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A new way to think about dementia and sex

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There’s an urgent need for a new ethic of dementia care that supports the facilitation of sexual expression.

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Persons living with dementia don’t have sex. Or they have weird sex. Or they have dangerous sex, in need of containment.

When it comes to dementia and sexuality, negative language and apocalyptic warnings abound. The aging population has been described in the media as a “rape case time-bomb.” Health practitioners often respond in punishing ways to sexual activity in residential care. And the sexual rights of persons living with dementia are largely ignored within residential care policy, professional training and clinical guidelines.

As critical social researchers, we argue that a new ethic of dementia care is urgently needed, one that supports the facilitation of sexual expression.

Practitioners and administrators often hold negative and judgmental attitudes about dementia and aged sexuality

Our research at the University of Toronto and the Toronto Rehabilitation Institute-University Health Network investigates embodiment, relationality, ethics and dementia. We are motivated by a shared concern about the reductive focus of dementia care on basic physical needs, and our desire to foster a more humane and life-enriching culture of care. We have explored how the sexualities of persons living with dementia are poorly supported in long-term residential care settings such as nursing homes.

Sex and dementia in the media

When we see persons living with dementia and sex linked in the media, it tends to be in high profile cases of

Institutional policies, structures and practices must support sexual expression.

alleged abuse. One example is the legal trial of Henry Rayhons, an Iowa lawmaker found not guilty of sexually abusing his wife who at the time was living with dementia in a nursing home. Another example is the wider investigation into sexual assaults in nursing homes in Ontario.

Vital as such investigations are to the safety of residents in long-term care, we rarely see sexual expression valued or as fundamental to human flourishing.

Our research has explored how these negative representations of the sexualities of persons living with dementia are also found within long-term residential care settings such as nursing homes.

Practitioners and administrators often hold negative and judgmental attitudes about dementia and aged sexuality. When faced with sexual activity, they can intervene in threatening and punishing ways. And long-term care policies, professional training and clinical guidelines tend to ignore the sexual rights of persons with dementia.

The problem with biomedical ethics

The sexualities of persons living with dementia are considered troubling partly because long-term care polices are shaped by biomedical ethics. This ethical approach relies on four core principles: autonomy, beneficence, non-maleficence and justice. These principles support intervening in residents’ sexual expression if it will cause harm to themselves or cause harm or offence to others.

However, this approach sets the bar for practitioners’ interference excessively high. It can restrict voluntary sexual expression by residents living with dementia in nursing homes.

Biomedical ethics also ignore the performative, embodied and relational aspects of ethical reasoning. It assumes that people are rational autonomous beings. It also assumes that self-expression, including sexuality, results only from cognitive and reflective decision making. Given that dementia involves progressive cognitive impairment, persons living with dementia may be unfairly discriminated against by this approach to sexual decision making.

A duty to support sexual expression

We use a model of relational citizenship to create an alternative ethic in which sexuality is seen as embodied self-expression. It is an ethic that recognizes human beings as embodied and embedded in a lifeworld. And one that views sexuality as an important part of being human.

Social and leisure activities supportive of the development of intimate relationships are essential within nursing homes.

This new ethic broadens the goals of dementia care. No longer do health professionals just have the duty to protect persons with dementia from harm. There is also a duty to support their right to sexual expression.

We argue that institutional policies, structures and practices must also support sexual expression. These should facilitate sexual rights. We must also introduce education for health professionals and the broader public — and policy initiatives to counteract the stigma associated with sexuality and dementia.

Social and leisure activities that are supportive of sexual expression and the development of intimate relationships are also essential within nursing homes.

Of course, protection from unwanted contact or sexual harm is still important. However, freedom of sexual expression should only be restricted when necessary to protect the health and safety of the individuals involved.

Complete Article HERE!

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Benefits Of Frequent Sex As You Age

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A High Sex Drive May Protect Language And Visual Skills

Sex shouldn’t stop just because you’ve gotten older.

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Declining brain power is a real worry for some people as they age, but new research from England suggests a fun and healthy way to keep your mind sharp, no matter how old you get – sex. According to the study, frequent sexual activity has been linked to improved brain function in older adults, adding yet another health benefit to everyone’s favorite activity.

The study, published online in The Journals of Gerontology, Series B: Psychological and Social Sciences, found that people who had sex more frequently scored higher on tests to measure their verbal fluency and their ability to visually perceive objects and spaces between them. This suggests that sex can act as a sort of exercise for the brain, helping to keep it sharp as we age, though researchers aren’t sure exactly why.

“We can only speculate whether this is driven by social or physical elements — but an area we would like to research further is the biological mechanisms that may influence this,” Lead researcher Dr Hayley Wright said in a recent statement on ScienceDaily. “Every time we do another piece of research we are getting a little bit closer to understanding why this association exists at all, what the underlying mechanisms are, and whether there is a ’cause and effect’ relationship between sexual activity and cognitive function in older people.

