Sex and intimacy are an important part of a physically and psychologically healthy life. Sex and intimacy also are not limited to young and middle-aged adults; older adults also enjoy lives of sex and intimacy. But when a partner becomes chronically ill, the caregiving partner may have difficulty with sex and intimacy issues. How should social workers and other service providers inquire into and counsel on the sex and intimacy needs of older adult caregivers?
To pursue an answer to this question, researchers studied the results from a phenomenological study of service providers’ interview answers regarding discussions of sex and intimacy with older adult women caregivers in heterosexual relationships. The study seeks to illuminate the challenges service providers face in discussing these issues with caregivers, and what practices can alleviate these challenges. Shari Brotman, PhD, Jennifer Drummond, MSW, Marjorie Silverman, PhD, Tamara Sussman, PhD, Pam Orzeck, MSW, Lucy Barylak, MSW, Isabelle Wallach, PhD, and Veronique Billette, PhD, published their findings in a recent issue of the NASW Press published journal Health & Social Work.
Research on the sexual health of older adults has found that a satisfying sexual and intimate life can contribute to positive health outcomes and improve quality of life, and that older women caregivers benefit positively when they continue to experience companionship, friendship, and physical and emotional closeness within their relationship. Research has also identified the many challenges associated with expressing sexuality and intimacy in the context of caring for a spouse or partner with a chronic illness or disability and the negative impact caregiving has on spousal caregivers’ identity, sense of marital closeness, and sexual and intimate lives. The shift in women’s identities from wife–partner to caregiver often erodes the possibility of a sexual identity for many women caregivers and often creates barriers to sexual and intimate contact. Specific illnesses also create unique and difficult challenges with respect to sexuality and intimacy. For example, Alzheimer’s disease can have a negative impact on intimacy in the spousal caregiver relationship due to ethical issues related to lack of recognition or confusion on the part of the ill spouse.
Social workers have a specific and important role to play in both improving the quality of interventions that recognize sexuality and intimacy as important elements in the health and well-being of caregivers, and in the development of training to enhance understanding among a variety of health and social care practitioners. Social workers are often on the frontlines of service provision and hold positions from which they can educate, train, and advocate. Social workers are unique partners on the health care team as they infuse the notion of “personhood” into interventions largely predicated on a biomedical model of aging that reduces older adults (including patients and caregivers) to the medical functioning of the body and mind.
In order to study how social workers might approach the question of sex and intimacy with older adult caregivers, the authors looked into a subset of findings from a qualitative study titled “The Impact of Caregiving on the Experience of Sexuality and Intimacy among Older Women Spousal Caregivers: Perspectives of Older Women and Their Service Providers.” They focused specifically on the results of conversations with service providers to illuminate the personal, professional, and organizational challenges experienced by service providers that serve to limit opportunities for meaningful interventions related to sexuality and intimacy with older women spousal caregiver clients. Specifically, they looked to answer these questions:
- How do providers understand and define sexuality and intimacy in the context of caregiving?
- What are providers’ current practices around sexuality and intimacy?
- What are their attitudes regarding the importance of addressing this issue?
- What are the challenges they face in addressing sexuality and intimacy in their work with older women spousal caregiver clients?
The researchers found that while all service providers in the study felt that sexuality and intimacy were important subjects to address with caregivers, most did not feel that actually this easily translated into actual practice. The providers identified a number of barriers to addressing sexuality and intimacy, such as the common assumption that older adults are asexual, the general discomfort in addressing sexuality, and that the caregivers themselves rarely brought up sexuality and intimacy. Institutional barriers included a lack of training and education in the area of sexuality and intimacy among older adults. Still, time spent building a rapport with client caregivers, and the careful use of language could help social workers address the issues of sexuality and intimacy with caregivers.
The authors conclude that more study is needed on the subject, and that social workers and other service providers need further training and awareness to address the issues of sexuality and intimacy with older adult spousal caregivers. Such research should go beyond that of heterosexual relationships as well.