A person can also use a BMI Chart such as the one at http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm. Or a BMI calculator can be used, such as the one at http://www.revolutionhealth.com/calculators/body-mass-index-bmi. In a similar vein, to discover the range of one's "ideal weight" might be, use the calculator at http://www.calculatorslive.com/Ideal-Weight-Calculator.aspx.

A healthy BMI for adults is usually considered to be between 18.5 and 25; anything higher indicates a certain amount of overweight; if it is over 30 obesity is suggested, and anything over forty reportedly signifies extreme obesity. However, there are some exceptions, and being elderly is one. In this case it may be better to have a BMI in the range of 25—27 as a slightly high BMI after age 65 may help protect from osteoporosis (HLCG 2007).

Another way to assess whether an individual has a problematic weight is to notice where they have the most fat. For reasons still unknown, it is more problematic if the fat is around the middle (waist) than around other parts of the body such as hips or thighs. More fat around the waist is considered to be an "apple" shape; if it is in the hips it is called "pear" shape.

Picture courtesy of A.D.A.M.

A high waist-to-hip ratio is considered to put one more at risk for diseases linked with excess weight, especially diabetes and heart disease. To find the waist-to-hip ratio, first measure the hip circumference at the level of the two bony prominences found at the front of the hips; then measure around the middle at naval height. Divide waist circumference by hip circumference. The guidelines say that this ratio should be below 0.8 for a woman and 1.0 for a man (HLGC 2007).

The National Heart, Lung, and Blood Institute (NHLBI) offers a more accurate way to estimate the risk of disease. The steps for this are:

1.   Measure the waist circumference as noted above.

2.   Determine the BMI using one of the methods given above.

Using those two figures, look at this chart from the NHLBI to see the degree of risk (NHLBI n.d.c):

*     Disease risk for type 2 diabetes, hypertension, and CVD.
+     Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

Overweight and Obesity

Unless an elderly person is obese, he/she probably does not need to lose weight according to one meta-analysis study (Asefeh et al 2001). The conclusion of the study said, "Evidence does not support mild-to-moderate overweight, defined by the new guidelines, as a risk factor for all-cause and cardiovascular mortality among elderly persons. We agree that marked overweight (obesity) might be a risk factor for this population. However, adverse effects of energy (calorie) restriction in elderly persons and the potential harms of diet-induced weight reduction, as well as the paucity of information about effectiveness of weight loss programs, would not support weight reduction interventions among mildly to moderately overweight elderly individuals."

Harlan M. Krumholz, the study's senior author, stated, "We found that in general, higher weight is associated with a smaller excess risk in older people compared with younger people" (Yale 2001).

Additionally, repeated dieting with weight loss followed by weight gain is bad for one's health. The Medical University of South Carolina discovered that "weight fluctuation is associated with a higher risk of all-cause and cardiovascular disease mortality in the U.S. population, even after adjustment for pre-existing disease, initial BMI and the exclusion of those in poor health or incapacitated. Thus, health care providers should promote a commitment to maintaining weight loss to avoid weight fluctuation and consider patients' weight histories when assessing their risk status" (Diaz et al 2005).

The U.S. Department of Health and Human Services and the U.S. Department of Agriculture (HHS & USDA 2005) make the following recommendation to " sustain weight loss in adulthood: Participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements. Some people may need to consult with a healthcare provider before participating in this level of activity."

Sometimes, however, there is unplanned weight loss.

Weight Loss and Cachexia

Many people who are not elderly may wish they had unintentional weight loss, because intentional doesn't seem to work very well. Unfortunately, unintentional weight loss, particularly cachexia (which includes wasting loss of fat and muscle), at any age is usually associated with illness and/or other problems. The cause of cachexia in the elderly is associated with increased morbidity and mortality. But it is hard to identify the cause, especially if the individual has multiple medical problems and is taking numerous medications, and especially if there is cognitive debilitation (Huffman 2002).

In addition to unintentional weight loss, cachexia is associated with one or more of the following symptoms and/or consequences ((Wikipedia 2009; Lewko et al 2003):

§        Muscle atrophy (always occurs in cachexia), and wasting of fat

§        Fatigue

§        Weakness

§        Significant loss of appetite

§        Anemia

§        Decreased cognition

§        Edema

§        Falls

§        Hip fractures

§        Immune dysfunction

§        Infections

§        Muscle loss

§        Osteoporosis

§        Pressure sores

There are numerous potential causes for cachexia. A mnemonic for common treatable causes of unintentional weight loss in the elderly is MEALS ON WHEELS (Huffman 2002):

In addition to the problems listed with the mnemonic, other studies have found that unintentional weight loss may be a preclinical indicator of Alzheimer's disease and that the weight loss often accelerates before diagnosis (Stewart et al 2005; Johnson et al 2006).