For the study, the team from Coventry University and Oxford University interviewed 73 people between 50 and 83 years old about their sex lives. The volunteers were asked to fill out a questionnaire which asked how often they had sex, as well as other general questions about their health and lifestyle. The volunteers also took a standardized test that measured different aspect of their cognitive function, such as their ability to pay attention and remember facts, as well as their language and visuospatial skills. Results revealed that increased sexual activity was linked to increased verbal fluency and visuospatial skills. However, sexual activity seemed to have no affect on their attention skills, memory, or language.

This isn’t the first study to look into the benefits of sex in older individuals. For example, in 2016, the same team found that the protective effects of sex on the brain were stronger in men than women. The team speculate that sex may help protect the brain through the release of dopamine and oxytocin, two hormones that not only cause good feelings, but are also vital to brain function by improving connectivity between certain parts of the brain.

Regardless of why sex is helpful for the brains of older individuals, these results suggest that sex is an important part of our health and shouldn’t be discarded just because you age.

“People don’t like to think that older people have sex — but we need to challenge this conception at a societal level and look at what impact sexual activity can have on those aged 50 and over, beyond the known effects on sexual health and general wellbeing,” said Wright.

Complete Article HERE!

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It’s not just about sex

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The basic human need of intimacy does not disappear as we age however in aged care planning it is mostly overlooked and often regarded as inappropriate.

by Annie Waddington-Feather

Couples in aged care facilities are being given little to no privacy in their intimate and sexual relationships, and it’s often the staff who prevent couples from having this intimacy.

A UK study involving residents, non-resident female spouses of residents with a dementia and 16 care staff, carried out last year, found feedback very different from the stereotypical assumption of older people not been sexual.

Carried out by a research team for the Older People’s Understandings of Sexuality (OPUS), some participants denied their sexuality, others expressed nostalgia for something they considered as belonging in the past, and some still expressed an openness to sex and intimacy.

More recently a New Zealand pilot study carried out by Associate Professor Mark Henrickson, from the School of Social Work, and School of Nursing senior lecturer Dr Catherine Cook explored attitudes to sexuality in aged residential care facilities.

They found the need for better understanding of the intimacy needs of older people and a significant number of staff, families and residents are managing complex situations without clear processes to protect residents’ rights and safety.

Intimacy in a care home setting is complicated. Issues include querying consent for someone who is in cognitive decline, staff managing adult children who deem their parent’s behaviour as wrong, and a lack of privacy for couples. Plus, there is a stereotype to overcome – for many sex and intimacy is associated with youth, not older people.

“We are a microcosm of an ageist culture,” says Australian expert Dr Catherine Barrett, Director, Celebrate Ageing.

Dr Barrett’s views go beyond a person’s sexuality and importance of sex, believing there should also be a focus on non-sexual physical intimacy. She highlights a study by the University of Queensland where babies were found to recover quicker if they are touched.

“We need to focus more broadly,” she says. “Some people have sexual relationships because they’re lacking skin on skin touch. Known as ‘skin hunger’ (also known as touch hunger) it is a need for physical human contact, and this can be mistaken as a need for sex.”

She cites one example of a male resident who behaved very inappropriately to any females in the room. “A massage therapist came once a week and he stopped doing what he was doing,” she says. While some residential homes do access sex workers, Dr Barret says in some cases it’s simply for a person to come over and cuddle.

Aged care advocate Anne Fairhall, whose husband of over 50 years is living with dementia and is in a care home says they both missed skin contact. And it wasn’t just between the two of them. “In an aged care home, everyone puts on rubber gloves,” she points out.

Ms Fairhall believes people living with dementia respond very well to love, affection and intimacy. “We’d gone from sleeping in one bed to sleeping in two different locations, and he asked me ‘do you still love me?’; he couldn’t comprehend why I’d put him in a home.” she says. “But it’s not just about holding his hand; it’s about having some privacy.”

“It’s also about eye contact, an arm around the shoulder and stroking his skin. It’s giving him the body language message I’m connecting with him,” says Ms Fairhall. “I’d go in later in the day, sit close to him at dinner and after he’d eaten, get him into his pyjamas, kiss, cuddle and put cheek to cheek.”

Just lying beside her husband is comforting. “Staff are surprised if they walk in and they are a bit embarrassed at first– less so now as they get to know you,” she says.

Dr Barret is calling for more training and education to be given. “We can’t point the finger and say ‘not good enough’ to aged care homes – we need to be asking how we can help,” she says.

