Aging and Sexual Health

Dr. Valli did a wonderful job on her presentation over Aging and Sexual Health: Intimacy over a Lifetime. Sex is a topic that requires discussion throughout several stages of our lives; however, it receives little to no allotted time. Engaging in sexual relations is an occupation, an integral part that affects many aspects of our wellness. It is imperative we discuss the natural changes that occur over time and how to resolve them in order to maintain a satisfactory sex life. It is our responsibility as occupational therapists to be at ease when talking about sex and intimacy, whatever the scenario. Many of the older clients we will see in the future will have questions or issues that need to be addressed but may be bashful and avoid bringing them up: it is our job to do so. Since the topic is avoided frequently, many people do now know about the health benefits that stem from regular sexual activity. Orgasms boost the immune system, reduce stress, improve sleep, and produce higher levels of cognitive thinking. Other advantages include lower blood pressure and healthier pelvic floor muscles as incontinence prevention. It is our role as OTs to bring up and handle these conversations as tactfully and openly as possible.

Some things that are within our scope of practice are activity pacing, task and work simplification, energy conservation, joint protection techniques, ROM, mobility and functional ambulation, and pain management. These areas address the key skill components in sexual activity that may have been impaired due to natural aging causes or due to comorbidities. By helping the clients remove the barriers to regain sexual health, their insecurities, resentment, and anger will dissipate leading to better overall quality of life. Some medical methods to help with ED include PDE5 inhibitor, MUSE, vacuum pump, intracavernous injections, or surgery. Occupational therapists would then facilitate successful application of those tool in conjunction with other things that have to be taken under consideration such psychological issues, communication, comorbidities, and other adaptive equipment (Maven sleeve).

One possible intervention is holding an education group therapy class for older adults in a Senior Home. Topics of discussion will include natural physical changes and how to resolve them. Safety should also be addressed because of the high incidence of STIs in older adults due to unprotected sexual activity. To make the intervention more effective the session will include an active learning portion where the participants will get a chance to look at Maven sleeves, a liberator ramp, liberator throw, and other useful products. There will also be a question and answer section where all members will have to write down questions and turn them in. Later, the anonymous questions will be read by the facilitator to help alleviate embarrassment and self-consciousness that comes with talking about sex. Addressing these topics in a group will promote social interaction, improve the sexual satisfaction for individuals both in relationships or single, and boost self-confidence/overall wellbeing.

Another appropriate intervention for this topic is an individual who has experienced a recent SCI at T10. The male patient is 30 years old and has not brought up the issue yet. The OT should tactfully approach the topic after building rapport with the client. The client should be educated on the difference between reflexogenic erections, spontaneous erection, and psychogenic erections, provided the necessary adaptive equipment and information pamphlets to look over. It is important to address the psychological aspect of the injury and emphasize that sexual intimacy and satisfaction is still achievable; this is a key in the beginning stages as the individual is coping with the loss of physical function. The therapist will then inquire for questions from the client when he/she is more comfortable with the topic. The patient will be allowed to experiment on their own and bring up the subject at a later time. Efficacy of this intervention depends on  the therapist’s therapeutic use of self and ability to be an active listener.

Driving and Community Mobility

This was a very informative lecture. The material covered complemented classes we have taken recently. The main take away points from this lecture include:

·      An occupational therapist in driving and community mobility has 3 main roles 1) to assess individuals for safety and potential to drive 2) evaluate persons with physical disabilities for appropriate adaptive equipment 3) train individuals in the use of adaptive equipment and/or compensation techniques for driving.

·      The most common diagnoses include CP, intellectual disabilities, stroke, TBI, SCI, Alzheimer’s Disease, visual processing deficits, and amputations.

·      Clients’ age varies from as young as 14 to 75+ years old.

·      It is difficult for anyone to hear they can’t do something they have had the ability to do in the past, however, it is important therapists separate the feeling the situation and perform accurate evaluations because we are responsible for the safety of the affected individuals as well as everybody else on the road (including us).

·      An evaluation has 2 components – clinical evaluation and the behind the wheel assessment.

·      Driving is a multi-dimensional task – it includes vision, ROM, cognition, sensation, insight and awareness, and grip/strength.

·      Appropriate assessments used for driving and community mobility include Trailmaking Tests A and B, MoCA, SIMARD – MD.

·      Certified Driving Rehabilitation Specialist Therapist (CDRS) is a certification therapists should obtain in order to accurately evaluate whether individuals are competent to drive.

Two occupational therapy interventions appropriate for this topic are:

1) Prepare an individual with intellectual disabilities to driving safely by helping them learn and understand the road signs and laws of the road. This is a one-on-one intervention appropriate for anyone age 14+.

2) Hold a group therapy class where individuals with TBI discuss and work together to come up with strategies to improve their low tolerance to frustration. By working together the individuals will increase their potential for improvement as they will hold each other accountable and share helpful techniques.

Changing Perspectives

At the beginning of my OT journey we were asked to draw a glyph representing our thoughts on leadership. Now, near the end, after all the ups and downs graduate school has presented us with, we were asked to repeat the same exercise. I was surprised to see what aspects of my perspective had changed. Some things had remained the same; I still see myself as a leader behind the scenes, I still believe an introvert can be a leader, and I still believe self-awareness is vital to effective leadership. These elements of what a leader is stayed the same because they were the most solid values; in fact, the past year and a half only reinforced them.

In regard to the opinions that have varied, I suppose my most accurate belief is in the middle: the average of my answers. The biggest view that changed was whether leadership was an inborn trait or if it stems from nurture over nature. I started out with stemming from nature and since then migrated to inborn trait. I believe that some people are more inclined to lead and naturally rise to become leaders, while others prefer to follow a leader, (or be a leader in their own, less obvious, overwhelming way). Yes, the latter will rise up to the occasion in the case of injustice or necessity, however, the trait is still stronger in some individuals.

My experience in graduate school has also allowed me to see that you do not have to see yourself as a leader for other people to see you in that way. As a leader, a person guides/helps while experiencing the same circumstances as everyone else. They will not be able to recognize their actions are setting an example because they will feel the same emotions as everyone else; they will simply react in a different way. This realization was exceptionally eye opening for me.