Protein-Energy Malnutrition

(Merck 2007)

Protein-energy malnutrition (PEM) refers to a form of malnutrition where there is inadequate protein intake, sometimes also called protein-calorie malnutrition. At times a person may ingest enough calories but not enough protein, which causes pure protein deficiency, but usually both deficiencies occur. Some individuals may get PEM not from inadequate ingestion but because they are unable to absorb protein (and probably other nutrients) or convert them into the energy needed to form healthy tissue or enable organs to function properly.

Primary PEM is the result of a diet lacking enough sources of protein and/or energy. Secondary PEM is the more common form that appears in the United States, and is usually a complication of AIDS, cancer, chronic kidney failure, inflammatory bowel disease, and other illnesses that hinder the body's ability to absorb or use nutrients or to compensate for nutrient losses.

In the U.S., PEM occurs most commonly in elderly people who live in nursing homes. It also occurs in 50% of surgical patients and 48% of all other hospital patients.

Secondary PEU is most commonly caused by:

·        Disorders that affect GI function; these disorders can interfere with digestion (e.g., pancreatic insufficiency), absorption (e.g., enteritis, enteropathy), or lymphatic transport of nutrients (e.g., retroperitoneal fibrosis, Milroy's disease)

·        Wasting disorders such as AIDS or cancer

·        Conditions that increase metabolic demands, including infections, hyperthyroidism, pheochromocytoma, other endocrine disorders, burns, trauma, surgery, and other critical illnesses.

In a patient with a chronic illness or who has chronic semi-starvation, PEM can gradually evolve. In a patient with an acute illness it may appear abruptly.

Secondary PEM symptoms range from mild to severe; they can change the form or function of just about every organ in the body. The nature and severity of the symptoms are influenced by patient's prior nutritional status, the makeup of the underlying disease and how fast it is progressing.

Individuals who unintentionally lose 10-20% of their body weight, have a weakened grip, and are unable to perform high-energy tasks are said to have moderate secondary PEM. This also fits the description of cachexia.

A person with severe secondary PEM will have lost 20% or more of body weight, and are unable to eat normal-size meals.  They also have low blood pressure and body temperature, and slow heart rates. They may also have:

o       Baggy, wrinkled skin

o       Constipation

o       Dry, thin, brittle hair

o       Lethargy

o       Pressure sores and other skin lesions

Most people can unintentionally lose up to 10% of their body weight without side effects; the loss of more than 40% is almost always fatal. In these cases death usually results from heart failure, an electrolyte imbalance, or low body temperature. Patients with the poorest prognosis have particular symptoms, including:

o       Semiconsciousness

o       Persistent diarrhea

o       Jaundice

o       Low blood sodium levels

If you have clients that begin to have symptoms of malnourishment, notify their physicians as soon as possible. They are likely aware of the problem, but if not will design a treatment to give adequate nutrition, restore normal body composition, and cure the condition that caused the deficiency. For patient who can't or won't eat protein-rich foods, tube or intravenous feeding may be used to furnish needed nutrients (Gale Encyclopedia 2008).

Food Safety

In addition to adequate nutrient intake, food safety is also to be recognized. From January 24 through March 27, 2009---a period of sixty days, over 550 food products were recalled in the U.S. ("the most significant product actions"), some voluntary and some involuntary, many based on a recall of the manufacturer of an ingredient, such as the peanut factory recall during that time (FDA 2009).

With this quantity of recalls, it is impossible for the average American, let alone the elderly, to never risk eating contaminated food. Also, the elderly population is more at risk to food-borne illness, because (FDA 2001):

1.   The immune system no longer functions at optimal levels.

2.   The lining of the stomach often is somewhat inflamed, and there is a reduction in stomach acids.

3.   There is often a lack of good and/or sufficient nutrition.

While a wide variety of foods is best for optimal nutrition, the FDA warns that seniors should not eat (FDA 2001):

·        Raw fin fish and shellfish, including oysters, clams, mussels, and scallops.

·        Raw or unpasteurized milk or cheese.

