grandparents are assuming caregiving roles. To whom are grandparents giving care? Grandparents Raising Grandchildren Over the past decade grandparents have assumed the primary caregiving responsibility for their grandchildren at an unprecedented rate. Global figures indicate that grandparents represent the majority of all kinship carers and are the largest providers of formal childcare between birth and 12 years of age (McLaughlin et al., 2017). More than 2.7 million grandparents are providing primary care (custodial grandparents) for grandchildren in the United States, and grandparentheaded households are one of the fastest-growing US family groups. A large number of grandparents provide care to multiple grandchildren simultaneously, and more than 36% have done so for more than 5 years. Grandparent caregivers are more prevalent in Latinx and Black communities, and White families have the lowest proportion of grandparent-headed families (Generations United, 2020). The reasons why grandparents take a child into the home without the child’s parents vary among countries, groups, and individuals. Many grandparents have become, by default, the primary caregivers of grandchildren because the parents are unable to provide the care needed as a result of child abuse, teen pregnancy, imprisonment, joblessness, military deployment, drug and alcohol addictions, illness, death, and other social problems. Drug addiction, especially to opioids, is behind much of the rise in the number of grandparents raising their grandchildren (Generations Now, 2020). Grandparents are the majority of all kinship caregivers and the largest providers of formal childcare between birth and 12 years of age. (© iStock.com/FG Trade.) Research related to the effect of grandparent caregiving on health status is lacking, but existing literature suggests that there are economic, health, and social challenges inherent in this role. About 25% of grandparent-headed households and more than half of grandmothers raising grandchildren live in poverty. Approximately 57% of grandparent caregivers experience depression. Often crisis situations precipitate the decision of a grandparent to assume caring for a grandchild, and time for preparation is not available. In many cases, grandparents assume care so that their grandchildren’s care is not taken over by the public care system. However, many custodial grandparents are not licensed in the foster care system and are not eligible for the same services and financial support as licensed foster parents. As with other types of caregiving, there are both blessings and burdens, and caregivers’ experiences will be unique. For many grandparents, the challenges may include limited income and financial support through the welfare system, lack of informal support systems, loss of leisure activities in retirement, and shame or guilt related to their children’s inability to parent (McLaughlin et al., 2017). Physical and mental stressors appear to be greater when grandparents are raising a child with a chronic illness or special needs or behavioral problems. Many of the NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide grandchildren being cared for have a history of trauma (physical or sexual abuse, neglect, abandonment, domestic violence, exposure to violent crime and illegal activity associated with substance abuse), which complicates the challenges faced by grandparent caregivers. Despite facing many barriers, research shows that the children in grandfamilies thrive. The benefits for the children cared for by grandparents are better than for children in nonrelative care and include increased stability, greater safety, better behavioral and mental health outcomes, more positive feelings about placements, more likely to report that they “always felt loved,” more likely to live with or stay connected to siblings, and greater preservation of cultural identity and community connections. Caregivers also experience benefits, such as an increased sense of purpose in life (Generations United, 2021). How can the nurse assist grandparents in their caregiving roles? Tips for Best PracticeNursing Actions With Grandparent Caregivers Early identification of at-risk grandparents Comprehensive assessment of physical, psychosocial, and environmental factors affecting those in the caregiving role for grandchildren Anticipatory guidance and counseling about child growth and development and other childraising issues Referral to resources for support, counseling, and financial assistance Advocacy for policies supportive of grandparents who have assumed a caregiving role Analyzing the question, it is evident that the user is seeking guidance on how nurses can support grandparents in their caregiving responsibilities. This implies a focus on understanding the unique challenges and needs faced by grandparents who are caring for their grandchildren, and how nurses can provide assistance in this context. 1. Education and Training: Nurses can provide grandparents with education and training on topics such as child development, health, safety, and nutrition. This can help grandparents feel more confident in their caregiving abilities and ensure the well-being of their grandchildren. 2. Emotional Support: Caring for grandchildren can be emotionally demanding for grandparents. Nurses can offer emotional support, counseling, and coping strategies to help grandparents manage stress, anxiety, and other emotional challenges that may arise. 3. Resource Referrals: Nurses can connect grandparents with community resources, support groups, and services that can provide additional assistance with childcare, financial support, legal issues, and other needs. 4. Health Monitoring: Nurses can help grandparents monitor the health and well-being of both themselves and their grandchildren. This may include regular check-ups, vaccinations, medication management, and guidance on maintaining a healthy lifestyle. 5. Advocacy: Nurses can advocate for the needs and rights of grandparents in their caregiving roles, ensuring they have access to appropriate services, benefits, and support systems. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide II. Intimacy and Sexuality 1. Discuss touch and intimacy as integral components of sexuality. Illness, confinement, and dependency seen in hospitalization and institutionalization are stressors on the intimate zone of touch. Touch Touch is the first of our senses to develop and provides us with our most fundamental means of contact with the external world. It is the oldest, most important, and most neglected of our senses, stronger than verbal or emotional contact. All other senses have an organ on which to focus, but touch is everywhere. Touch is unique because it frequently combines with other senses. An individual can survive without one or more of the other senses, but no one can survive and live in any degree of comfort without touch. In the absence of touching or being touched, people of all ages can become sick and become touch starved. Touch is experienced physically as a sensation and affectively as emotion and behavior. The interaction of touch affects the autonomic, reticular, and limbic systems, and thus profoundly affects the emotional drives. The human yearning for physical contact is embedded in our language in such figurative terms as “keep in touch,” “handle with care,” and “rubbed the wrong way.” We will focus on touch as an overt expression of closeness, intimacy, and sexuality. We believe that an individual must recognize the power of touch and its intimacy to fully comprehend sexuality. Touch and intimacy are integral parts of sexuality, just as sexuality is expressed through intimacy and touch. Together, touch and intimacy can offer the older adult a sense of well-being. Throughout life, touch provides emotional and sensual knowledge about other individuals—an unending source of information, pleasure, and pain. Response to Touch The Touch Model suggests that attitudes toward touch and acceptance of touch affect the behaviors of both caregivers and patients. Two types of touch occur during the nurse-patient relationship: procedural and nonprocedural. Procedural touch (task-oriented or instrumental touch) is physical contact that occurs when a particular task is being performed. Nonprocedural touch (expressive physical touch) does not require a task and is affective and supportive in nature, such as holding a patient’s hand. People have definite feelings, opinions, and comfort with touch based on their life experience. The boundaries of tactual communication are learned culturally. Cultural and religious norms determine the appropriateness and acceptability of touch. The nurse should ask the person’s permission before touching and not assume that a person likes or wants to be touched (Chapter 4). Of all health care professionals, nurses have the most frequent opportunities to provide gentle, reassuring, renewing touch. Therapeutic, caring touch by the nurse is a potent healing intervention. It is important that touching be done with respect regarding the person’s comfort and with the nurse’s intention of providing a comforting and healing modality within the nursepatient relationship. