Sexuality and sexual capacities of elderly people

Sexual behavior depends on biological and psychological factors. A gradual decline in interest and capacity may occur with advancing age. Sexual relationships have patterns that are influenced by prior degrees of sexual tension and outlet, physical and emotional status, and the mutual needs of the partners. In this article, the authors explore sexuality, psychosocial issues, and sexual capacities of elderly people, including issues of menopause and erectile dysfunction. The role of rehabilitation nurses in helping older adults understand and adjust to changes is addressed. Sexual counseling, already a part of rehabilitation nursing for younger patients, also should be provided for elderly patients. Nursing goals and strategies need to address identifying sexual problems and educating elderly rehabilitation patients about altered sexual needs and capacities. To do this, rehabilitation nurses must be knowledgeable about the physiology and sexual needs of older adults, be aware of myths about sexuality, and understand their own values and attitudes regarding sex and sexuality as well as the values and attitudes of individual patients.     

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

Purpose/Objective: Acquired brain injury produces a host of behavioral changes, and specialized training in proper management of these behaviors is essential to resolve crises and calm aggressive clients. This study was conducted to determine whether crisis intervention training was effective in increasing staff comfort with difficult client behaviors in a residential rehabilitation program for individuals with postacute acquired brain injury and whether changes would be maintained over time. Research Method/ Design: Twenty-five rehabilitation staff members participated in Nonviolent Crisis Intervention training and completed the Rehabilitation Situations Inventory before training, immediately following completion of the program, and 1 month later. Results: Immediately following completion of the program, participants reported increased comfort when faced with client behaviors related to motivation and adherence, sexuality, and aggression and when interacting with other staff and client families. Changes in comfort level with sexual situations, aggression, and staff/staff interactions were maintained 1 month post training. Conclusions/Implications: These results suggest that crisis intervention training is effective in increasing levels of staff comfort with difficult situations commonly experienced in the rehabilitation setting and the changes are maintained following training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of child sexual abuse on developing sexuality.

This article reviews theoretical and empirical literature on sexual abuse and focuses on the effects of child sexual abuse on developing sexuality. The issues addressed include (a) prominent family qualities associated with sexual socialization, (b) theoretical formulations that account for the effects of sexual abuse on developing sexuality, and (c) research findings on the impact of child sexual abuse on the sexuality development of child victims and adult survivors. Directions for future research and implications for practitioners are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of research on gender differences in sexuality, 1993–2007.

In 1993 Oliver and Hyde conducted a meta-analysis on gender differences in sexuality. The current study updated that analysis with current research and methods. Evolutionary psychology, cognitive social learning theory, social structural theory, and the gender similarities hypothesis provided predictions about gender differences in sexuality. We analyzed gender differences in 30 reported sexual behaviors and attitudes for 834 individual samples uncovered in literature searches and 7 large national data sets. In support of evolutionary psychology, results from both the individual studies and the large data sets indicated that men reported slightly more sexual experience and more permissive attitudes than women for most of the variables. However, as predicted by the gender similarities hypothesis, most gender differences in sexual attitudes and behaviors were small. Exceptions were masturbation incidence, pornography use, casual sex, and attitudes toward casual sex, which all yielded medium effect sizes in which male participants reported more sexual behavior or permissive attitudes than female participants. Most effect sizes reported in the current study were comparable to those reported in Oliver and Hyde’s study. In support of cognitive social learning theory, year of publication moderated the magnitude of effect sizes, with gender differences for some aspects of sexuality increasing over time and others decreasing. As predicted by social structural theory, nations and ethnic groups with greater gender equity had smaller gender differences for some reported sexual behaviors than nations and ethnic groups with less gender equity. Gender differences decreased with age of the sample for some sexual behaviors and attitudes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survivors of the Holocaust and their children: Current status and adjustment.

Compared a group of 52 concentration camp and other survivors of World War II with a control group of 29 persons of similar European and religious background. 47 children of these survivors and 16 children from the comparison group were also evaluated. The psychological adjustment (MMPI; Parent and Children's version of the Current Life Functioning Form) of both groups of adults and their children was within the normal range. Cultural rather than specific survivor influences were noted in the present attitudes and behaviors of the parents. There were no significant differences between the survivor and control group children on any of the psychological variables or in their attitudes and behaviors toward their parents. Based on these findings, the authors question notions of survivor guilt, the manifestation of emotional blunting in the survivors, and the extremely maladaptive psychological influence of their parents' experiences on the children of survivors. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early predictors of sexually intimate behaviors in an urban sample of young girls.