·        Soft cheeses such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. (Hard cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be avoided.)

·        Raw or lightly cooked egg or egg products including salad dressings, cookie or cake batter, sauces, and beverages such as eggnog.

·        Raw meat or poultry.

·        Raw alfalfa sprouts which have only recently emerged as a recognized source of food-borne illness.

·        Unpasteurized or untreated fruit or vegetable juice. When fruits and vegetables are made into fresh-squeezed juice, harmful bacteria that may be present can become part of the finished product. Most juice in the United States, 98%, is pasteurized or otherwise treated to kill harmful bacteria. To help consumers identify unpasteurized or untreated juices, the Food and Drug Administration is requiring a warning label on these products. The label says:

• CLEAN: Wash hands and surfaces often.
Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, sponges and counter tops. Here's how to Fight BAC:
o Wash your hands with hot soapy water before handling food and after using the bathroom, changing diapers and handling pets.
o Wash your cutting boards, dishes, utensils and counter tops with hot soapy water after preparing each food item and before you go on to the next food.
o Use plastic or other non-porous cutting boards. These boards should be run through the dishwasher -- or washed in hot soapy water -- after use.
o Consider using paper towels to clean up kitchen surfaces. If you use cloth towels, wash them often in the hot cycle of your washing machine.

·        SEPARATE: Don't cross contaminate

Cross-contamination is the scientific word for how bacteria can be spread from one food product to another. This is especially true when handling raw meat, poultry and seafood, so keep these foods and their juices away from ready-to-eat foods. Here's how to Fight BAC:

o       Separate raw meat, poultry and seafood from other foods in your grocery shopping cart and in your refrigerator.

o       If possible, use a different cutting board for raw meat products.

o       Always wash hands, cutting boards, dishes and utensils with hot soapy water after they come in contact with raw meat, poultry and seafood.

o       Never place cooked food on a plate which previously held raw meat, poultry or seafood.

·        COOK: Cook to proper temperatures

Food safety experts agree that foods are properly cooked when they are heated for a long enough time and at a high enough temperature to kill the harmful bacteria that cause food-borne illness. The best way to Fight BAC is to:

o       Use a clean thermometer, which measures the internal temperature of cooked foods, to make sure meat, poultry, casseroles and other foods are cooked all the way through.

o       Cook roasts and steaks to at least 145°F. Whole poultry should be cooked to 180°F for doneness.

o       Cook ground beef, where bacteria can spread during processing, to at least 160°F. Information from the Centers for Disease Control and Prevention (CDC) link eating undercooked, pink ground beef with a higher risk of illness. If a thermometer is not available, do not eat ground beef that is still pink inside.

o       Cook eggs until the yolk and white are firm. Don't use recipes in which eggs remain raw or only partially cooked.

o       Fish should be opaque and flake easily with a fork.

o       When cooking in a microwave oven, make sure there are no cold spots in food where bacteria can survive. For best results, cover food, stir and rotate for even cooking. If there is no turntable, rotate the dish by hand once or twice during cooking.

o       Bring sauces, soups and gravy to a boil when reheating. Heat other leftovers thoroughly to 165°F.

·        CHILL: Refrigerate promptly

Refrigerate foods quickly because cold temperatures keep harmful bacteria from growing and multiplying. So, set your refrigerator no higher than 40°F and the freezer unit at 0°F. Check these temperatures occasionally with an appliance thermometer. Then, Fight BAC by following these steps:

o       Refrigerate or freeze perishables, prepared food and leftovers within two hours.

o       Never defrost food at room temperature. Thaw food in the refrigerator, under cold running water or in the microwave. Marinate foods in the refrigerator.

o       Divide large amounts of leftovers into small, shallow containers for quick cooling in the refrigerator.

o       Don't pack the refrigerator. Cool air must circulate to keep food safe.

It is unlikely that you will get a senior to follow all of these, especially if they haven't done it for most of their lives already---you probably won't follow them all yourself. However, do your best to be sure they are aware of them, and if you become aware of them repeatedly doing one of the more risky procedures, do your best to help them change.

Finding an Eating Plan

In these days of the Internet, individuals can find an eating plan for any philosophy they choose. Many are healthy diets, many are not---and many of those are simply fads. The U.S. Department of Health and Human Services and the U.S. Department of Agriculture jointly recommend using either the USDA Food Guide or the DASH Eating Plan (HHS & USDA 2005).

