VOLUME 22 ISSUE 1 SPRING 2012 Published by the National Association of Professional Geriatric Care of Managers 3275 West Ina Road Suite 130 Tucson, Arizona Geriatric Care Management 85741 520.881.8008 / phone 520.325.7925 / fax www.caremanager.org Older Adult Sexuality, Intimacy, and Sexual Orientation Guest Editor’s Message: Addressing the Elephant in the Room: Dealing with Matters of Sexuality and Sexual Orientation in Care Management Practice ...................................................................................2 Lenard W. Kaye, DSW, PhD Defining Moments: Sexuality and Care of Older Adults.........................................4 Marilyn R. Gugliucci, MA, PhD, AGSF, GSAF, AGHEF and Shirley Weaver, MT(ASCP), MA, PhD, GCG Intimacy in Later Life: Reflections on Love and Care ......................................... 10 Amanda Smith Barusch, PhD Addressing Diversity in Sexuality and Aging: Key Considerations .................... 13 for Healthcare Providers Nancy A. Orel, PhD, LPC and Wendy K. Watson, PhD Older Lesbian Adults and Alcoholism: A Case Study for Practitioners ............... 19 Noell L. Rowan, PhD, LCSW, CADC Aging, Relationships, & Sexuality: Tools and Resources .................................. 25 for Geriatric Care Managers Jennifer A. Crittenden, MSW and Lindsay Day, LSW of Geriatric Care Management Spring 2012 Guest Editor’s Message Addressing the Elephant in the Room Dealing with Matters of Sexuality and Sexual Orientation in Care Management Practice By Lenard W. Kaye, DSW, PhD Talk about the proverbial informal models of service delivery emotionally charged and commonly elephant in the room! I would hazard are often entrenched in past societal avoided by our clients as well has only to guess that the prospect of dealing mores. These, too, warrant fresh served to feed this tradition of neglect. with matters of sexuality, intimacy, perspectives in order to encourage Our expert contributors will and love with your clients will give change and progress. broach the topics but no doubt realize virtually all of you pause no matter This issue of the Journal of that they can only scratch the surface how seasoned a mental health Geriatric Care Management will of such complex matters. I believe I professional you may be. Fear not – address highly relevant subject speak for them in expressing the hope you are not alone. These are issues matter dramatically impacting the that their presentations will encour- that the vast majority of helping lives of older adults that has been, age a beginning discourse on a set of professionals likely avoid addressing unfortunately, ignored by too many issues extremely relevant to more fully as a matter of course in their daily of us for far too long. Whether understanding the challenges impact- practices. we perceive matters of sexuality ing our older clients and patients. More than “correct” language is and intimacy to be controversial, Multiple dimensions of the needed to insure adequate levels of embarrassing, or socially taboo, we subjects of sexuality, intimacy, and understanding and informed care as have steered clear of addressing sexual orientation will be addressed we encounter issues of intimacy and them in our work with older clients in the pages to follow, including the sexual satisfaction expressed by older and patients and their families. The impact of physiological changes of adults. Tenets that guide formal and fact that these are matters that are aging on sexual expression and long- EDITORIAL BOARD Rona Bartelstone, LCSW Fort Lauderdale, FL Cathy Cress, MSW Santa Cruz, CA Lenard W. Kaye, PhD Orono, ME of Leonie Nowitz, MSW, LICSW New York, NY Journal Emily Saltz, MSW, LICSW Newton, MA Geriatric Care Management Monika White, PhD Santa Monica, CA Published by the: National Association of Professional Geriatric Care Managers EDITOR-IN-CHIEF 3275 West Ina Road, Suite 130, Tucson, Arizona 85741 • www.caremanager.org Karen Knutson MSN, MBA, RN © Copyright 2012 Bryn Mawr, PA The Journal of Geriatric Care Management is published two times per year as a membership benefit to GRAPHIC members of the National Association of Professional Geratric Care Managers. Non-members may subscribe DESIGN to Journal of Geriatric Care Management for $95.00 per year. Send a check for your one-year subscription to: HagerDesigns Subscription Department, NAPGCM, 3275 West Ina Road, Suite 130, Tucson, Arizona 85741. Dallas, Texas PAGE 2 of Spring 2012 Geriatric Care Management Lenard W. Kaye, DSW, PhD, is Professor of Social Work at Multiple dimensions of the subjects of the University of Maine School sexuality, intimacy, and sexual orientation will be of Social Work and Director of addressed in the pages to follow, including the the University of Maine Center on Aging. A