In recent years, concern has been raised about girls’ involvement in sexual activity at progressively younger ages. Little is known about the prevalence of emerging intimate behaviors, the psychosocial factors associated with these behaviors, or the moderating effects of ethnicity on these associations in early adolescence. In the current prospective study, we examined the prevalence and predictors of sexually intimate behaviors at age 12 years in an urban community sample of 1,116 ethnically diverse girls. Cluster analysis revealed 3 groups at age 12: no sexual behavior, mild behavior (e.g., holding hands), and moderate behavior (e.g., laying together). Minority status girls reported higher rates of both mild and moderate sexually intimate behaviors compared with European American girls. After controlling for the significant effects of age 11 intimate behaviors, lifetime alcohol use, poor parent–child communication, deviant peer behavior, onset of menarche, and interactions between ethnicity and impulsivity, social self-worth and depression uniquely increased the odds of engaging in moderately intimate behaviors at age 12 years. Parenting characteristics increased the likelihood of moderate, relative to mild, behaviors. For European American girls only, high levels of impulsivity and low social self-worth were associated with a higher likelihood of engaging in moderate intimate behaviors, whereas high levels of depressive symptoms reduced the odds. The results suggest that early prevention efforts need to incorporate awareness of different social norms relating to sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse

Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.     

The challenge for women with a drug-abusing family member: the Jamaican perspective

The abuse of alcohol and other drugs presents a multiplicity of problems for the abuser, family members and the wider community. The psychosocial, as well as the economic, problems can produce an environment of chaos and misery. Women in families in which there is an abuser are challenged in a variety of ways and, depending on the severity of the situation and their capacity to cope, they may confront the problem, seek help of withdraw from it. The present article reviews the impact of drug abuse within the family on Jamaican women from the viewpoint of treatment and rehabilitation specialists and the women themselves and on the basis of case histories and the work experience of the author. Although there have been efforts through demand reduction strategies and culturally relevant treatment and rehabilitation programmes to control the epidemic of drug abuse, the specific needs of women have been left largely unattended. Both men and women are however critical in the fight against drug abuse and women have the skills and experience that can contribute to making such programmes achieve their desired objectives. Addressing their needs would not only help them, but also the family and the wider community. In order to address these needs effectively with the limited resources available, however, a credible basis for action has to be established, which can only be done by research and analysis so that the issues can be clearly defined and a plan of action developed.     

Review of Brain injury casebook: Methods for re-integration to home, school, and community.

Reviews the book, Brain injury casebook: Methods for re-integration to home, school, and community by Dorrie Rapp (1986). Any professional who has been part of the difficult process of helping a brain injured individual re-integrate into life will undoubtedly find Dr. Rapp's book useful and timely. Recent head injury seminars have begun to focus directly upon the myriad of problems facing the traumatically brain injured when he or she begins to deal with life after traditional rehabilitation. Through the use of actual and often poignant case studies, Dr. Rapp illustrates the flexibility, creativity, and persistence necessary when working with the traumatically brain injured and their families. As we begin to grasp the complexity of re-integration for the traumatically brain injured individual, more documentation of the comprehensiveness of the problem needs to be published. Professionals working with the brain injured will find both support and new ideas from reading Dr. Rapp's book. The only criticism is that it does not delve into vocational issues which, by far, comprise a large portion of reintegration problems. However, professionals, care providers, brain injured individuals, families, schools, funding agencies, and employers can all obtain an excellent overview of the complexity of successful re-integration following traumatic brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative survey of beliefs about "normal" childhood sexual behaviors

OBJECTIVE: This study sought to collect data on what adults believe constitutes normal childhood sexual behaviors, and how variables, such as role, gender, and life experience might contribute to the formation of one's beliefs. METHODS: A survey describing 20 different scenarios of children under the age of 13 interacting with themselves or other children in a sexual manner was administered to four groups of adults: sexual abuse experts; therapists involved in a sexual abuse training program; medical students attending a human sexuality program; and group facilitators of the human sexuality program. RESULTS: Behaviors that involved oral, vaginal, or anal penetration were judged by a majority of adults to be abnormal sexual behaviors in children under 13 years of age. Professionals working with sexually abused children rated certain sexual behaviors as more abnormal than adults participating in a human sexuality course. Both sexual abuse trainees and facilitators of the human sexuality course showed more directional biases than other groups, with trainees always rating behaviors in the direction of abnormal and facilitators always rating behaviors in the direction of normal. Females also judged many of the sexual behaviors to be more abnormal than males. CONCLUSIONS: Role and gender significantly influence what adults believe constitutes normal and abnormal childhood sexual behavior.     

