Holistic Care of the Chronically Ill and Elderly

Holistic Care of the Chronically Ill and Elderly
Sexual satisfaction and intimate relationship are some of the key
determinants of the quality of life. Chronic illness and age advancement
affect the sexual relationship in all phases through dissatisfaction or
sexual dysfunction. The two factors (chronic illness and old age) affect
the patients physically and psychologically. Holistic care is the most
suitable approach that health care providers can use to assist their
chronically ill patients. Ioanna, Melachrini & Lambrini (2013) defined
holistic care as a therapeutic approach that deals with the human being
as a whole using a multifaceted method to deal with a given health
issue. This paper will address the issue of sexuality and chronic
illness with a focus on the disease process, its relationship with
chronic illness, and its relevance to nursing care. The trajectory
approach will be the most suitable model to explain the disease process
and interventions that can be applied at different stages of illness.
The holistic care approach provides the suitable alternatives for health
care providers to address sexual dysfunction and satisfaction among the
chronically ill and the elderly.
Disease process and its relevance to chronic illness and the elderly
Sexuality affects the quality of life of a human being from birth till
death plays a significant role in the development of a personal
identity, interpersonal relationships, and role development. However,
the significance of sexuality in human life can be disrupted by
pharmacological, hormonal, psychological, or physical factors that may
be associated with chronic illness or old age. Chronic illness and
advancement in age affects personal expression of sexuality through
pulmonary, vascular, neurological, pain level, hormonal system, mood,
self-esteem, or energy level (Finger, 2012). There is a wide range of
(including arthritis, cancer, diabetes mellitus, HIV, hypertension,
obesity, and cardiovascular disease) disease that can result in these
effects and negative impact on human sexuality. However, the level of
sexual dissatisfaction or dysfunction changes gradually depending on the
severity of chronic illness and age as explained in a trajectory model
of illness.
The chronic illness trajectory begins with pre-trajectory phase, which
is a stage that occurs before the onset of signs and symptoms (AIPPG,
2012). The pre-trajectory phase is followed by trajectory phase, which
include the diagnostic period. Sexuality (satisfaction and dysfunction)
may not be highly affected and there are no significant impacts of
illness on the quality of life. The third phase of illness is referred
to as crisis phase and it is characterized by life-threatening
circumstances. This is followed by acute phase, a period in which
illness can be controlled by prescribed regimen. The stable phase occurs
when the symptoms are successfully controlled. However, clients’
symptoms eventually reach a stage (unstable phase) in which they cannot
be controlled by pre-determined regime. This marks the onset of chronic
illness and progress to the last two phases namely downward phase, which
is characterized by deterioration of physical and mental conditions and
the dying phase, which is characterized by a short period that precede
death (AIPPG, 2012). Human sexuality deteriorates continually with
deterioration in physical and mental conditions of the patient from the
onset of acute to chronic illness. According to Laumann, Das & Waite
(2008) the decline in sexual functionality among the older adults
results from their response to stressors that affect their mental and
physical wellbeing. The presence of these life stressors increases with
the increase in age, thus affecting human sexuality.
Relevance to the nursing care
Although chronic illness reduces sexual activeness of the affected
people, research shows that there are some instances in which sexuality
is not affected by chronic illness or age (46 %) of it may increase with
during chronic illness (13 %) (McLnnes, 2003). This means that health
care providers should develop interventions that cater for three
scenarios (where sexuality declines, remains unaffected, of increase) to
assist partners who may be affected by the societal perception that the
elderly or chronically ill should not have sex. There are three measures
that nurse or health care providers should consider in their efforts to
design effective interventions. First, attitudinal change can help the
health care providers in enhancing inquiry and constructive discussion
with chronically ill as well as the elderly. Secondly, health care
providers need to acquire some knowledge about sexuality of the
chronically ill and elderly. Third, health care providers should use
simple plans to assist patients (McLnnes, 2003). This means that health
care providers have a role to play in overcoming the negative attitudes
and recommend the suitable ways of enhancing sexual functionality and
intimate relationships among chronically ill patients and the elderly
Health care providers should use a holistic approach to address both
psychological and physical barriers of human sexual functions of the
chronically ill and the elderly. The PLISSIT model outlines four levels
of counseling intervention that can be used to overcome psychological
barriers (McLnnes, 2003). This type of intervention begins with the
doctor asking simple questions about sex, which is intended to reduce
the level of perceived embarrassment and increase the client’s
comfort. Client’s openness allows the health care provider to screen
and discuss sexual concerns of the chronically ill and aged patients. A
successful counseling session is achieved when the health care provider
manages to establish the link between the client’s medical condition
and sexual function. This is accomplished by the use of open-ended
questions that facilitate a discussion instead of a question and answer
The holistic approach allows health care providers to use different
methods to assist patients with sexual dysfunction and clients with
normal sexual function, but experiencing some difficulties in doing sex
because of physical illness or old age. Health care providers often
prescribe the suitable sex position depending on the physical impact of
chronic illness on patients (Model, 2003). The use of appropriate
positions allows affected partners to achieve sexual satisfaction
irrespective of the prevailing medical condition or age. In addition,
assistive devices (such as positioning devices and lifts) can be used to
help patients with mobility challenges. Communication is also an
effective tool that can be used to arouse sexual desires among patients
who are experiencing sexual dysfunction. Health care providers can use a
combination of these approaches to protect the clients sexual
functioning when they are undergoing treatment for chronic illness or
managing their old age.
The holistic care approach provides the suitable alternatives for health
care providers to address sexual dysfunction and satisfaction among the
chronically ill and the elderly. Sex is a fundamental determinant of
quality of life in healthy, chronically ill, and the elderly. However,
human sexuality may decline in the increase in physical and mental
conditions caused disease of advancement in age. In such situations,
health care providers can use multiple approaches to restore the normal
sexual functioning of the chronically ill and the elderly. Since the
sexual functioning is affected by physical and mental factors, the
combination of therapeutic approaches should also consist of physical
(positioning) and mental approaches (such as counseling).
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Finger, B. (2012). Sexuality and chronic illness. Johnson City: East
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(1), 1-5. doi: 10.11648/j.ajns.20130201.11
Laumann, O., Das, A. & Waite, J. (2008). Sexual dysfunction among older
adults: Prevalence and risk factors from a nationally representative
U.S. probability sample of men and women 57-85 years of age. The Journal
of Sexual Medicine, 5 (10), 2300-2311. Retrieved December 17, 2013, from
HYPERLINK “http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2756968/”
McLnnes, A. (2003). Chronic illness and sexuality. The Medical Journal
of Australia, 179 (5), 263-266.
Model, J. (2003). Sexuality, intimacy & chronic illness. Ontario:
Amyotrophic lateral sclerosis society of Canada.