prolific writer in the impact of physiological changes of aging on sexual field of health care and aging, he expression and long-standing myths held of older has published approximately 150 journal articles and book chapters people, sex, and sexuality that are perpetuated and 12 books on specialized in our youth-dominated culture. topics in aging including home health care, productive aging, rural practice, family caregiving, controversial issues in aging, support groups for older women, standing myths held of older people, a useful framework for practitioners and congregate housing. His sex, and sexuality that are perpetuated to use that systematically considers pioneering research and writing in our youth-dominated culture. The ten cultural factors and personal on older men’s caregiving authors will examine why there is attributes that influence sexuality. The experiences and help-seeking discomfort with exploring this topic authors maintain that appreciating the behaviors, is widely recognized among many professionals and allied importance of these factors for their and frequently cited. His current health care providers. In addition, older patients will enable providers book project is a self-help manual issues of sexual identity among the to more appropriately and adequately for mid-life and older men on 60-and-over age group will also be meet their needs in the arena of healthy, active aging. Kaye sits on examined. Special attention will be sexuality and sexual health. the editorial boards of the Journal directed at the anticipated impact Finally, Noell Rowan addresses of Gerontological Social Work of having a dramatically expanding a rarely discussed issue in clinical and Journal of Geriatric Care cohort of lesbian, gay, bisexual, and practice -- the older chemically Management and is a Fellow of transgender (LGBT) baby boomers dependent lesbian and her health the Gerontological Society of using a wide range of health and and mental health needs. Rowan America. social services, including both considers the issues faced by older community and institution-based lesbians with alcoholism and further forms of care in the coming years. research necessary to enhance our Marilyn Gugliucci and understanding of the lived experiences Shirley Weaver set the context by of these individuals. She includes an presenting foundational information illustrative case study to demonstrate on the issues that affect both a variety of critical issues likely to be heterosexual and homosexual older faced by practitioners working with adults, including such matters as this client group. We very much hope terminology, stereotypes associated readers will want to read more about with aging in our society and with the topics raised in this special issue, older adult sexuality, as well as and to that end Jennifer Crittenden associated psychosocial factors, care and Lindsay Day have prepared strategies, and resources available to a compendium of professional providers and older adults. resources, information, consumer Amanda Smith Barusch, resources, and training materials on drawing on her research into elder love, relationships, and sexuality in romance and love, presents four older age. The authors have provided vignettes on late-life intimacy with them as a general starting point for direct implications for geriatric considering, discussing, and exploring care managers. She includes special issues of older adult relationships and attention directed at “Living Apart sexuality. Together” relationships, late-life infatuations, and the insidious effects of ageism on intimacy in late life. Nancy Orel and Wendy Watson explore the heterogeneity of the older adult population and provide PAGE 3 of Geriatric Care Management Spring 2012 Defining Moments: Sexuality and Care of Older Adults Marilyn R. Gugliucci, MA, PhD, AGSF, GSAF, AGHEF Shirley A. Weaver, MT (ASCP), MA, PhD, GCG Summary such an issue. We are who Health care providers we are throughout life – are reticent to discuss “We are squeamish about the hopefully gaining wisdom as intimacy and sexual issues sex lives of the elderly we move through the ages, with their older adult but still the “same person” inside. This simple realiza- patients or the patients’ …even more so when those elderly adult children. This article tion could greatly aid us in is written with the provider are senile or our parents” providing positive descrip- in mind and presents tions of aging and a more foundational information —An Affair to Remember, realistic understanding of on older adult sexual health Henneberger, 2008 life-long issues of sexual- and intimacy issues that ity. This is something that affect both heterosexual we hope will become more and homosexual older prevalent as we advance adults. We begin