HP 626 week 3 discussion 3 1 evaluating capacity for decision making and sexual expression in senior living discussion questions
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HP 626 week 3 discussion 3 1 evaluating capacity for decision making and sexual expression in senior living discussion questions
Paper Instructions
Initial Post
If your first name begins with the letters A–M Topic 1 – Evaluation Capacity of Older Adults
After completing the readings, respond to the following prompts
- Discuss the ethical and legal factors as well as professional standards of practice considered in evaluating a person’s capacity to make decisions.
- Discuss challenges you as a service provider for aging adults would have in evaluating a person’s capacity and how you may go about doing this.
- Discuss what you found surprising in the readings as it relates to determining capacity.
- Propose methods in which you as a service provider for aging adults would incorporate capacity evaluation practices into your interaction with aging adults.
- Your initial post should be 500 to 700 words, with one to two supporting references included.
- If your first name begins with the letters N–Z Topic 2 – Sex Stigmas and Senior Living
After reading Syme and Cohn (2016), identify two factors you found interesting as well as explain how the authors help you better understand how to combat stigma and generational differences about sex.
Identify ways in which leadership of a residential health care facility can support the sexual expression of aging adults. Propose methods by which healthcare professionals can incorporate sexual education into routine interactions with aging adults.
Discuss how you, an aging service provider, would educate and train staff working in a residential aging service setting on how to respond to aging adults engaging in sexual relationships.
What are challenges you might anticipate in these situations? How might you address staff’s ageist assumptions, attitudes, and personal beliefs regarding older adult sexuality?
Your initial post should be 500 to 700 words, with one to two supporting references included.
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Sample Answer
The purpose of this discussion is to touch on the terms capacity, competency, the challenges this presents for a service provider, what I found surprising and methods that I may incorporate in evaluating capacity.
According to Boron (2020), there needs to be a distinction between competency and capacity. Capacity is about the autonomy of an individual and their ability to make their own decision. Capacity is a determined by an assessment by a clinician.
There are 4 components to decision making in a capacity evaluation and they include understanding, communicating a choice, appreciation, and reasoning; this involves asking open-ended questions (Boron, 2020).
Decision making capacity can be infringed upon with dementia (Boron, 2020).
Competency is not only the capacity to make a decision about finances and such, but is the capacity to make a decision related to the personal goals of the person (Boron, 2020).
This is made legal and is determined by a judge in a court of law. In straight terms, capacity is variable, but competency is black and white, yes, or no. Competency is whether or not a person can make a decision for themselves (Boron, 2020).
Sexuality in light of dementia raises many medical and ethical concerns. Inappropriate sexual behaviors are estimated to occur in 7%-25% of demented patients (Hillman, 2016).
From the opposite standpoint, Eshmawey ( 2021), concludes from a study based on literature review, that sexual needs of dementia patients are still important for their well-being and cannot necessarily be separated from their lives.
In spite of cognitive decline, or neurogenic processes, along with other comorbidities, sexuality is an essential part of a patient with dementia (Eshmawey, 2021).
There is a fine line in balancing an individual’s right to autonomy and privacy and protecting the individuals from harm (Hillman, 2016). Sexual consent capacity isn’t something that is determined ahead of time in writing, but is something that is decided in the present.
I think these decisions have to be made over and over depending on the day and the mood and desire of the patient. Patients with dementia do have lucid moments, happy memories, and may be moved to have a close, intimate, or sexual, connection with their partner on that day.
According to an article in Hastings Center Report, which is a peer-reviewed academic journal of bioethics, writer Samuel Director states “People with dementia are often prohibited by nursing-home staff, sometimes in extreme ways, from having sex with their partners.
This prohibition is at least partly motivated by the goal of protecting the vulnerable. However, cutting people with dementia off from sex has negative health effects and is a needless restriction of their autonomy” (Director, 2023).
It is his opinion that many people with dementia are competent to consent to sexual activity with their long-term partners (Director, 2023). I found this article to be surprisingly honest, putting the possible sexual desires of the patient above their diagnosis; that these individuals are not always to be treated as a vulnerable population, but as one that can, depending on the day, the mood, the occasion, make a concerted decision.
This is a most challenging situation, to be sure. According to a study by Sandberg (2020) regarding sexuality for couples with an Alzheimer diagnosis, it was concluded that intimate sexual relationships provided comfort and well-being rather than being pathological, troublesome, or inappropriate.
As a health service provider, I believe that I would have to approach each situation individually, discuss it with the patient’s partner as well as the patient, come to an agreement that there will be times that they will not be interested in engaging in any type of close or intimate contact, and those times must be honored.
References
- Boron, J. B. (2020). Cognitive competence and decision-making capacity. Creighton Law Review, 53(4), 659–667.
Director, S. (2023). Dementia and concurrent consent to sexual relations. Hastings Center Report, 53(3), 37–45. https //doi.org/10.1002/hast.1489
- Eshmawey, M. (2021). Sexuality and neurodegenerative disease an unmet challenge for patients, caregivers, and treatment. Neurodegenerative Diseases, 21(3–4), 63–73. https //doi.org/10.1159/000522042
- Hillman, J. (2016). Sexual consent capacity Ethical issues and challenges in long-term care. Clinical Gerontologist, 40(1), 43–50. https //doi.org/10.1080/07317115.2016.1185488
- Sandberg, L. (2020). Too late for love? Sexuality and intimacy in heterosexual couples living with an Alzheimer’s disease diagnosis. Sexual and Relationship Therapy, 38(1), 118–139. https //doi.org/10.1080/14681994.2020.1750587
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