Experiences and Attitudes of Healthcare Professionals and Care Staff on Sexual Expression of Older Adults, With and Without Dementia, in Long Term Care Facilities: A Qualitative Systematic Review

Abstract

Objective: To identify and synthesise available qualitative evidence on the experiences and attitudes of healthcare professionals and care staff on sexual expression of older adult residents, with and without dementia, in long term care facilities.

Background: Sexual expression is significant regardless of age and residence. However, negative attitudes from healthcare professionals and care staff have been reported as barriers to sexual expression in long-term care facilities. Staff’s experiences and challenges need to be known to improve their attitudes.

Methods: PubMed, Cochrane Library, EMBASE, Scopus, Web of Science, PsycINFO, CINAHL and ProQuest Theses and Dissertations were searched for studies. Inclusion criteria were as follows: (a) studies exploring experiences and/or attitudes of healthcare professionals and care staff providing direct care to older adults residing in long-term care settings (b) published qualitative studies from inception till December 2020 (c) mixed-methods studies if qualitative data can be isolated (d) studies in English language. The Critical Appraisal Skills Programme checklist was used for critical appraisal, although all studies appraised are included. Data extracted were tabulated onto Microsoft Excel spreadsheet before performing metasynthesis using Sandelowski and Barroso’s two-step approach. Screening of studies, critical appraisal and data extraction were performed independently by two reviewers. Disagreements at any phase was resolved through discussion.

Results: Staff have varying experiences and attitudes towards sexual expression in residents. Cultural beliefs and social influences shape staff’s perceptions while presence of policies, trainings and co-workers’ support determine staff’s ability and confidence to address sexual expression. Consent issues and potential for sexual harassment towards staff were additional complication for staff managing sexual expression in dementia.

Conclusion: The findings provide insight to the true experiences, attitudes and complexity of challenges staff face, supporting the need for training and educational interventions, clearer policies and involvement of institutional leaders.