The role of professionals and service providers in supporting sexuality and intimacy in later life: theoretical and practice perspectives

The transformation of intimacy and sexuality issues within historically and culturally dependent institutions is challenging established views about ageing (Bildtgard and Oberg, 2017). Health and social care are one such institution yet to respond fully, to the growing empirical evidence on what contributes a meaningful life for older people interacting with care services in relation to sexuality and intimacies across different sexual and gender identities. Transcending established views about the role of health and social care professionals in providing meaningful engagement and support for older people to fulfil their sexual needs, requires providers to recognise opportunities for responding to the complexity of issues arising in care. Being open to the range of peoples’ relationship situations; making spaces within assessment and provision of care to enable information and support on sex and intimacy to be made available and to engage proactively with the topic is beginning to be recognised within workforce development (SfC, 2017). Building on these involve developing new structures and methods of embedding sexuality within professional education, in policies and care practices and in the commissioning of, and evaluation of services (Hafford-Letchfield et al, 2009; 2020).

This chapter engages with the literature focusing on what we know or need to know about how professionals and providers within health and social care exchange and interact around sex as a meaningful concept in the provision and quality of care. It focuses on themes that are important to initiating and supporting sexual expression in later life and addresses important transition points where older people are considered ‘vulnerable’ in care services and where their sexual rights are less likely to be promoted or transgressed. As we saw in Chapter 9, issues may occur in residential care, for people with cognitive decline and in this chapter we expand further on issues that may emerge at the end of life. Building further on Villa and Fabà’s contribution in this volume, I highlight some of the underlying theoretical concepts that forge pathways to improved practice and point to areas in which there are good practice guidance from the current evidence available.