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Touch Zones Hall (1969) identifies different categories of touching—expanding or contracting zones around which every individual extends the sensory experience of touching, smelling, hearing, and seeing. The categories of touching include intimate, vulnerable, consent, and social zones (Fig. 33.1). Providing care in the zone of intimacy, which is identified generally as the area within an arm’s length of the individual’s body and is the space used for comforting, protecting, and lovemaking, is part of the nurse’s caregiving activities. The vulnerable zone is highly sexually charged and will be protected. The most intimate area, the genitalia, is the most personally protected area of the body and causes the most stress and anxiety when approached, touched, or viewed by the caregiver. The consent zone requires the nurse to seek out or ask permission to touch or initiate procedures to these areas. The social zone includes the areas of the body that are the least sensitive or embarrassing to be touched and that do not necessarily require permission to be handled. Illness, confinement, and dependency seen in hospitalization and institutionalization are stresses on the intimate zone of touch. Just as caregivers enter a room without knocking, so do they often intrude into the intimate circle of touch without asking. A person’s need for privacy and personal space is strongly related to acceptance and response to touch. If the need for privacy and distance is great, touch should be used judiciously. 2. Discuss the therapeutic benefits of touch for older people. Discuss how touch may be harmful. Therapeutic Touch Touch is a powerful healer and a therapeutic tool that nurses can use to satisfy “touch hunger” that may be present among older adults. Nursing has recognized the importance of touch and has the social sanctions to touch the body in the intimate and personal care of a person, an opportunity too often not fully used for the betterment of the older adult’s adaptation to environment and location in time and space. Touch can serve as a means of providing sensory stimulation, reducing anxiety, relieving physical and psychological pain, comforting the dying, and sexual expression. Krieger’s (1975) groundbreaking experiments with therapeutic touch provided the framework for the use of therapeutic touch in nursing. Her work demonstrated physiological and psychological improvement in patients who are exposed to consistent “doses” of touch. Handson healing and energy-based interventions have been found in cultures throughout history, dating back at least 5000 years. “Laying on of the hands” and the power of touch to heal had largely disappeared with the scientific revolution. The phenomenon has reemerged as healing touch and therapeutic touch movements. Many nurses have learned how to perform therapeutic and healing touch and use these modalities in their practice with people of all ages. Positive outcomes of interventions using touch in nursing homes, particularly with people with NCDs and agitated behaviors, have been reported. Further research on the use of touch with older adults is needed. Touch is a powerful NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide tool to promote comfort and well-being when working with older adults, many of whom may not have opportunities for physical contact. 3. Discuss factors that affect older adults’ sexual function. Sexuality is a basic human need. Just because we age doesn’t mean that this need goes away. SEXUAL HEALTH The WHO defines sexual health as a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships and the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled (WHO, 2020). Sexual health is a realistic phenomenon that includes four components: personal and social behaviors in agreement with individual gender identity; comfort with a range of sexual role behaviors and engagement in effective interpersonal relations with both sexes in a loving relationship or long-term commitment; response to erotic stimulation that produces positive and pleasurable sexual activity; and the ability to make mature judgments about sexual behavior that is culturally and socially acceptable. These interpretations address the multifaceted nature of the biological, psychosocial, cultural, and spiritual components of sexuality and imply that sexual behavior is the capacity to enhance self and others. Sexual health is individually defined and wholesome if it leads to intimacy (not necessarily coitus) and enriches the involved parties. Factors Influencing Sexual Health Older adults are becoming increasingly open in their attitudes and beliefs about sexuality. A shift in views toward the end of the 20th century that emphasized the importance of sexual activity in older adulthood for a person’s health and well-being has made sex in late life an indicator of “successful aging” (Sinkovic & Towler, 2018). However, a large number of cultural, biological, psychosocial, and environmental factors can influence the sexual behavior of older adults. Older adults may be confronted with barriers to the expression of their sexuality by reflected attitudes, health, culture, economics, opportunity, and historical trends. Factors affecting a person’s attitudes on intimacy and sexuality include family dynamics and upbringing and cultural and religious beliefs (Chapter 4). Older adults often internalize the broad cultural proscriptions of sexual behavior in late life that hinder the continuance of sexual expression. There remains a prevailing assumption that as we age, we become sexually undesirable, incapable of sex, or asexual. “It is erroneously believed that older adults (especially older women) are unattractive, that older sex is disgusting, risky, or ‘wrong,’ aging entails sexual dysfunction and sex, as a rule, should be discouraged in old age homes and other facilities” (Dhingra et al., 2016, p. 132). Health care professionals are not immune to these stereotypes and may assume that sexual issues are of lesser concern to older adults and neglect to address this important aspect of healthy aging. It is refreshing to see more movies with older actors that incorporate more NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide positive views of older adults enjoying intimate and satisfying sexual relationships (e.g., The Best Exotic Marigold Hotel and Our Souls at Night). Much sexual behavior stems from incorporating other people’s reactions. Older adults do not feel old until they are faced with the fact that others around them consider them old. Similarly, older adults do not feel asexual until they are continually treated as such. An often-quoted statement by Alex Comfort (1974) sums it up nicely: “In our experiences, old folks stop having sex for the same reasons they stop riding a bicycle—general infirmity, thinking it looks ridiculous, no bicycle” (p. 440). Box 33.1 presents some of the myths about sexuality in older women that may be held by older adults themselves