Managing Intimacy Among Residents with Dementia in Assisted Living

University Of Maryland Baltimore County, Baltimore MD

Investigators

Abstract

Social relationships are critically important to residents of assisted living (AL), a form of care for older adults. For older adults in general, there is a strong association between positive social relationships and their health and subjective well-being. In AL, developing and sustaining close relationships with co-resident peers can help facilitate good physical and mental health functioning. Alternately, lack of social engagement can ultimately result in poor health, e.g., depression and heart disease. Further, recent studies on loneliness have determined that 29% to 50% of older adults are lonely, and this in itself can result in negative outcomes, such as an increased need for assistance with activities of daily living, decline in mobility, and a higher risk of death. This proposed study addresses an important aspect of social relationships that is often ignored in AL, that of intimacy. Here we define intimacy as a tendency to spend time with a specific person or persons, to positively value that time, and to include the possibility of expressing social closeness through emotional investment and physical expression. Although research has shown that intimacy is tied to older adults? sense of independence, good cognitive functioning, expectations in life, and lower cancer and cardiovascular rates, AL settings infrequently actively promote or encourage social relationships among residents. This is especially true of residents? most intimate or personal companionate behaviors, showing affection and expressing sexual needs and a sexual identity. In previous research, we have found (a) residents? intimate needs to be sometimes ignored, overlooked, infantilized, ridiculed, and constrained by negative staff attitudes; (b) residents often viewed stereotypically by staff as asexual or non-companionate beings and as culturally sexually problematic; and (c) residents given little autonomy as to the expression of intimacy. This is despite research that has determined intimate, including sexual, activity in aging populations to be both normal and health protective, adding greatly to older adults? quality of life. Our proposed research will focus on AL co-resident close physical, social, and emotional relationships from the points of view of AL frontline and management staff by examining (1) staffs? definitions and perceptions of resident intimacy; (2) the role and degree that Alzheimer?s disease and related dementias play in staffs? attending to resident expressions of intimacy; and (3) the way intimacy is addressed, permitted, and managed by staff on a day-to-day, case-by-case, basis to accommodate their own value systems as well as those of the residents and the setting. The focus on staff perceptions of intimacy is important given the power they hold in AL settings. In addition, we will explore barriers to expressions of intimacy so that meaningful social relationships among residents, especially those with dementia, can be promoted to improve residents? quality of life and well-being. We propose to spend 24 months conducting ethnography and interviewing frontline staff and managers in each of three diverse AL settings. Standard methods of qualitative data analysis will be used.