The USDA food guide has been discussed earlier when their food pyramid was presented, so it will not be further considered here.

The DASH diet formed the basis for the USDA MyPyramid (DASH 2009), so it also many not be adapted for seniors, but guidelines given earlier should be used. The basic diet is:

Another excellent plan is presented by Dr. Eric R. Braverman in Younger You: Unlock the Hidden Power of Your Brain to Look and Feel 15 Years Younger (2007) and Younger You: Unlock the Hidden Power of Your Brain to Look and Feel 15 Years Younger (2009). Dr. Braveman focuses on nutrient-dense foods that together restore hormonal balance of the brain and improve health and aid in weight loss if that is needed.

Nutritional Supplements

There are those who strongly advocate taking nutritional supplements; there are those who advocate just as strongly against them, stating that people can get all the nutrients they need from food. You can find experiences of people on both sides, but many who take supplements have astounding stories, whereas those who do not take them also seldom have astounding stories. A 2007 survey (Williams) found that, of 1,202 adults under 60 years of age and 528 who were 60+, there were significantly more people who regularly took vitamin and mineral supplements than those who took them only occasionally or never took them. Those who took them regularly also (Williams 2007):

·        Relied heavily on the medical profession for general health information

·        Obtained supplements and diet information from diet books and periodicals

·        Believed that taking vitamins and minerals prevented serious illness; reduced stress; prevented colds, skin problems, heart attacks, cancer, and other health problems

·        Believed their overall well-being was improved through the use of supplements, but apparently did not believe that the use of supplements ensured good health.

·        Did not seem to believe that the current food supply filled nutritional needs.

Whether or not one can get proper nutrition from foods alone takes one to the argument regarding organic vs. non-organic foods. One meta-analysis of studies on this topic says in the abstract (Heaton 2002):

"Any attempt to answer the question ‘is organic food better for you?’ requires an assessment of the safety, nutritional content and biological value aspects of food quality. Previous reviews have been unable to reach definitive conclusions after failing to ensure only valid comparisons are considered. When methodologically flawed studies are screened out and a complete assessment of nutritional quality is made, collectively, the available evidence supports the hypothesis that organically produced food is superior in terms of safety, nutritional content and nutritional value to that produced non-organically."

Rather than get in the fray, the best procedure for you is to help them get the best they can from food; if they want food supplements, help them find the best there---there are huge differences in quality and effectiveness between different supplements.

Exercise

In the last number of years, it has become well known that moderate exercise can significantly improve one's health and extend life. Physical inactivity is associated with increased incidence rates of obesity, diabetes, cardiovascular diseases, osteoporosis, and cancer; however, increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation (Byberg et al 2009).

For most elderly people, aerobic exercise (considered strenuous exercise) is either intimidating or out-and-out impossible.

Some of the results of a comparison of 22 studies on various populations with a variety of moderate exercises show that some of the exercises done, both type and quantity, would offer excellent results for seniors (Simon 2006):

If the client is able to progress to 30 minutes of moderate exercise a day, they may experience some or all of the following benefits (Mayo 2008):

ü     Lower blood pressure

ü     Improve cholesterol

ü     Prevent or manage type 2 diabetes

ü     Manage weight (coupled with a healthy diet)

ü     Prevent osteoporosis

ü     Prevent cancer

ü     Maintain mental well-being

ü     Increase energy and stamina---a lack of energy often results from inactivity, not age

One of the easiest exercises for the elderly is whole body vibration (WBV). Whole body vibration, which is exactly what you would deduce from its name, is performed by standing on a vibrating platform. The individual may just stand there (or sit, if needed) or he or she may do simple exercise on it. Motors underneath the platform transfer to the person on the machine. Machines can be adjusted to change the intensity, and often the direction, of the vibrations.

A traditional platform for standing with

an add-on for sitting (Miyamoto et al 2003)

The frequency is one of the most important factors involved; every person has his own muscle frequency (Rittweger 2004). The direction differences focus the exercise on different areas of the body. This type of mechanical stimulation generates acceleration forces acting on the body. These forces cause the muscles to lengthen, transfers a signal through the central nervous system to all of the muscles involved. This uses many more muscle fibers than a conscious, voluntary movement does (Issurin and Tenenbaum 1999).

Medical research reports on vibration exercise---often performed for just 3-4 minutes a day several days a week---benefits show the following benefits for seniors:

·        Significant improvement in walking speed, step length, maximum standing time on one leg (Iwamoto et al n.d.)

