Sexuality and the chronically ill older adult: a social justice issue

Pangman and Seguire Journal Review

"Sexuality and the Chronically Ill Older Adult:

A Social Justice Issue"

"Sexuality and the Chronically Ill Older Adult: A Social Justice Issue" is an article by Verna C. Pangman and Marilyn Seguire, first published in 2000 in Volume 18 of the journal Sexuality and Disability. In their article, Pangman and Seguire provide a penetrating look at an issue all too often obscured by either false assumptions of unimportance, or perhaps mere squeamishness. The subtitle of their article makes it clear that Pangman and Seguire are approaching this issue from a political (if not indeed activist) standpoint: they seem particularly concerned that there is a sense of invisibility to the sex problems of the elderly, and a willingness to ignore those problems. They offer nurses a way of thinking about these issues.

Summary of Article

Pangman and Seguire begin by brushing away some of the myths and rumors that still cling like cobwebs to the subject of sexuality and the elderly -- notions that the elderly are sexless or undesirable, based on the strong association of sexuality with youth in western society. They offer a definition of sexuality and sexual health in which the life-affirming aspects of the sex act, and conceive of "sexual health care" as being "an essential component of overall wellness during one's developmental lifespan" (49). They offer a cursory discussion of "invisibility and visibility perspectives" of the sexuality of the elderly and chronically ill, sketching some stereotyped views that are lingeringly held by some sectors of society and even among health care professionals. Pangman and Seguire are explicit in offering a "social justice" perspective in which the mere awareness of these issues among nurses can "[raise] the level of consciousness" and "help to dispel the myth that aging renders the chronically ill older adult sexless and worthless" (50).

The authors approach the issue with a willingness to acknowledge that this topic has been neglected and misrepresented in the past: "only a few decades ago our society publicly denied that people in later life feel desire or are sexually active" (52). This is what they refer to as the "invisibility" of sexuality among the elderly and chronically ill: it is not an issue that forms the subject of glamorous Hollywood movies, and is hampered in public discussion by a sort of "ick factor" which causes people to skirt the issue or deny its importance. The authors propose to counteract this "invisibility" by increased visibility.

By visibility, the authors mean that changing sexual mores have ensured greater public discussion, awareness, and comfort with sexuality, including the sexuality of the elderly. They note a seeming shift in public opinion on these matters, which is surely do to the aging population of Baby Boomers who participated in the Sixties and the "Summer of Love" but who are now themselves in their sixties, and looking forward to a long twilight in which their sheer numerical bulk ensures that attitudes towards sexual issues in elder care must reflect all sectors of the patient population. The authors think this visibility is important and that nurses ought to validate it, because "by allowing them credence to their sexual expression, the older adults who are chronically ill are able to claim a sense of self-identity, respect, and dignity in society" (53).

The remainder of the paper consists in Pangman and Seguire relating their subject to the nursing profession, and exploring how an awareness of the sexual needs and sexual-identity-related quality-of-life issues entailed in caring for chronically ill older persons might greater inform nursing strategies, education, practice, and nursing research. In terms of education, Pangman and Seguire are keen to "influence student's [sic] attitudes and thinking processes" so that "more favorable attitudes toward sexuality and the elderly can be promoted" (54). Nurses, in their view, can also play "a significant role in educating" (55). In terms of practice, the authors insist that "a sexual history should be viewed as part of the complete assessment of any older adult" (55), including the desire for emotional intimacy as part of this assessment. Their suggestions for further research include specific examinations of how sexuality plays a role in the aging of lesbian and gay populations, and how to "create changes in the environment in personal care homes to allow the older adult to express his/her sexuality" (57). Their concluding thoughts offer a guideline for how nurses might influence social policy development on issues related to the elderly, mostly by insisting on the importance of sexuality even to the oldest and most chronically ill patients. Their conclusion reminds nurses that -- when this article was published in 2000 -- they were coming off a major United Nations initiative declaring 1999 the "Year of the Older Person" (58) with an awareness that geriatric issues will only become more important in the coming years to the nursing profession.

Evaluation of Article

The article's definition of "social justice" perhaps reflects the authors' Canadian origins, and their explicit reference to surveys of the Canadian population like Sex in the Snow, which offers evidence that "a number of Canadians defy the societal stereotypes associated with old age" (53). Pangman and Seguire's picture of sexuality is accordingly a very Canadian picture indeed, and the reader wonders if their attitude towards the sexuality of the elderly would remain quite so blase and healthy-minded if they were conducting their nursing practice in a different culture, one for example in which institutionalized sexism and intractable cultures of masculinity or machismo are more evident than they are in Manitoba.