and by society in general. Box 33.1 Sexuality and Aging Women: Common Myths Masturbation is an immature activity of youngsters and adolescents, not older women. Sexual prowess and desire wane during the climacteric, and menopause is the death of a woman’s sexuality. Hysterectomy creates a physical disability that results in the inability to function sexually. Sex has no role in the lives of older adults, except as perversion or remembrance of times past. Sexual expression in old age is taboo. Older adults are too old and frail to engage in sex. The young are considered lusty and virile; older adults are considered lecherous. Sex is unimportant or over in the lives of the older adults. Older women do not wish to discuss their sexuality with professionals. Activity Levels For both heterosexual and lesbian, gay, bisexual, and transgender individuals, research supports that liberal and positive attitudes toward sexuality, greater sexual knowledge, satisfaction with a long-term relationship or a current intimate relationship, good social networks, psychological well-being, and a sense of self-worth are associated with greater sexual interest, activity, and satisfaction. Both early studies of sexual behavior in older adults and more recent ones indicate that older adults are continuing to enjoy active sex lives well into their 70s and 80s. In a US national poll on healthy aging, current sexual activity overall was 40%, with 46% of those ages 65 to 70, 39% of those ages 71 to 75, and 25% of those ages 76 to 80 being sexually active, with men more sexually active than women (Solway et al., 2019). Determinants of sexual activity and functioning include the interaction of each partner’s sexual capacity, physical health, motivation, conduct, and attitudes and the quality of the dyadic relationship. Having a sexual partner, frequent intercourse, good health, low level of stress, and an absence of financial worries enhanced a happy sexual relationship. Sexual activity is closely tied to overall health, and individuals with better health are more likely to be sexually active. Depression, anxiety, lack of sexual reciprocity in the couple, a monotonous and repetitive sexual NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide relationship, and illness are some factors that may be responsible for changes in sexual behavior. The most common reason for sexual inactivity among heterosexual couples is the male partner’s health. Patterns of sexual activity in earlier years are a major predictor of sexual activity in later life, and individuals with higher levels of sexual activity in middle age show less decline as they age. Older adults with positive sexual attitudes during aging report positive sexual experiences (Ricoy-Cano et al., 2020). Regular sexual expression enhances psychological and physical wellbeing in older adulthood and may improve cognitive functioning (Schafer et al., 2018). Sexuality is an important need in late life and affects pleasure, adaptation, and a general feeling of well-being. Cohort and Cultural Influences The era in which a person is born and the culture one belongs to influence attitudes about sexuality. Years ago, sexuality was not openly expressed or discussed, and pleasurable sex was viewed as for men only; women engaged in sexual activity to satisfy their husbands and to make babies. Findings from qualitative research on the sexuality and sexual health of older adults noted that men’s sexual satisfaction is often viewed as a woman’s obligation and that women take a passive role and leave initiating sex to men, particularly in more traditional societies (Sinkovic & Towler, 2018). These kinds of experiences shape beliefs and knowledge about sexual expression and comfort with sexuality. The next generation of older adults (baby boomers) have experienced other influences, including more liberal attitudes toward sexuality, the women’s movement, a higher number of divorced adults, the human immunodeficiency virus (HIV) epidemic, and increased numbers of LGBTQ+ individuals, that will affect their views and attitudes as they age. It has been suggested that an emerging stereotype now sits alongside negative stereotypes of sex and aging: the “sexy oldie.” “Sex is now being promoted as integral to physical and emotional health in older age. This new stereotype, although more positive toward the idea of active sexual lives among older adults, may create new barriers for those whose body image, physical capabilities, and partner status do not conform to the ‘sexy oldie’ model” (Sinkovic & Towler, 2018, p. 1239). However, stereotypes about old age and sexuality persist despite the more liberal attitudes of newer generations toward sex and sexual behavior. It is important to come to know and understand the older adult within that person’s social and cultural background and not make judgments based on one’s own belief system. Most of what is known about sexuality in aging has been gained through research with well-educated, healthy, White older adults. Further research is needed among culturally, socially, and ethnically diverse older adults; those with chronic illness; and LGBTQ+ older adults. Biological Changes Acknowledgment and understanding of the age changes that influence sexual physiology, anatomy, and the stages of sexual response may partially explain alteration in sexual behavior to accommodate these changes and facilitate continued pleasurable sex. Characteristic physiological changes during the sexual response cycle do occur with aging, but these vary NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide among individuals depending on general health factors. The changes occur abruptly in women starting with menopause but more gradually in men, a phenomenon called andropause. The “use it or lose it” phenomenon applies here: the more sexually active the person is, the fewer changes that person is likely to experience in the pattern of sexual response. Changes in the appearance of the body (wrinkles, sagging skin) also may affect the older person’s security about his or her sexual attractiveness. Table 33.1 summarizes physical changes in the sexual response cycle. A major nursing role is to provide information about these changes and provide appropriate assessment and counseling within the context of the individual’s needs. Table 33.1 Physical Changes in Sexual Responses in Older Adults As people age, their sexual responses can change due to various physiological, psychological, and social factors. These changes can affect both men and women and can influence their sexual health and intimacy. Understanding these changes can help older adults adjust their expectations and find ways to maintain a fulfilling sexual life. Here's an overview of typical physical changes in sexual responses in older adults: In Men 1. Erectile Dysfunction (ED): - With age, men may experience a decrease in the firmness of erections or a longer time required to achieve erections. Erectile dysfunction becomes more common as men grow older, influenced by health conditions like diabetes, cardiovascular diseases, or neurological disorders. 2. Slower Arousal: - Older men often require more time to become sexually aroused. The response to physical stimulation can diminish, necessitating more direct stimulation to achieve and maintain arousal. 3. Reduced Testosterone Levels: - Testosterone levels gradually decrease with age, which can affect libido (sexual desire), mood, and energy levels. 4. Changes in Ejaculation and Orgasm: - The force of ejaculation may decrease, and the volume of semen typically reduces. The sensation of orgasm can change, sometimes becoming less intense. The refractory period (the time needed to achieve another erection after an orgasm) increases, often significantly. In Women 1. Menopause: - Women experience menopause, typically around the age of 50, which marks the end of menstrual cycles. This comes with a decrease in estrogen and other hormones, which can lead to various changes affecting sexual function. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 2. Vaginal Changes: - Decreased estrogen levels can lead to vaginal dryness, making sexual intercourse uncomfortable or painful. Vaginal atrophy (thinning of the vaginal walls) and decreased vaginal elasticity can also occur. 3. Decreased Libido: - Similar to men, some women experience a decrease in sexual desire. This can be influenced by hormonal changes, emotional factors, or health conditions. 4. Changes in Arousal and Orgasm: - Women may notice longer arousal times and reduced intensity of orgasms. Some women might find it harder to reach orgasm, while others may experience more frequent or more intense orgasms. General Changes 1. Health Conditions: - Chronic health issues like arthritis, diabetes, cardiovascular disease, and neurological disorders can impede sexual function through various mechanisms, such as pain, fatigue, or decreased mobility. 2. Medications: - Many medications common in older age, such as antihypertensives (for high blood pressure) or antidepressants, can affect sexual function as side effects. 3. Psychological Factors: - Mental health plays a crucial role in sexual desire and satisfaction. Depression, anxiety, and stress, which may be more prevalent in older age due to life changes, can impact sexual function. Adapting to Changes Understanding and adapting to these changes can help maintain a satisfying sexual life. This might include: - Communication: Open discussions with partners about needs, preferences, and changes can help in adjusting sexual practices. - Medical Consultation: Consulting healthcare providers can address treatable issues like erectile dysfunction or vaginal dryness. - Lubricants and Moisturizers: Using lubricants during intercourse or vaginal moisturizers can alleviate discomfort caused by dryness. - Therapy: Sex therapy or couples counseling can help address emotional or relational aspects affecting sexual health. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide In conclusion, while sexual function does change with age, sexuality can remain a vital and enjoyable part of life. By understanding and addressing these changes proactively, older adults can continue to have a fulfilling sexual life. 4. Describe approaches to assessment of a client’s sexuality that may reduce nurse-client anxiety. Response to Touch The Touch Model suggests that attitudes toward touch and acceptance of touch affect the behaviors of both caregivers and patients. Two types of touch occur during the nurse-patient relationship: procedural and nonprocedural. Procedural touch (task-oriented or instrumental touch) is physical contact that occurs when a particular task is being performed. Nonprocedural touch (expressive physical touch) does not require a task and is affective and supportive in nature, such as holding a patient’s hand. People have definite feelings, opinions, and comfort with touch based on their life experience. The boundaries of tactual communication are learned culturally. Cultural and religious norms determine the appropriateness and acceptability of touch. The nurse should ask the person’s permission before touching and not assume that a person likes or wants to be touched (Chapter 4). Of all health care professionals, nurses have the most frequent opportunities to provide gentle, reassuring, renewing touch. Therapeutic, caring touch by the nurse is a potent healing intervention. It is important that touching be done with respect regarding the person’s comfort and with the nurse’s intention of providing a comforting and healing modality within the nursepatient relationship. 5. Discuss challenges faced by lesbian, gay, bisexual, and transgender older adults. SEXUAL HEALTH OF LGBTQ+ INDIVIDUALS While the US census has never measured how many LGBTQ+ people live in the United States, reports estimate that there are around 3 million LGBTQ+ adults over the age of 50 in the country, and this population will increase dramatically over the next few decades given the significant aging of the population (SAGE & National Resource Center on LGBT Aging, 2021). The total number of older adults who self-identify as LGBTQ+, have engaged in same-sex behavior or romantic relationships, and/or are attracted to members of the same sex is estimated to increase to more than 20 million by 2060 (Fredriksen-Goldsen & Kim, 2017). Chapter 32 discusses LGBTQ+ relationships in more detail. Discrimination in health and social systems affects LGBTQ+ individuals of all ages. Discrimination ranges from refusal of care to biases or incorrect assumptions to overt derogatory statements. Older adults may be even more at risk for discrimination because of lifelong experiences with marginalization and oppression. They may have been shunned by family or friends, religious organizations, and the medical community; ridiculed or physically attacked; or labeled as sinners, perverts, or criminals. In the 1950s, same-sex behaviors were typically characterized as sodomy and were criminal, and the American Psychiatric Association classified homosexuality as a psychiatric disorder (Fredriksen-Goldsen, 2016). NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide It was not until 1973 that homosexuality was removed from the Diagnostic and Statistical Manual of Mental Disorders. The baby boomer generation is the first generation of LGBTQ+ people to have lived openly gay or transgender lives in large numbers (Henriquez et al., 2019). LGBTQ+ individuals may face dual discrimination due to their age and their sexual orientation or gender identity, and older women in lesbian relationships face the triple threat of being women, being old, and having a different sexual orientation (American Psychological Association, 2018). As a result of lifelong discrimination and negative experiences with health care agencies and personnel, LGBTQ+ older adults are much less likely than their heterosexual peers to access needed health and social services or identify themselves as gay or lesbian to health care providers. Approximately one-fifth of LGBTQ+ older adults do not disclose their sexual orientation to nurses or other kinds of providers because of fear of receiving inadequate care. As a result, they are at greater risk for poorer health than their heterosexual counterparts. Although many LGBTQ+ adults manifest resilience and good health despite marginalization, compared to heterosexuals of similar age, gay and bisexual adults 50 years of age and older are more likely to report higher prevalence of poor general health, disabling chronic conditions, depression, high rates of substance abuse, and suicide (Burton et al., 2020; Caceres, 2019). Transgender older adults experience higher levels of discrimination compared to nontransgender lesbian, gay, or bisexual older adults and are at greater risk for disparities and poorer health outcomes (Henriquez et al., 2019). Sexual orientation and gender identity have been identified as key gaps in health disparities research, with LGBTQ+ older adults an especially understudied population. The landmark Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first federally funded longitudinal national project designed to better understand the aging, health, and well-being of LGBTQ+ midlife and older adults and their families. With more than 2400 LGBTQ adults ranging in age from 50 to over 100, this project will deepen understanding of how various life experiences are related to changes in aging, health, and well-being over time. Most health surveys do not include sexual identity questions, so there are limited data on this population. Some population-based surveys, such as the National Health Interview Survey, have added sexual identity questions, as have some state-level efforts made through the Behavioral Risk Factor Surveillance System surveys. The needs of LGBTQ+ older adults differ across race, ethnicity, religion, cultural beliefs, and other aspects of their identity (Caceres, 2019). There is a dearth of research addressing LGBTQ+ health. Research has been conducted primarily with middle-class White gay men and lesbians in urban areas. Even less is known about bisexual and transgender older adults. Nursing as a whole, particularly gerontological nursing, continues to remain relatively silent on LGBTQ+ issues in health and aging. Nurse researchers are encouraged to consider study designs, methods, and procedures that support inclusion and visibility of LGBTQ+ older adults. 