Department of Neuropsychiatry and Behavioral Science, PH- USC Medical Group, University of South Carolina School of Medicine, 3555 Harden St. Ext. Suite 301, Columbia, SC, 29203, USA.
Department of Psychiatry & Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH, 44307, USA.
Curr Psychiatry Rep. 2019 Sep 14;21(10):97. doi: 10.1007/s11920-019-1090-4.
This paper provides an overview of biopsychosocial components of sexuality in older adults, sexual expression in older LGBTQ and cognitively impaired adults, and inappropriate sexual behaviors (ISBs) in dementia.
Sexual expression of older adults is influenced by diverse psychosocial and biologic determinants including ageist beliefs. Although the prevalence of sexual dysfunction increases with age, studies of sexual satisfaction reveal that only a minority experience significant distress. Stigma against sexual expression in LGBTQ older adults may cause concealment of sexual orientation from family or care providers due to fears of rejection. Cognitive impairment affects frequency of and satisfaction with sexual activity, as well as capacity to consent. Staff biases about sexuality can negatively impact sexual expression in healthcare settings. Dementia-related inappropriate sexual behaviors (ISBs) are common and distressing. Recent research has focused on early identification and prevention of ISB, in addition to management through non-pharmacologic and pharmacologic approaches. Sexuality remains integral to quality of life for many older adults and informed consideration of their needs is critical to healthcare delivery and institutional service planning. A comprehensive understanding of older adults' sexuality can enhance education, research, policy, and clinical care for this growing population.
本文概述了老年人性行为的心理-社会-生物因素、老年 LGBTQ 人群和认知障碍成年人的性表达，以及痴呆症患者的不适当性行为（ISB）。
老年人的性行为受到多种心理社会和生物决定因素的影响，包括年龄歧视观念。尽管性功能障碍的患病率随年龄增长而增加，但对性满意度的研究表明，只有少数人会经历明显的困扰。由于担心被拒绝，LGBTQ 老年人群体可能会对性表达感到羞耻，从而向家人或护理提供者隐瞒自己的性取向。认知障碍会影响性行为的频率和满意度，以及同意的能力。工作人员对性行为的偏见会对医疗保健环境中的性表达产生负面影响。与痴呆症相关的不适当性行为（ISB）很常见，也令人痛苦。最近的研究侧重于早期识别和预防 ISB，以及通过非药物和药物方法进行管理。对许多老年人来说，性行为仍然是其生活质量的重要组成部分，因此，认真考虑他们的需求对于医疗保健的提供和机构服务规划至关重要。全面了解老年人的性行为可以促进对这一不断增长的人群的教育、研究、政策和临床护理。