To this end, through the OPAL (Older People And SexuaLity) Institute, Dr Barret has developed a set of tools and resources for service providers and organisations. This includes holding workshops and helping develop policies and procedures around sexuality and intimacy.

After attending one of the workshops, Victorian provider Cooinda is in the process of implementing a sexuality policy template.

“This is an important step forward in what we do and the care we give,” says April Betheras, community support, Cooinda. “We talk a lot about person centred care and we have ideas about sexuality and intimacy, but the big thing is being able to think about the whole picture. It’s about identifying with the person and having the conversation.”

She says there is more communication with residents about the subject now, but acknowledges not all residents want to participate. “While some feel that [sexual] part of their life has gone, there are other ways of being close,” says Ms Betheras. “A partner can participate in aspects of care. This is what keeps them close and feeling connected still.”

Training in sexuality and intimacy is also now compulsory for staff. “Staff feel confident in speaking about and dealing with issues. For instance if someone wants access to a sex worker, what would you do that? Who would you go to?,” says Ms Betheras. “LGBTI is also incorporated so we can consider all particular needs.”

Complete Article HERE!

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Why men and women lie about sex, and how this complicates STD control

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When it comes to reporting the number of sex partners or how often they have sexual intercourse, men and women both lie. While men tend to overreport it, women have a tendency to underreport it. Although the story is not that simple and clear-cut, I have discovered some interesting reasons why this is the case – and why it matters to doing research on sexual health.

Lying is an inherent aspect of reporting sexual behaviors. For instance, more females report being a virgin (i.e., had not had sexual intercourse) despite having had genital contact with a partner, compared to males.

I have studied sexual avoidance and also frequency of sex in patient populations. In this regard I have always been interested in gender differences in what they do and what they report. This is in line with my other research on gender and sex differences.

The low validity and usefulness of self-reported sexual behavior data is very bad news for public health officials. Sexual behavior data should be both accurate and reliable, as they are paramount for effective reproductive health interventions to prevent HIV and STD. When men and women misreport their sexual behaviors, it undermines program designers’ and health care providers’ ability to plan appropriately.

Pregnant virgins, and STDs among the abstinent

A very clear example is the proportion of self-reported virginal status among pregnant women. In a study of multi-ethnic National Longitudinal Study of Adolescent Health, also known as Add Health, a nationally representative study of American youth, 45 women of 7,870 women reported at least one virgin pregnancy.

Another example is the incidence of sexually transmitted diseases (STDs) which are not expected among young adults reporting sexual abstinence. Yet more than 10 percent of young adults who had a confirmed positive STD reported abstaining from any sexual intercourse in the last year before STD testing.

If we ask youth who have had sexual experience, only 22 percent of them report the same date of first sex the second time we ask about it. On average, people revise their (reported) age at first sex to older ages the second time. Boys have higher inconsistency reporting their first sex compared to females. Males are more likely than females to give inconsistent sexual information globally.

Why don’t people tell the truth about sex?

Why do people lie about their sexual behavior? There are many reasons. One is that people underreport stigmatized activities, such as having multiple sexual partners among women. They overreport the normative ones, such as higher frequency of sex for men. In both cases, people think their actual behavior would be considered socially unacceptable. This is also called social desirability or social approval bias.

Social desirability bias causes problems in health research. It reduces reliability and validity of self-reported sexual behavior data. Simply said, social desirability helps us look good.

As gender norms create different expectations about socially acceptable behavior of men and women, males and females face pressures in reporting certain (socially accepted) behaviors.

In particular, self-reports on premarital sexual experience is of poor quality. Also self-reports of infidelity are less valid.

Although most studies suggest these differences are due to the systematic tendency of men and women to exaggerate and hide their number of partners, there are studies that suggest much of this difference is driven by a handful of men and women who grossly inflate and underreport their sexual encounters.

Even married couples lie

Men and women also lie when we ask them who is making sexual decisions regarding who has more power when it comes to sexual decision-making.

We do not expect disagreement when we ask the same question from husbands and wives in the same couples. But, interestingly, there is a systematic disagreement. More interestingly, in most cases when spouses disagree, husbands are more likely to say “yes” and wives “no.” The findings are interpreted in terms of gendered strategies in the interview process.

Not all of the gender differences in reported sexual behaviors are due to men’s and women’s selective under- and over- reporting of sexual acts. And, some of the sexual behaviors do vary by gender. For instance, men have more sex than women, and men less commonly use condoms. Men have more casual partners, regardless of the validity of their report.

Secretive females, swaggering males

Studies have found that on average, women report fewer nonmarital sexual partners than men, as well as more stable longer relationships. This is in line with the idea that in general men “swagger” (i.e., exaggerate their sexual activity), while women are “secretive” (i.e., underreport sex).