6. What resources are available for older LGBT individuals in your community? NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Not able to find anything specifically directed for older or aging member of LGBT community. https://uca.libguides.com/aqualib/support Arkansas Gay Black Men’s Forum Central Arkansas Pride 7. Describe interventions that foster sexual integrity. Interventions for the following Arthritis Advise patient to perform sexual activity at time of day when less fatigued and most relaxed Suggest use of analgesics and other pain-relief methods before sexual activity Encourage use of relaxation techniques, such as a warm bath or shower or application of hot packs to affected joints, before sexual activity Advise patient to maintain optimal health through a balance of good nutrition, proper rest, and activity Suggest that patient experiment with different positions, use pillows for comfort and support Recommend use of a vibrator if massage ability is limited Suggest use of water-soluble jelly for vaginal lubrication Cardiovascular Disease Encourage counseling on realistic restrictions that may be necessary Post–myocardial infarction (MI): Those able to engage in mild to moderate physical activity without symptoms generally can resume sexual activity; those with a complicated MI may need to resume sexual activity gradually over a longer period of time Avoid large meals several hours before sex Avoid anal sex Instruct patient and partner on alternative positions to avoid strain and allow for unrestricted breathing Stop and rest if chest pain is experienced, take nitroglycerin if prescribed, and seek emergency treatment for sustained chest pain Post-CABG or pacemaker or ICD insertion: Avoid strain or direct pressure on device and incision Individuals with poorly controlled arrhythmias should not engage in sexual activity until the condition is well managed Instruct individual that ICD could fire with sex, although uncommon; a change in device setting may be needed Cerebrovascular Accident (stroke) Encourage counseling Instruct patient to use alternative positions Suggest use of a vibrator if massage ability is limited NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Suggest use of pillows for positioning and support Suggest use of water-soluble jelly for lubrication Suggest alternate forms of sexual expression acceptable to the individuals Chronic obstructive pulmonary disease (COPD) Encourage patient to plan sexual activity when energy is highest Instruct patient to use alternative positions; use ample pillows for support and elevate the upper body or use a sitting upright position; avoid any pressure on the chest Advise patient to plan sexual activity at time medications are most effective Suggest use of oxygen before, during, or after sex, depending on when it provides the most benefit Teach partner to observe for breathing difficulty and allow time for change of positions and time to catch breath when needed Diabetes Recommend possible candidates for penile prosthesis Suggest use of alternative forms of sexual expression Recommend immediate treatment of genital infections Cancers N/A Breast Refer to support groups, sex therapists, counselors Encourage open expression of sexual concerns Prostate Kegel exercises and routine toileting Use of phosphodiesterase inhibitors Provide information related to sexual functioning and continence Most other Cancers New sexual positions may be helpful; explore alternative sexual activities 8. What are the older adult’s risk factors for acquiring a sexually transmitted disease including HIV/AIDS? HIV/AIDS AND OLDER ADULTS An increasingly significant trend in the global HIV epidemic is the growing number of people age 50 years and older who are living with HIV. The latest data reported showed that in 2018, more than half (51%) of people in the United States living with HIV were over 50 years old. This trend is occurring in both developed and developing countries. While rates of HIV/AIDS have remained relatively stable and even declined a little in younger age groups, the number of older adults NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide infected with the virus is growing. Though new HIV diagnoses are declining among people age 50 and older, 1 in 6 HIV diagnoses in 2018 were in this age group (Centers for Disease Control and Prevention [CDC], 2020). Gay and bisexual men remain disproportionally affected by HIV, and 59% of infections among men in this older age group are attributed to male-to-male sexual contact. The number of women living with HIV has been steadily growing in recent years, and women older than age 60 make up one of the fastest-growing risk groups; most contracted the virus from sex with infected partners (The Well Project, 2021). Transgender women are also at disproportionate risk for HIV, and transgender people of color have the highest reported rates (Human Rights Campaign, 2021). The prevalence of HIV among older adults is expected to continue to increase as more individuals become infected later in life and those who were infected in early adulthood live longer, healthier lives because of effective treatment. The compromised immune system of older adults makes them even more susceptible to HIV or AIDS than younger adults. Older women who are sexually active are at high risk for HIV/AIDS (and other sexually transmitted infections) from an infected partner, resulting in part from normal age changes of the vaginal tissue—a thinner, drier, friable vaginal lining that makes viral entry more efficient. Studies show that sexually active older men and women do not routinely use condoms, thus increasing their risk of sexually transmitted diseases (STDs). Recently widowed or divorced individuals may not understand the need for practicing safe sex because they do not worry about an unwanted pregnancy and may not understand the risk of STDs. Older women are more likely than their younger counterparts to be in noncommitted relationships, and difficulty negotiating safe sexual relationships can contribute to increased HIV risk (Coleman, 2017). Box 33.3 presents some other risk factors. Box 33.3 Guide to Risk Factors for HIV You are sexually active and do not use a latex or polyurethane condom. You do not know your partner’s drug and sexual history. Questions you should ask the person: “Has your partner been tested for HIV/AIDS?” “Has your partner had a number of different sexual partners?” “Has your partner ever had unprotected sex with someone or shared needles?” “Has your partner injected drugs or shared needles with someone else?” Drug users are not the only people who might share needles. People with diabetes who inject insulin or draw blood to test glucose levels might share needles. You have had a blood transfusion or operation in a developing country at any time or a blood transfusion in the United States between 1978 and 1985. Website Focus Areas Please view the following websites and answer the questions provided. Centers for Disease Control and Prevention (CDC) – Guide to taking a sexual History NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Please list and discuss the 5 p’s , the 5 “Ps” may be useful to help you remember the major aspects of a sexual history 1. Partners - Questions focus on: The number of partners, the sex of partners, and the nature of the relationships (e.g., are they monogamous, casual, or anonymous?). - Purpose: This helps in assessing the risk of sexually transmitted infections (STIs) and understanding the patient's sexual network. 2. Practices - Questions focus on: The types of sexual practices the patient engages in, such as vaginal, anal, or oral sex. - Purpose: To determine specific risks associated with different sexual activities and to guide discussions about protective measures. 