·        Improve elements of fall risk and health-related quality of life (Bruyere et al 2005)

·        Performance gains in chair rising, 18% (Runge et al 2000)

For a huge list of scientific studies, go to http://www.hmgco.com/studies.html. They show numerous studies on WBV that show positive results in the areas of (we've not checked all of the links recently, so they may not all be current):

§      Fitness

§      Performance

§      Blood circulation

§      Bone density

§      Falls prevention

§      Flexibility/Mobility/Balance

§      Hormonal response

§      Metabolism

§      Neurological conditions

§      Osteoporosis

§      Pain management

§      Multiple sclerosis

§      Parkinson's disease

§      Medical conditions and rehabilitation                                   

An initial output of about $600 is required, although the machines can go for many thousands of dollars. There are cheaper ones, but they are so lightweight that they tip easily. The highest it is necessary to pay is $1300 for a vibrator that has three different settings for direction of vibration. They all have variable speeds for vibration.

Other exercises recommended for the elderly are strength (e.g., with dumbbells), stretching, yoga, and Tai Chi. Some recommend, "Just move!"

You can find a short regimen of armchair exercises for less mobile seniors at http://www.articledashboard.com/Article/Armchair-Exercises-for-the-Elderly/553828. 

Aging and Sexuality

Sexual desire and activity extend well into later life for both men and women. However, it can be affected by aging. One study (Bretschneider and McCoy 1988) found that approximately 63% of men aged 80 to 102 are still sexually active.

Of participants in another study (Sill 2005) the majority of the women, and almost a majority of men did not report a low level of sexual desire until age 75 or older.

Factors other than age that reduced sexual desire were:

·        Illnesses and medications. There is a high incidence of decreased sexual desire in those who take antidepressant drugs (Kuzmarov and Bain 2008).

·        Negative attitudes towards sex

·        Lack of education

·        Presence of partner

Sill (2005) also reported that other studies found hormones reduced sexual desire and activity in the elderly.

Age and Sexual Response

In elderly men, increased physical stimulation is needed to achieve and maintain erections; orgasms are not as intense. In women, after menopause there are changes because of estrogen reduction or deficiency (Meston 1997).

The extent that aging affects sexual function is largely dependent on psychological, pharmacological, and illness-related causes.

Bretschneider and McCoy (1988) found that for both men and women ages 80--102, the most common activity was touching and caressing with no sexual intercourse. Next was masturbation, and then sexual intercourse. Only touching and caressing declined significantly from the 80s to the 90s for men, but not for women. With the exception of touching and caressing and past enjoyment of sexual intercourse, men had more activity and enjoyment. Being married, extramarital sex, and church attendance were significantly related with continuing to perform and enjoy some sexual behaviors. Current physical and social factors were of more importance than past and present frequency of sexual behavior except for sexual intercourse.

General effects of aging include (Laflin 2002, 281-2):

Men:

1.   Circulating testosterone is decreased but rarely contributes to erectile disorders in healthy aging men.

2.   Penile erection takes more time, and the erection may not be as hard as before; direct, continuous penile stimulation is usually required. The advent of drugs has aided in this area.

3.   Testicles do not increase in size; they elevate later and to a lesser degree.

4.   Nipple erection becomes less discernible.

5.   Ejaculatory control increases.

6.   Sex flush is rare in the elderly.

7.   Sense of ejaculatory inevitability is diminished or absent.

8.   Ejaculation is less powerful and orgasm is often less intense, consisting of one or two expulsive contractions vs. four major contractions followed by minor contractions over several seconds of younger men.

9.   Ejaculate is expelled with less force and contains less seminal plasma. Men do not become sterile because of age.

10.                     Loss of erection after ejaculation and testicular descent occur rapidly.

11.                     Refractory period between ejaculations is longer, generally 12 to 48 hours.

12.                     Climax still provides extreme sensate pleasure.

Women:

1.   Vaginal lubrication takes longer.

2.   The expansion of the vaginal barrel is reduced in length and width.

3.   The lining of the vagina begins to thin and becomes easily irritated.

4.   The bladder and urethra may become irritated during intercourse.

1.   Vaginal secretion becomes less acidic, increasing the possibility of vaginal infection.

2.   The uterus does not elevate as high.

3.   The labia majora loses fullness, the clitoral size decreases, and the clitoral hood and fat pad over the mons veneris atrophy.

