Department of Recreation and Leisure Studies, 7961Brock University, St. Catharines, ON, Canada; KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute - University Health Network - University Health Network, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
Dementia (London). 2022 May;21(4):1077-1097. doi: 10.1177/14713012211056253. Epub 2021 Dec 14.
Despite the recognized benefits of sexual expression and its importance in the lives of people living with dementia, research demonstrates that there are multiple barriers to its positive expression (e.g., expression that is pleasurable and free of coercion, discrimination, and violence) in RLTC homes. These barriers constitute a form of discrimination based on age and ability, and violate the rights of persons living with dementia to dignity, autonomy, and participation in everyday life and society. Drawing on a human rights approach to dementia and sexual expression, we explored the experiences of diverse professionals, family members, and persons living with dementia with explicit attention to the ways in which macro-level dynamics are influencing the support, or lack thereof, for sexual expression at the micro level. Focus groups and in-depth interviews were conducted with 27 participants, and the collected data were analyzed thematically. While all participants acknowledged that intimacy and sexual expression of persons living with dementia should be supported, rarely is such expression supported in practice. Micro-level factors included negative attitudes of professionals toward sexual expression by persons living with dementia, their discomfort with facilitating intimacy and sexual expression in the context of their professional roles, their anxieties regarding potential negative reactions from family members, and concerns about sanctions for failing to prevent abuse. In our analysis, we importantly trace these micro-level factors to macro-level factors. The latter include the cultural stigma associated with dementia, ageism, ableism, and erotophobia, all of which are reproduced in, and reinforced by, professionals' education, as well as legal and professional standards that exclusively focus on managing and safeguarding residents from abuse. Our analysis demonstrates a complexity that has enormous potential to inform future research that is critically needed for the development of educational initiatives and to promote policy changes in this area.
尽管性表达被认为有很多好处，对痴呆症患者的生活也很重要，但研究表明，在长期护理机构中，其积极表达（例如，愉悦且无胁迫、歧视和暴力的表达）存在多种障碍。这些障碍构成了一种基于年龄和能力的歧视，侵犯了痴呆症患者的尊严、自主以及参与日常生活和社会的权利。我们借鉴了人权视角下的痴呆症和性表达，探讨了不同专业人员、家庭成员和痴呆症患者的体验，特别关注宏观层面的动态如何影响微观层面对性表达的支持或缺乏支持。我们对 27 名参与者进行了焦点小组和深入访谈，并对收集到的数据进行了主题分析。虽然所有参与者都承认应该支持痴呆症患者的亲密关系和性表达，但实际上很少有这种表达得到支持。微观层面的因素包括专业人士对痴呆症患者性表达的负面态度、他们在专业角色背景下对促进亲密关系和性表达的不自在、对家庭成员可能产生负面反应的担忧，以及对未能防止虐待的制裁的担忧。在我们的分析中，我们重要地将这些微观层面的因素追溯到宏观层面的因素。后者包括与痴呆症相关的文化耻辱、年龄歧视、能力歧视和厌恶色情，所有这些都在专业人员的教育中得到体现，并得到强化，以及专门侧重于管理和保护居民免受虐待的法律和专业标准。我们的分析表明了一种复杂性，这种复杂性具有巨大的潜力，可以为未来的研究提供信息，而这些研究对于制定教育计划和推动这一领域的政策变革是非常必要的。