3. Protection from STIs - Questions focus on: What methods of protection are used, such as condoms, dental dams, or none at all. - Purpose: To evaluate the patient's risk of STIs and to provide appropriate counseling on the use of barriers and preventive measures like vaccinations. 4. Past History of STIs - Questions focus on: Any previous history of sexually transmitted infections. - Purpose: This information can affect current health and guide decisions on screening and prevention strategies. It’s also important for informing treatment decisions if recurrent problems are identified. 5. Pregnancy Intention - Questions focus on: Whether the patient is currently trying to conceive or if they wish to avoid pregnancy. Also, discussions around the types of contraception used, if any. - Purpose: To assist in family planning and discuss contraceptive options that align with the patient's reproductive health goals. Using the 5 P's provides a systematic approach to collecting data critical for assessing sexual health risks and tailoring health education and interventions appropriately. This method also ensures that the conversation covers broad aspects of sexual health, beyond the prevention and treatment of STIs, including considerations of consent, satisfaction, and reproductive health. National Institute on Aging NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Please search and discuss the following topics. Short thoughts are needed: sexuality in later life, changes in intimacy and sexuality in Alzheimer’s disease, HIV, AIDS and Older People. Sexuality in later life 1. Continued Desire and Activity The NIA notes that many older adults remain sexually active and interested in sex. Although sexual activity may decrease with age due to health conditions or medications, many older adults continue to find pleasure and companionship through physical intimacy. 2. Changes in Sexual Health The NIA acknowledges that natural changes occur in sexual function as people age. For men, this may include longer time to achieve erection, less firm erections, and more time required between erections. For women, changes such as decreased vaginal lubrication, thinning of the vaginal walls, and pain during intercourse may occur due to menopause. The NIA encourages consulting healthcare providers to address these issues, as many can be treated. 3. Health Benefits The NIA highlights the health benefits of an active sex life, noting that physical intimacy can lead to improved heart health and overall fitness, as well as reduced stress and enhanced mental well-being. 4. Safety and Communication It is emphasized that older adults should practice safe sex, just like younger people. This includes using protection against sexually transmitted infections (STIs) and discussing sexual health openly with partners and healthcare providers. The NIA promotes communication about sexual health and function as a normal part of healthcare at any age. 5. Impact of Health on Sexuality The NIA points out that chronic diseases and their management can affect sexual function. Conditions such as diabetes, heart disease, arthritis, and dementia can have implications for sexual health and activity. Medications can also have side effects impacting sexual function, and the NIA advises discussing these potential side effects with a healthcare provider. 6. Importance of Intimacy and Emotional Bonds Recognizing that intimacy is broader than just sexual activity, the NIA also discusses the importance of emotional closeness and companionship. Many older adults find new ways to experience intimacy and connection even if sexual activity decreases. 7. Age-Related Adjustments The NIA suggests that adaptations may be necessary to maintain a satisfying sex life. This might include finding new sexual positions to accommodate physical limitations or using devices to assist in activity. 8. Resources and Guidance NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide The NIA provides resources and guides for older adults and healthcare providers to support healthy aging including aspects of sexual health. This encourages an informed and proactive approach to maintaining sexuality as a component of overall health and happiness in later life. Changes in intimacy and sexuality among individuals with Alzheimer's disease 1. Cognitive Decline and Memory Loss As cognitive functions decline, a person with Alzheimer's may forget the names or faces of their partner or confuse them with someone else. They may also forget the nature of their relationship or the social norms associated with sexual behavior. This can lead to awkward or inappropriate sexual advances or expressions of intimacy. 2. Changes in Sexual Behavior Sexual behavior in individuals with Alzheimer’s can vary significantly. Some may lose interest in sexual activities due to the disease’s impact on cognition and emotional connectivity. Others might display increased sexual behavior or inappropriate sexual advances, which can be challenging for caregivers and partners to manage. This can stem from reduced impulse control and altered judgment. 3. Altered Perception and Recognition Individuals with Alzheimer’s might not recognize their long-term partner, which can impact their expressions of intimacy. They might respond to their partners as if they are strangers, which can be distressing for both parties. 4. Emotional and Personality Changes Mood swings, depression, irritability, and personality changes are common in Alzheimer’s disease. These can affect how individuals relate to others, including their life partners, and can alter their need for closeness and intimacy. 5. Dependency and Care Needs As Alzheimer’s progresses, the physical and cognitive dependencies increase. The shift from a partner to a caregiver role can alter the dynamics of the relationship, affecting intimacy. Caregivers might feel more like a parent or nurse, which can impact sexual intimacy. 6. Communication Challenges With the progression of Alzheimer's, the ability to communicate effectively decreases. This can make it difficult for individuals to express their needs and desires or to understand those of their partner. This loss of communication can be a significant barrier to maintaining intimacy. 7. Physical Health Decline Physical symptoms of Alzheimer’s, such as motor skills decline and general frailty, can also make traditional expressions of intimacy more challenging. Physical closeness, like cuddling or holding hands, may also decrease as a result. Coping Strategies and Support NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide For caregivers and partners, understanding these changes and adapting to them is crucial. Here are a few strategies: - Education and Support: Learning about Alzheimer’s and its impact on intimacy and sexual behavior can help partners and caregivers manage their expectations and responses. - Professional Guidance: Consulting with healthcare providers, therapists, or counselors who specialize in Alzheimer's care can provide strategies to handle sensitive situations. - Setting Boundaries: It may be necessary to set clear boundaries that help manage inappropriate behaviors while maintaining dignity and respect for the individual with Alzheimer’s. - Alternative Expressions of Intimacy: Finding new ways to connect, such as through music, art, or simple physical presence, can help maintain a bond. Changes in intimacy and sexuality for individuals with HIV 1. Physical Health Impact HIV, and the medications used to treat it, can have side effects that impact sexual function. For example, some antiretroviral medications can cause side effects like fatigue, nausea, or diarrhea, which can decrease sexual desire and overall energy levels. Hormonal changes and weight loss associated with HIV might also affect body image and libido. 2. Psychological Impact The diagnosis of HIV can lead to anxiety, depression, and feelings of insecurity, all of which can significantly affect sexual desire and performance. Individuals might also experience changes in their self-esteem and body image, fearing rejection or judgment from partners due to their status. This can lead to reduced sexual activity and avoidance of intimacy. 