Couples treatment for incest survivors.

Explores sexless marriages between female incest survivors and their heterosexual partners. The sexless marriage is a common manifestation of the incest survivor's difficulties with sexuality. Three couples are discussed who experienced a nearly complete breakdown in emotional and sexual intimacy that threatened to dissolve their relationships. Each couple was unwittingly engaged in an elaborate mutual reenactment of the survivor's incestuous relationships. In the reenactment, the survivor experienced her spouse simultaneously as the perpetrator and as her mother who did not know of the abuse and whom she felt she could not tell. Grounded in both object relations theory and trauma theory, the suggested treatment strategy rests on interpreting the central role of reenactment in the couple's relationship difficulties. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Countertransference behavior and management with survivors of sexual assault.

Examined the impact of therapist gender on countertransference behavior toward rape survivors and tested a 2-step model of countertransference management. The model recommends awareness of countertransference feelings (ACF) followed by employment of theoretical framework to understand these feelings. 47 counseling and clinical psychology graduate students (aged 20–44 yrs) completed measures of ACF and of theoretical framework. 1 wk later, countertransferential "approach" and "avoidance" behaviors were assessed as Ss responded to videotapes of an actress portraying a client survivor of date rape. Based on hierarchical regression analysis, an interaction effect was identified between ACF and theoretical framework. A combination of high ACF and high theoretical framework yielded the least avoidance behavior. As hypothesized, male therapists provided significantly more avoidance responses to the rape survivor than did female therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transitioning to independence: challenges for young people with disabilities and their caregivers

For all teens, the process of moving from childhood to adulthood is challenging. For young people with disabilities, transitioning to independence presents even more challenges. Barriers to successful transition for young people with disabilities include low expectations by parents and other significant people in the community, lack of knowledge of existing career and vocational education services, and lack of self-advocacy skills. This article provides an overview of issues related to transitioning to adult independence and offers suggestions for assessment, planning, and intervention that can help nurses be effective partners with families and other caregivers in transition efforts. Nurses caring for children with disabilities can help families see strengths in their children and develop realistic, developmentally-appropriate expectations for skill development, attitudes, and behaviors that will promote self-sufficiency in adulthood. Nurses can help families think about possibilities for independence and refer families to community resources that can help young people with disabilities pursue postsecondary education, obtain and maintain jobs, and live independently.     

Anger as a vehicle in the treatment of women who are sexual abuse survivors: Reattributing responsibility and accessing personal power.

Some clinicians view client anger as a problematic symptom to be reduced, whereas others view it as an opportunity for therapeutic development. The present authors describe how client anger, a fitting emotional response to abuse, can work as a vehicle to help sexual abuse survivors reattribute responsibility and develop personal efficacy. The role of anger in the healing process of the sexual abuse survivor is explored through 2 case studies. It is suggested that by reframing anger as a vehicle for recovery rather than a symptom, therapists can learn to effectively incorporate anger work (which involves successfully negotiating any dynamics that cause therapist discomfort) into the treatment of survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis Intervention With Individuals and Their Families Following Stroke: A Model for Psychosocial Service During Inpatient Rehabilitation.

Reduced length of stays for inpatient rehabilitation challenge psychologists to develop new models of psychosocial service. Crisis intervention is a useful model that can be adapted to meet the needs of stroke patients and their families. The authors describe a 1-session intervention, utilizing crisis intervention and psychoeducational and cognitive behavioral techniques with stroke survivors and primary family caregivers in the inpatient rehabilitation setting. A case study illustrates the process and potential benefits of this approach. The intervention is feasible within the confines of the inpatient setting and well tolerated by participants. A controlled trial is necessary to establish the broad efficacy of this intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The study of sexual behavior in relation to the transmission of human immunodeficiency virus: Caveats and recommendations.

To create the behavior-change programs essential for limiting the acquired immune deficiency syndrome (AIDS) epidemic, we must obtain a precise understanding of the sexual behavior, knowledge, and attitudes of our nation's various ethnic, racial, social, age, regional, and sexual orientation groups. Such information is necessary for developing the precisely targeted educational programs that currently are our most effective means of reducing risk behaviors and halting the spread of the disease in the United States. These behavioral data are also crucial to biomedical investigations, making possible the identification of appropriate subjects for programs ranging from the testing of vaccines to the evaluation of the threat to pregnant women and their offspring. In this article, we summarize data on sexual behaviors associated with the transmission of the AIDS virus (i.e., human immunodeficiency virus [HIV]) and discuss selected issues relevant to the conduct of research on human sexuality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's sexuality: Behaviors, responses, and individual differences.

