How To

2.5

try this

HOURS

Continuing Education

By Meredith A. Wallace, PhD, APRN

Assessment of

Sexual Health
in Older Adults

Ed Eckstein

Using the PLISSIT model to talk about sex.

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read it watch it try it

Overview: Sexuality is a continuing human concern, regardless of a persons age. Even as normal

Web Video

and pathologic changes affect their sexual health,

Watch a video demonstrating the best practices

for assessing sexual health in older adults at
http://links.lww.com/A276.

older adults have an ongoing interest in sexual activity, which holds many benefits for them. Nurses
have a role in assessing sexual health and in developing plans for managing sexual problems. Watch
a free video demonstrating the best practices for
assessing sexual health in older adults at
http://links.lww.com/A276.

aymond Ford is a 78-year-old man hospitalized for evaluation after visiting the
ED because of a severe, persistent headache hed had for 24 hours. (This case is
a composite based on my clinical experience.) On admission to the ED, his blood pressure
was 210/120 mmHg. His blood pressure and pain
are now controlled (140/80 mmHg), and you are
obtaining a health history. When asked what medications he is taking, Mr. Ford gives a list, including
two drugs prescribed for hypertension: generic hydrochlorothiazide, a diuretic, and amlodipine (Norvasc), a calcium channel blocker. Since Mr. Fords
blood pressure was so high on admission, you ask
whether he adheres to the medication regimen. I
dont take the pills, he answers. They dont let me
function. When you ask furtherWhat do you
mean by function?Mr. Ford says, You know,
those medications dont let me work down there
when I need to, so I stopped taking them.
AN APPROACH TO ASSESSING SEXUAL FUNCTION
The PLISSIT model outlines an approach to sexual
assessment and intervention and includes open-ended
questions about sexuality. It has been used widely
with older adults. (For more information on the
importance of assessment and intervention, see Why
Assess Sexual Health in Older Adults? page 54.1-8)
The first step in using the PLISSIT model is to ask
permission (P) to begin the sexual assessment of the
older adult, followed by a series of open-ended questions designed to elicit the patients concerns about
sexual health.9 (Some have interpreted permission

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A Closer Look
Get more information on why its important to
assess older adults sexual health on page 54.

Try This: Sexuality Assessment for

Older Adults
This shows the best practices in their original
form. See page 57.

in the PLISSIT model to mean giving the patient permission to discuss sexuality. See Do Ask, Do Tell,
Sexually Speaking, July 2005.) Next, the nurse should
provide the patient with limited information (LI) about
normal and pathologic changes that may affect sexual health and try to dispel any misconceptions.
Based on the patients responses to the open-ended
questions, the nurse then makes specific suggestions
(SS) as part of a tailored plan of care. The last part
of the model calls for intensive therapy (IT), which
may be indicated for older patients with sexual problems other than those related to normal aging, disease, or environmental factors such as a lack of
privacy. Patients recommended for therapy may
include those who meet the criteria for sexual dysfunction as defined in the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition, text
revision, or those who have a disturbance in one or
more phases of the sexual response cycle (desire,
excitement, orgasm, resolution). The list of patients
who require referral may also include those with a
history of sexual abuse, depressive disorders that
affect sexual function, or orgasmic dysfunction or
other sexual problems that require management by a
specialist. For those with chronic medical conditions
that affect sexual desire and function, an extended
version of the PLISSIT model is also available.10
USING THE PLISSIT MODEL
Older patients will be most comfortable sharing
information if they are not concerned about others
overhearing them and passing judgment, so the
nurse should conduct the sexual assessment in a
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How To

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Why Assess Sexual Health in Older Adults?
exual health remains a continuing concern for all
adults, regardless of age. Lindau and colleagues
recently studied a nationally representative sample of
3,005 older adults in the United States and concluded
that 26% of Americans between the ages of 75 and
85 were sexually active (having had sex at least once
in the previous year).1 They also found that sexual
activity decreased with age: for example, 73% of
those between 57 and 64 years of age and 53%
of those between 65 and 74 were active.
Helping patients to manage their sexual health must
be a priority for nurses in all settings. (To watch the portion of the online video in which the author discusses the
importance of sexual assessment in older adults, go to
http://links.lww.com/A278. ) Older adults experience normal and pathologic changes as part of the
aging process, and many of these affect sexual health.
Addressing older adults sexuality can increase their selfesteem and promote companionship; it can restore function, inspire healing, and enhance energy.
Normal age-related changes. In women, a loss of
estrogen at menopause may result in a thinning of the
vaginal wall and a reduction in vaginal lubrication in
response to sexual stimulation, which can lead to pain
during intercourse or avoidance of it altogether. Decreased
lubrication can be treated with currently available gels.
With age, the vagina shortens, the labia atrophy, and
the cervix may descend into the vagina, resulting in pain
or discomfort. Uterine contractions may become less frequent, resulting in less-pleasurable orgasms. Moreover,
postmenopausal women tend to return to the prearoused
state faster than they would at an earlier age.2
Older men generally experience less frequent and
weaker erections with less ejaculate and a longer refractory period between erections.2 The use of oral medica-