4.   Orgasmic phase is shorter.

5.   Resolution phase occurs more rapidly.

6.   Capability for multiple orgasm remains.

Sexuality, Estrogen Replacement and Other Hormone Therapy

In some cases, decreased sexual desire in women may have a hormonal element; post-menopause, hypopituitarism, adrenal inefficiency, or surgical menopause may play a role, but the major factors are likely to reside in psychological and situational conditions.

How the decline in levels of estrogen and progesterone and the role of testosterone relate to female sexual functioning as aging advances is not wholly clear. It is known that estrogen replacement therapy will restore vaginal epithelial function, increase vaginal flow, and increase the sense of well-being, but whether or not it improves sexual function is uncertain (Kuzmarov et al 2008).

Estrogen replacement therapy (ERT) has been reported to improve sexual desire in a significant percent of women, but there are many who experience no response. There is apparently a significant subgroup of women, particularly those whose problem has been a loss of libido, whose sexual issues initially respond to ERT, but who later regress to their original problems (Sarrel 2000).

ERT may have other benefits. Some studies suggest that hormone replacement therapy may have a selective beneficial effect on verbal memory in older non-demented women (Maki et al 2001).

There has been a general belief that since testosterone has libido-enhancing properties, it might intensify currently declining sexual interest among women---at least among women who have a low testosterone-producing capability due to physiological or pathological reasons (Kuzmarov and Bain 2008).

Erectile Dysfunction

(Merck n.d.a)

When the soft spongy tissue in the shaft of a male penis fills with blood, causing the penis to enlarge, stiffen and become erect, you have what is called penile erection. Erectile dysfunction has been a commonly used phrase ever since the first advertisements of Viagra.

There are several kinds of causes of erectile dysfunction:

·        Vascular disorders, the most frequent cause in the elderly.

·        Neurologic disorders---penile sensitivity may diminish with age and contribute to erectile dysfunction.

·        Endocrine disorders, of which the most common in elderly men is the ADAM (Androgen Deficiency in the Aging Male) syndrome.

·        Structural abnormalities

·        Drugs

·        Psychologic disorders. Among the elderly, most erectile dysfunction is organic rather than psychologic.

Treatment of erectile dysfunction has had radical changes in the last number of years. The patient's goals and desires and the risks of various options guide the choice of treatment. 

·        Drugs

o       Sildenafil---a common trade name is Viagra. However, it can cause problems with cardiac function and vision, as well as headaches, flushing, and dyspepsia.

o       Alprostadil---common adverse effects are a penile burning sensation and aching; less common in priaprism.

o       Testosterone therapy may help if the problem is libido or the erectile dysfunction is due to hypogonadism.

·        Other means

o       Constriction rings may be useful for men who can obtain erections but can't sustain them.

o       Vacuum tumescent devises that increase penile engorgement by creating a vacuum or negative pressure, drawing blood into the penis.

o       Permanent penile prostheses or implants, used when other treatments don't seem to work.

o       Penile revascularization surgery, so far not found to have a high success rate.

Sex in Nursing Homes

Everyone has heard of "strange bedfellows." Is "senior care and sex" one of them? Well, perhaps not. Aging does not stop one from being a sexual being---nor does living in a nursing home. Sexuality doesn't always mean intercourse; many residents are lonely or depressed and looking for ways to relieve them---simple touching may be enough.

Nursing homes are beginning to come to grips with the fact of senior sexuality. Following the guidelines of a study by Kansas State aging experts, they are looking at the following goals:

1.   Through education and open discussion, make staff comfortable with talking about seniors' sexuality (Hamilton 2008).

o       Explain what sexuality means for older adults.

o       Identify barriers to fulfilling the sexual needs.

o       Find strategies to help residents.

o       Learn how to discern appropriate from inappropriate sexual behaviors.

2.   Clear up staff misconceptions; add a dose of humor.

3.   Once staff appreciate the seniors' needs to be sexual and to be touched, look at several issues:

o       Residents' right to privacy

o       Finding ways to give residents this privacy

o       When is sex for a person with dementia consensual and when is it rape?

o       Making sure the sex is safe---educate the residents about sexually transmitted diseases.

o       Be prepared to answer resident's requests for

§        Lubrication products

§        Pornography

§        Double beds

§        Access to drugs like Viagra

If social workers have a nursing home client with an unmet sexual need, they must find a way to address that need (KSU 2008, Edwards 2003).

They also recommend some steps for preparing food safely at home.