Classic and contemporary approaches to the assessment of female sexuality are discussed. General approaches, assessment strategies, and models of female sexuality are organized within the conceptual domains of sexual behaviors, sexual responses (desire, excitement, orgasm, and resolution), and individual differences, including general and sex-specific personality models. Where applicable, important trends and relationships are highlighted in the literature with both existing reports and previously unpublished data. The present conceptual overview highlights areas in sexual assessment and model building that are in need of further research and theoretical clarification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality of life in elderly patients with COPD: measurement and predictive factors

OBJECTIVE: To examine the interrater reliability and completion time of the Functional Assessment Measure, which is the Functional Independence Measure (FIM) plus additional items (FIM+FAM). DESIGN: Interrater reliability study. SETTING: Inpatient rehabilitation units of a postacute care brain injury rehabilitation program. PATIENTS: A convenience sample of 53 extremely severely impaired adult survivors of traumatic brain injuries (40 men, 13 women, mean age 38yrs). MAIN OUTCOME MEASURES: Treatment team members' ratings of the 30 FIM +FAM items, and time taken to complete the FIM+FAM. RESULTS: Intraclass Correlation Coefficients (ICCs) were within the good to excellent range (ICC > .60) for 29 of 30 items and for all subscales except psychosocial adjustment. Higher mean ICC values were obtained for motor domain items than for cognitive/psychosocial domain items. Treatment teams became progressively faster over a 12-week period in completing the FIM+FAM. The generally good to excellent range interrater reliability found in this study helps support the use of the FIM+FAM in rehabilitation settings. Further support was obtained for the finding that motor items are more reliable than cognitive and psychosocial items. Administration of the FIM+FAM can be done in a timely manner in a rehabilitation setting.     

Sexual abuse trauma among Chinese survivors

OBJECTIVE: As an initial effort to examine Chinese sexual abuse trauma in relation to the cultural construction of sexual victimization of women, this study applies Finkelhor and Browne's (1985) traumagenic dynamics model to examine post-abuse trauma among Chinese child and adolescent survivors in Taiwan. In analyzing sexual abuse trauma in the context of Chinese patriarchal familialism and cultural fetish for female chastity, this study attempts to explore cultural constructional process of sexual abuse in Chinese society. METHOD: This study conducted in-depth interviews with 19 survivors of, and three social workers on, sexual abuse in Taiwan. These interviews were guided by a semi-structured questionnaire on sexual abuse incidents and post-abuse responses/concerns, and had generated a total of 84 pages of written reports, which serve as the text-data for the analysis. RESULTS: This study identifies sexual stigmatization and senses of disempowerment and betrayal as the most pervasive trauma complex among Chinese sexual abuse survivors in Taiwan. This study found that, in addition to lowering self-esteem, sexual stigmatization results in polarized sexuality among adolescent survivors, as manifested in aversion to and preoccupation with sexuality. The abuse-induced disempowerment is manifested in the survivors' fear for personal safety and heightened sense of vulnerability to re-victimization. The sense of betrayal results in interpersonal difficulties as manifested in self-imposed isolation from others and/or suspicious attitudes toward others, which further impair the survivor's efficacy in meeting her abuse-induced clinging need. CONCLUSIONS: Overall, this study observes similar traumatic symptoms between Chinese survivors and their American counterparts as documented in the literature. Nevertheless, this study observes the sexual stigmatization represents the most prevailing post-abuse trauma among Chinese sexual abuse survivors, and reflects the patriarchal fetish for female chastity in the Chinese cultural construction of sexual victimization.     

Ethnicity and age issues: Attitudes affecting rehabilitation of individuals with spinal cord injury.

The individual with spinal cord injury, family, staff, and significant others bring attitudes regarding age and ethnicity into the rehabilitation team dynamic. Such preconceived attitudes may direct one's ability to be open to change and incorporate new information. The authors present 3 cases that highlight the bidirectional nature of bias challenges and the potential impact of bias issues on the hospital setting, staff, individual, family, and significant others. The bidirectional nature of bias challenges is illustrated with 2 cases of bias issues presented by individuals with spinal cord injury during hospitalization and with I case of bias impact on an individual health care provider. Interventions and strategies to maximize information sharing, education, and adjustment during hospitalization, discharge planning, and community living are discussed. Individuals may face increasing challenges in maximizing the derived benefit from both health care delivery and community services if personal bias plays a role in excluding qualified personnel from consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)