3. Stigma and Disclosure Stigma is a major issue for many people living with HIV. The fear of disclosure of their HIV status and the potential for rejection or discrimination can lead to significant stress and may deter individuals from seeking or maintaining relationships. Negotiating when and how to disclose their HIV status to potential or existing partners can be a significant source of anxiety. 4. Concerns about Transmission Despite advances in treatment, such as antiretroviral therapy (ART) that can reduce viral load to undetectable levels (making the virus untransmittable, U=U or Undetectable = Untransmittable), concerns about transmitting the virus to a partner can still affect intimacy. This can lead individuals to limit their sexual activities or avoid them altogether, even in contexts where transmission risk is minimal or nonexistent. 5. Changes in Sexual Behavior Some individuals may change their sexual behaviors by choosing less risky activities to minimize the chance of HIV transmission. Others might engage in safer sex practices more consistently, including the NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide use of condoms and other barriers. This can change the dynamics of sexual encounters, potentially making them feel less spontaneous or intimate. 6. Impact on Relationships HIV can put significant strain on relationships. Partners may face challenges in how they relate to each other, not only sexually but emotionally and socially. The partner who is HIV-negative might also experience anxiety about contracting HIV, even when safe practices are followed. 7. Medication Adherence The necessity for rigorous adherence to antiretroviral therapy can also become a central aspect of a person’s routine, which might impact spontaneity in sexual activities due to the structured nature of medication schedules. Coping and Adaptation Adapting to these changes typically involves a combination of medical, psychological, and social interventions: - Medical Management: Effective management of HIV with ART can help reduce the virus to undetectable levels, improving physical health and reducing fears about transmission. - Counseling and Support: Mental health support can help address feelings of depression, anxiety, and low self-esteem. Support groups can also provide a safe space to discuss fears and experiences related to intimacy and sexuality. - Education and Communication: Educating oneself and partners about HIV, how it is transmitted, and how to engage in safe sex can alleviate some fears and promote healthier sexual relationships. - Navigating Intimacy: Finding new ways to be intimate that feel safe and satisfying for both partners can help maintain closeness without undue stress. Changes in intimacy and sexuality in older adults 1. Physiological Changes - Men: Older men may experience a decrease in testosterone levels, which can lead to reductions in libido, erectile dysfunction, and longer time required to achieve erection. They may also notice changes in orgasm and decreased volume of ejaculate. - Women: Post-menopause, women often experience changes such as decreased vaginal lubrication, which can make sexual activity uncomfortable or painful. The vaginal walls also become thinner and less elastic, a condition known as vaginal atrophy. 2. Health-Related Issues - Many older adults suffer from chronic conditions like arthritis, diabetes, heart disease, or neurological conditions that can impact physical ability and sexual functioning. Additionally, the medications used to treat these conditions can have side effects that affect libido, arousal, and performance. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide - Mental health issues such as depression and anxiety, which are more prevalent in older populations, can also significantly reduce sexual desire and overall interest in intimacy. 3. Psychological and Emotional Changes - Self-perception and body image often change with age. Feelings about aging, and the way bodies look and function, can affect sexual confidence and desire. - Bereavement and loneliness, especially after the loss of a partner, can greatly impact an older adult's interest in sex and capacity for new intimate relationships. 4. Social and Cultural Factors - Stereotypes and cultural norms can discourage sexual expression in older adults, leading many to believe that sexual interest should diminish with age, which is not necessarily true or healthy. - Older adults may also face challenges related to finding new partners, particularly in environments such as retirement communities or nursing homes where the ratio of women to men can be significantly skewed. 5. Changes in Relationship Dynamics - For long-term couples, sexual routines may become less frequent or intense as physical capabilities change, but other forms of intimacy like touching, kissing, and shared activities can become more significant. - Caregiving situations can also alter relationship dynamics, where one partner may assume more of a caretaker role, potentially affecting how both partners perceive intimacy and sexuality in their relationship. Coping with Changes To manage and adapt to these changes, several strategies can be helpful: - Medical Intervention: Addressing physical symptoms with a healthcare provider can aid in managing conditions like erectile dysfunction or vaginal atrophy. Hormonal treatments, lubricants, and other therapies might be recommended. - Communication: Open dialogue with partners about changing needs and expectations can foster intimacy and mutual understanding, even if sexual activity decreases. - Education: Learning about the normal changes associated with aging can normalize experiences and reduce anxiety around sexual health. - Counseling: Therapy can help individuals and couples navigate emotional or psychological challenges affecting their sexual life. - Exploring Other Forms of Intimacy: Finding new ways to connect that do not rely solely on sexual intercourse but on companionship, shared interests, and other forms of physical closeness can enhance the relationship. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide Application Questions or Case Studies The following case studies were retrieved from the textbook: Touhy, T.A., & Jett, K.F. (2020). Ebersole & Hess' toward healthy aging: Human needs & nursing response (10th ed.). Elsevier. Joe and Betty James have been married for 54 years. They have 7 children together and consider themselves a close-knit family. They are visited often by their children and grandchildren. Both Joe and Betty are in their late 70s and are generally in good health. Mr. and Mrs. James live in a retirement community where they enjoy many activities that are offered in the recreational center. They participate in group exercise activities, travel, game nights, and Bible study. They have maintained a monogamous marital relationship and continue to enjoy intimacy in later life. Joe and Betty are always seen walking their dog and holding hands while doing so. They insist that their physical well-being is associated with their healthy sex life. 1. How is sexual activity and meaningful intimacy associated with good physical health? 1. Cardiovascular Health Regular sexual activity can be likened to a form of moderate physical exercise. It increases heart rate and promotes better circulation. Studies suggest that regular sexual activity is associated with reduced risk of heart disease and other cardiovascular issues. Furthermore, during sexual activity, the body releases hormones such as endorphins and oxytocin which help in lowering blood pressure. 2. Immune System Boost Engagement in sexual activities has been linked to the strengthening of the immune system. Research has shown that sexually active people tend to have higher levels of certain antibodies (immunoglobulin A), which help the body defend against infections and other pathogens. 