Structural factors such as social norms shape men’s and women’s perceptions of appropriate sexual behaviors. Society expects men to have more sexual partners, and women to have fewer sexual partners.

According to the sexual double standard, the same sexual behavior is judged differently depending on the gender of the (sexual) actor (Milhausen and Herold 2001). Interestingly, men are more likely to endorse a double standard than women.

In the presence of sexual double standards, males are praised for their sexual contacts, whereas females are derogated and stigmatized for the same behaviors, “He’s a Stud, She’s a Slut.”

Research suggests that lifetime sexual partnerships affect peer status of genders differently. A greater number of sexual partners is positively correlated with boys’ peer acceptance, but negatively correlated with girls’ peer acceptance.

Self-serving bias is common

As humans, self-serving bias is a part of how we think and how we act. A common type of cognitive bias, self-serving bias can be defined as an individual’s tendency to attribute positive events and attributes to their own actions but negative events and attributes to others and external factors. We report on sexual behaviors which are normative and accepted to protect ourselves, and avoid stress and conflict. That will reduce our distinction from our surroundings, and will help us feel safe.

As a result, in our society, men are rewarded for having a high number of sexual partners, whereas women are penalized for the same behavior.

The only long-term solution is the ongoing decline in “double standard” about sexual morality. Until then, researchers should continue questioning the accuracy of their data. Computerized interviews may be only a partial solution. Increasing privacy and confidentiality is another partial solution.

Complete Article HERE!

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Childhood cancer treatment may hinder later-life sexual relationships

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Neurotoxic treatment for cancer during childhood may influence sexual activity and relationships in adulthood, according to new research.

Study co-author Vicky Lehmann, Ph.D., of Nationwide Children’s Hospital and Ohio State University – both in Columbus, OH – and colleagues found that adults who received high-intensity neurotoxic treatment for cancer as a child were less likely to meet certain sexual and romantic milestones.

However, the team found that childhood cancer treatment did not affect overall satisfaction for sexual and romantic relationships in adulthood.

Lehmann and team recently reported their findings in the journal Cancer.

According to the American Cancer Society, it is estimated that around 10,380 children aged 15 and under were diagnosed with cancer in the United States last year.

Leukemia is the most common form of childhood cancer, accounting for around 30 percent of all cases, followed by brain and spinal cord tumors, which make up around 26 percent of all childhood cancer cases.

Childhood cancer treatment and psychosexual development

While cancer was responsible for more than 1,200 childhood deaths last year, over 80 percent of children diagnosed with the disease will survive for at least 5 years. This is due to significant advances in cancer treatment, which include surgery, chemotherapy, and radiation therapy.

However, such treatment is certainly not without risk. For example, studies have shown that cranial radiation – often used to treat brain tumors – may cause harm to the developing brain, leading to long-term neurocognitive impairment.

Previous research has shown that neurocognitive impairment as a result of childhood cancer treatment may impact social interaction in adulthood, but studies investigating the effects of such treatment on psychosexual development are few and far between.

“Psychosexual development entails reaching certain milestones, such as sexual debut, entering committed relationships, or having children.

It is a normative part of becoming an adolescent or young adult, but only comparing such milestones without taking satisfaction into account falls short. These issues are understudied among survivors of childhood cancer.”

Vicky Lehmann, Ph.D.

To address this gap in research, the team enrolled 144 survivors of childhood cancer aged between 20 and 40. A further 144 participants who were not treated for childhood cancer (the controls) were matched by age and sex.

All participants completed questionnaires on psychosexual development, sexual satisfaction, and relationship satisfaction.

To determine the brain toxicity of cancer treatments in childhood, the researchers used data from the participants’ medical charts.

Neurotoxic cancer treatment might predict later-life psychosexual issues

Overall, the team found that adults who were treated for cancer in childhood did not differ significantly from the controls in terms of psychosexual development, sexual satisfaction, and relationship satisfaction.

However, on analyzing subgroups of childhood cancer survivors, the researchers found that those who previously received treatments high in neurotoxicity were less likely to have had sexual intercourse, be in a relationship, or have had children, compared with controls.

The type of cancer treatment in childhood did not appear to affect sexual satisfaction, the team reports. “This highlights the subjective nature of psychosexual issues, and the importance of addressing any concerns in survivorship care,” notes Lehmann.

The researchers say that their findings indicate that the neurotoxicity of cancer treatment in childhood may predict the likelihood of psychosexual problems in adulthood. They add:

“Additional research is needed to delineate how neurocognitive impairment undermines social outcomes for survivors, as well as other related factors.

Given the findings of the current study, healthcare providers should assess romantic/sexual problems among survivors, especially those who received high-dose neurotoxic treatments. Referrals to psychosocial care could prevent or reduce potential difficulties.”

 
Complete Article HERE!

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