**5. Discussion and conclusions**

Table 3 also shows the descriptive statistics for the scales; the mean values for the items range from M=3,21 (bipolar adjective: *intimate-public*) to M=4,66 (bipolar adjective: *frequently-rarely*); with standard deviations from SD=1,45 (adjective: *beneficial-detrimental*) to SD=1,74 (adjective: *honest-dishonest*). Ratings of bipolar sets of adjectives show neither extremely positive and

**Adjectives Min Max Mean Std. Deviation Evaluation Activity/**

Determined 1,00 7,00 3,94 1,45 0,48 Painful 1,00 7,00 3,73 1,51 0,60 Strong 1,00 7,00 4,07 1,50 0,61 Exciting 1,00 7,00 3,83 1,56 0,62 Active 1,00 7,00 4,33 1,54 0,73 Frequently 1,00 7,00 4,66 1,58 0,73 Intensive 1,00 7,00 4,26 1,46 0,81

**Table 3.** Dimensional structure and descriptive statistics of attitude toward sexuality among institutionalized elderly

scale

202 Sexology in Midwifery

**Descriptive statistics Components**

**potency**

neither extremely negative, but rather moderately positive evaluations.

Safe 1,00 7,00 3,42 1,67 0,42 Acceptable 1,00 7,00 3,94 1,45 0,42 Healthy 1,00 7,00 3,28 1,56 0,51 Ordinary 1,00 7,00 3,65 1,61 0,51 Liberal 1,00 7,00 3,90 1,62 0,58 Disrupting 1,00 7,00 3,62 1,50 0,58 Beneficial 1,00 7,00 3,27 1,45 0,63 Pleasant 1,00 7,00 3,45 1,58 0,64 Faithful 1,00 7,00 3,54 1,53 0,65 Embarrassing 1,00 7,00 4,43 1,73 0,65 Honest 1,00 7,00 3,98 1,74 0,69 Satisfying 1,00 7,00 3,67 1,56 0,70 Tolerant 1,00 7,00 3,51 1,59 0,73 Intimate 1,00 7,00 3,21 1,59 0,73 Relaxing 1,00 7,00 3,65 1,64 0,74 Spontaneous 1,00 7,00 3,35 1,54 0,76 The pilot study of attitudes toward intimate relations between institutionalized elderly scale had two goals: i) to develop an instrument to assess nursing care professionals attitudes toward sexuality among institutionalized elderly and to ii) determine how nurses that work in nursing home facilities evaluate the expression of sexuality among residents of nursing homes. Already during the process of the scale development, especially during the focus groups with nursing care students, the beliefs, behavioral and affective reactions toward the theme (sexuality toward elderly in institutional care) were evoked. For participants of the focus group the theme was embarrassing and needed some time to feel comfortable in their expressions. The dichot‐ omy of the question "what it is right" and "how I feel about that" was clearly expressed in participants comments: "I know, it is something ordinary, it is normal and many times for them a pleasant experience that enhance the quality of their life, but still, I do not feel relaxed, I am embarrassed when I encounter such situations or when they want to discuss about sexuality and intimacy… Probably it is so because we are talking about sexuality, the age of people involved… also the fact that people live in institutions, where thinks must be under "control" all the time." Similar notion of self-justification in avoiding problems and interac‐ tions in relation to sexual behavior can be found in Villar et al. [39]. "Having the control over the situation" is a form of similar self-justification as to "ensure safety" [39]. Self-justification is in this case needed as a mean to avoid taboos and social presssures related to them.

The factor analysis of the attitudes toward intimate relations between institutionalized elderly scale suggests that nursing staff attitudes toward sexuality and intimate relations of institu‐ tionalized elderly have a strong affective component. Exploring nursing staff attitudes towards sexuality among elderly in nursing homes suggests that this is still a taboo issue. The qualita‐ tive phase of the scale development process offers deeper understanding of the evaluations of the theme, more than the assessed evaluations. Therefore in further studies of attitudes toward elderly in institutionalized settings, a mixed method approach is advised. The attitudes toward intimate relations between institutionalized elderly scale needs further studies on its reliability and validity, as well as additional validation of the adjectives included in the scale.

Sexuality of elderly in nursing homes is a complex societal phenomenon with multiple causes arising from different groups of people for a given society coexisting with old people. In a first place it is about attitudes that elderly might have towards their own sexuality. Here we must also take into account their desires and ability to fulfill sexual needs if there are any. A second important factor are relatives with their personal views on sexual life in general what may have a great impact in determining what should be or should be not the sexual lives of their parents living in nursing home. Finally we must consider how life in the institution itself might influence the sexual expression of elderly. Although it seems that the impact on sexuality among elderly depends especially upon the policy of nursing home and work processes, it is basically always influenced by attitudes of the individual. Nursing home policy and staff attitudes seem to be in vice versa relationship. Those attitudes make positive or negative effects on the nursing homes policy about sexual expression in late life, but also a vice versa effect on individuals (nursing staff and residents in nursing homes). To break this vicious circle we have to take into account that only education is not enough. Nursing staff must get also a concrete practical experience working with the elderly. This will allow them to know, recognize and understand, without any judgment, the area of sexuality in institutionalized elderly. Willing to know, understand and accept is a starting point in implementing a more permissive attitude to the sexuality among elderly which can be subsequently resulting in practice through restructured nursing home policies and ways of addressing the elderly when it is to ensure and facilitate their need, desire and rights for close, intimate relationships. A balance between rights of elderly to fulfill their sexual needs and ensuring them safety, on the other hand is a very important and challenging aspect for restructuring nursing home policies in a way that this area of late life would be respected as it must be. This is necessarily associated with cultural and even religion characteristics of society, but also with capability of recognizing the need for more knowledge and tolerance regarding sexual expression in elderly. If we point out that sexuality is an important area of human's life, then is not difficult to recognize the importance of training from an early age in a sense of instilling tolerance and understanding sexuality in different stages of life.

### **Author details**

Doroteja Rebec\* , Igor Karnjuš, Sabina Ličen and Katarina Babnik

\*Address all correspondence to: doroteja.rebec@fvz.upr.si

University of Primorska, Faculty of Health Sciences, Izola, Slovenija

### **References**


[6] Ziherl S. Starost in spolnost. In: F Kresal, editor. 1 znanstveni simpozij fizioterapev‐ tov Slovenije. Gerontologija-izzivi in priložnosti v fizioterapiji. Radenci: Zbornica fi‐ zioterapevtov Slovenije; 2011. p276-281.

to take into account that only education is not enough. Nursing staff must get also a concrete practical experience working with the elderly. This will allow them to know, recognize and understand, without any judgment, the area of sexuality in institutionalized elderly. Willing to know, understand and accept is a starting point in implementing a more permissive attitude to the sexuality among elderly which can be subsequently resulting in practice through restructured nursing home policies and ways of addressing the elderly when it is to ensure and facilitate their need, desire and rights for close, intimate relationships. A balance between rights of elderly to fulfill their sexual needs and ensuring them safety, on the other hand is a very important and challenging aspect for restructuring nursing home policies in a way that this area of late life would be respected as it must be. This is necessarily associated with cultural and even religion characteristics of society, but also with capability of recognizing the need for more knowledge and tolerance regarding sexual expression in elderly. If we point out that sexuality is an important area of human's life, then is not difficult to recognize the importance of training from an early age in a sense of instilling tolerance and understanding sexuality in

, Igor Karnjuš, Sabina Ličen and Katarina Babnik

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**Author details**

Doroteja Rebec\*

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