The ethics of intimacy and sexuality of older adults living in nursing homes: A systematic review of argument-based literature.

Abstract

Admission to a nursing home does not automatically blunt the desire or reduce the need for intimacy and sexuality in older residents. This ageist and ableist stereotype that older people are asexual or post-sexual negatively affects nurses and other healthcare professionals, as they are regularly faced with residents' sexual expressions. How are nurses to view and respond appropriately if a clear understanding of current ethical concepts and argumentations about intimacy and sexuality in older adults is lacking? This study aimed to document and better understand current ethical concepts and arguments about intimacy and sexuality in institutionalised older adults. We used PRISMA and Reporting of Systematic Reviews in Ethics guidelines in a systematic review of current ethical literature (2010 to 2023). Six databases were searched: PubMed, Embase, Web of Science, CINAHL, Atla, and Philosopher's Index. Inclusion criteria were (1) publication was argument-based; (2) contained ethical concepts and arguments concerning intimacy and/or sexuality in institutionalised older adults; and (3) written in English, French, German, or Dutch. Our search returned 4371 publications; of those, 29 publications met our inclusion criteria. Since all included articles appeared in peer-reviewed journals, article quality was assumed to be sufficiently good. Our use of a modified version of the Qualitative Analysis Guide of Leuven showed that two main approaches characterised discussions of intimacy and sexuality in institutionalised older adults: (1) individual-cognitive-oriented approach and (2) relational-embodied-oriented approach. The first emphasises respect for autonomy and consent, fundamental to protecting rights and dignity. The second focusses on intentional bodily capacities and the interdependent nature of being human, both crucial for the emotional well-being of the residents, even when cognitive abilities decline. We conclude that the ethical landscape on sexuality in ageing has shifted, implying that changes are warranted on how ethicists, society, and healthcare professionals view sexual expressions of older adults.