3. Pain Relief Sexual activity leads to the release of hormones like endorphins and oxytocin. These hormones act as natural painkillers, which can help alleviate chronic pain conditions such as arthritis and headaches. Oxytocin particularly has been shown to reduce the perception of pain. 4. Improved Sleep The release of oxytocin, commonly referred to as the "love" or "cuddle" hormone, during sexual activity, and particularly following orgasm, can enhance an individual's ability to fall asleep more quickly and sleep more deeply. Good sleep is crucial for overall physical health, aiding in regeneration and repair of the body. 5. Stress Reduction and Mental Health Sex and intimate interactions can significantly reduce stress levels. The activities involve physical touch and emotional connection, leading to the release of endorphins and oxytocin, which can produce feelings of happiness and relaxation. Reduced stress is directly linked to lower risks of many physical health issues, including digestive problems and chronic diseases like hypertension. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide 6. Longevity There is some evidence to suggest that regular sexual activity may be associated with longer lifespans. The health benefits such as reduced stress, better immunity, and improved cardiovascular health all contribute to potentially increased longevity. 7. Hormonal Balance Sexual activity influences the levels of various hormones in the body. For women, sexual activity can help regulate menstrual cycles and reduce symptoms associated with menopause. For men, regular sexual activity helps maintain levels of testosterone, which is important for bone density and muscle strength. 8. Pelvic Floor Strength Especially for women, sexual activity can help strengthen pelvic floor muscles, which can prevent urinary incontinence and improve pelvic health overall. 9. Enhanced Physical Fitness Regular sexual activity can contribute to physical fitness. It burns calories, increases heart rate, strengthens muscles, and improves flexibility and balance. Overall Well-being Engaging in sexual activities and experiencing intimate connections with others contribute to an overall sense of well-being, which is fundamental to physical health. The psychological benefits, including increased self-esteem and satisfaction, often translate into healthier lifestyle choices, which further support physical health. 2. In the event that Joe and Betty require a move into long-term care, how can nursing staff facilitate their need for intimacy? Nurses and staff at long-term care facilities play a critical role in supporting the intimacy needs of residents, including couples. Ensuring that couples continue to enjoy close, intimate relationships requires a thoughtful, respectful approach that balances privacy, dignity, and safety. Here are several ways nurses can facilitate intimacy for couples in a long-term care setting: 1. Promote a Positive Environment - Respect Privacy: Ensure that couples have private time together without interruptions. This can be as simple as making sure they can spend time together in a private room with the assurance they won’t be disturbed. - Facilitate Visits: If one partner is living in the facility and the other is not, help facilitate visits that are convenient and comfortable, ensuring they have private space available during visits. 2. Address Physical Needs NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide - Assist with Mobility: Help residents with mobility issues get to and from their partner’s room or arrange furniture so that they can comfortably spend time together. - Manage Medication: Be mindful of medication schedules to ensure that side effects do not interfere with private time. - Adaptive Aids: Provide or suggest adaptive aids for sexual activity if needed, and ensure that residents have access to these in a discreet manner. 3. Educate and Support - Staff Training: Train staff on the importance of intimacy and sexual health in older adults. Encourage an open, non-judgmental attitude toward resident sexuality. - Resident Education: Provide education for residents and their families about maintaining sexual health and intimacy as they age, addressing common myths and barriers. 4. Create Supportive Policies - Develop Intimacy Policies: Establish clear policies that support intimate relationships among residents. These should address privacy, consent (particularly for residents with cognitive impairments), and the facilitation of relationships. - Respect Rights: Ensure that the facility’s policies on intimacy and relationships are in line with legal standards and ethical practices, emphasizing the rights of residents to express their sexuality and engage in consensual intimate relationships. 5. Encourage Social Interaction - Social Activities: Foster a community environment that encourages social interaction, which can be beneficial even for couples, helping them engage with others and participate in activities together. - Counseling Services: Offer or arrange for counseling services for couples to help them adjust to the new living arrangements and maintain their relationship under changed circumstances. 6. Consider Personalized Rooms - Room Sharing: Where possible, facilitate couples living together in the same room or adjoining rooms to maintain their closeness and regular contact. - Room Setup: Help personalize the room to make it feel homier and conducive to intimacy, such as allowing couples to bring in their own furnishings or decorations. 7. Open Communication - Discuss Needs and Preferences: Have open conversations with couples and their families about their needs and how the facility can support their relationship. This includes discussing aspects of their physical and emotional intimacy needs. NURS 3540 – Gerontological Nursing Module 13 Active Learning Guide - Feedback Mechanism: Implement a feedback mechanism where couples can express their satisfaction or concerns regarding the support they receive for maintaining their relationship By taking these steps, nurses and care facility staff can significantly contribute to the well-being and quality of life of elderly couples, ensuring that their need for intimacy and closeness is met with sensitivity and respect. This approach not only supports the couples but also sets a standard for resident care that recognizes and honors the holistic needs of all individuals. 3. What are the common myths associated with sexuality and aging women? There are several myths surrounding sexuality and aging in women that can negatively impact their self-esteem, sexual health, and overall quality of life. Addressing these misconceptions is important for both older women and their healthcare providers to ensure that they can maintain a healthy and satisfying sexual life as they age. Here are some of the most common myths: 1. Sexual Interest Declines With Age The assumption that all women lose interest in sex as they get older is a pervasive myth. While hormonal changes such as menopause can affect libido, many women continue to enjoy sexual activity and desire well into their later years. Interest in sex is highly individual and can be influenced by many factors beyond age, including emotional connection with partners, overall health, and life satisfaction. 2. Aging Negatively Affects Sexual Function While it is true that menopause and aging can lead to physical changes like vaginal dryness and decreased elasticity, these issues do not universally prevent women from enjoying sexual activity. Treatments such as lubricants, vaginal moisturizers, and hormonal therapies can help manage these symptoms. Additionally, many women adapt their sexual practices to accommodate changes, finding new ways to experience pleasure and intimacy. 3. Older Women Do Not Need to Worry About STDs There is a mistaken belief that older women are not at risk of sexually transmitted diseases (STDs). This misconception can lead to unsafe sexual practices among aging populations. The reality is that STDs can affect anyone who is sexually active, regardless of age, necessitating the use of protection and regular screenings. 4. Physical Attractiveness and Sexuality Fade With Age This myth perpetuates the idea that older women are no long

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