tions for erectile dysfunction such as sildenafil (Viagra),

vardenafil (Levitra), and tadalafil (Cialis) can compensate
for these normal age-related changes in men.
Pathologic changes. Common health problems
associated with sexual dysfunction in older adults include
depression, cardiovascular diseases,3 and diabetes.4 These
illnesses can result in a decrease in libido or otherwise
affect sexual function. For example, a lack of sexual desire
is a common symptom of depression, and diabetes can
alter circulation to the genital area, resulting in sexual dysfunction. Moreover, selective serotonin reuptake inhibitors,
commonly used to treat depression, can result in sexual
dysfunction,5 and antihypertensive agents commonly used
by older adults (such as angiotensin-converting enzyme
inhibitors and - and -blockers) can result in impotence
and ejaculatory disturbances in older men.6
Cognitive impairment does not prevent sexual desire
in older adults but may complicate its expression.
Nagaratnam and Gayagay reported that cognitively
impaired older adults may exhibit aggression and irritability as well as sexual behaviors including cuddling,
touching of the genitals, sexual remarks, propositioning,
grabbing and groping, use of obscene language, and
masturbating without shame.7 In a study of 2,278 cognitively impaired older adults in a long-term care psychiatric consulting service in Edmonton, Canada, 41
patients (1.8%) displayed sexually inappropriate behavior.8 While this percentage may seem low, the authors
point out that this behavior is among the most difficult to
manage in people with cognitive impairment. Theres a
need for better definitions of this type of behavior, as
well as management plans.
Nurses must be aware of the continuing sexual needs of
older adults, even those who are cognitively impaired, and
develop plans of care that promote respect and dignity.

quiet, private area. Its important to create an environment of open communication between nurse and
patient. The nurse should maintain a nonjudgmental attitude and perform the assessment in a respectful manner that conveys an understanding of older
adults sexuality. The nurse should never laugh or
look surprised at the patients responses. Its also a
good idea for an inexperienced nurse to rehearse with
a colleague the questions to be asked and the
responses to be given to the information provided by
the patient. The more comfortable the nurse is with
the assessment, the more comfortable the patient will
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be. (To see the segment of the online video in which a

nurse demonstrates the use of the PLISSIT model
with a patient, go to http://links.lww.com/A277. )
Permission (P). The nurse should begin the assessment with a query along the lines of, Mr. Ford,
would it be all right if I asked you some questions
about how your medication has affected your sexual health? Asking the patients permission helps
the patient feel in control of the situation. A slightly
different approach is to preface the question with an
acknowledgment of the continuing sexual needs of
older adults. For example, the nurse could say,
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Watch It!
o to http://links.lww.com/A276 to watch a nurse use
the PLISSIT model to discuss sexual health with an
older patient and watch the health care team discuss
strategies and interventions to help the patient overcome
possible obstacles to normal sexual activity.
View this video in its entirety and then apply for CE credit
at www.nursingcenter.com/AJNolderadults; click on the How
to Try This series link. All videos are free and in a downloadable format (not streaming video) that requires Windows
Media Player.

G
Many of my patients have problems with their sexual health as they age. Would it be okay if I asked
you some questions about your sexual health?
Open-ended questions. If the patient agrees, the
nurse can then begin with general open-ended questions and progress to more specific ones. For example, the nurse might first ask, What concerns you
about your sexual health? or What changes have
you noticed in your sexual feelings since you were
first diagnosed or treated for your disease? or Has
your sexual function changed since you started taking blood pressure medications? After getting a
sense of the patients general concerns, the nurse can
elicit more specific information with a follow-up
question such as, In what way does your medication affect your sexual function? After a level of
trust is established, the nurse might conclude by asking, What thoughts have you had about enhancing
your sexual health or relationship?
Getting partners involved. A patient like Mr. Ford
might reply this way: A few weeks after they put
me on that blood pressure pill, I couldnt get an erection. No matter how aroused I was, nothing was
happening. Such a response may be an opportunity
to involve the patients partner in the discussion and
elicit the partners concerns about sexual function
and possible strategies for resolution. For example,
the nurse might ask Mr. Ford, Would you like your
partner to join us in discussing this? If Mr. Ford
agrees, an open-ended question such as, What concerns do you have about his sexual health? would
be appropriate for the partner.
Providing limited information (LI). Once the nurse
understands the patients concerns, the next step is
to provide information about both normal and pathologic age-related changes that can affect sexual health,
which is limited by the patients desire to have this
information and by the providers professional skills.
Its often helpful to affirm the continuing sexual needs
of older adults and acknowledge that, in some cases,
there may be barriers to sexual fulfillment, such as
the lack of privacy commonly found in health care
settings. More detailed information on the physical
and psychological changes that affect the sexual
health of older adults can be found in Sexuality in
Midlife and Beyond: A Special Health Report from
Harvard Medical School (purchase is required).2
Specific suggestions (SS) for patients like Mr. Ford
might include a recommendation that he change his
blood pressure medication or try an oral medication
to treat erectile dysfunction. The nurse might say, for
example, I understand that the blood pressure medication youre taking often causes erectile dysfunction. If you say its okay, I will ask your NP about
ajn@wolterskluwer.com

switching you to another medication that doesnt

have this side effect or adding a medication that
might improve your erectile function.
The nurse might also ask patients about ways in
which they were able to achieve sexual fulfillment in
the past. For example, if the patient once used erotic
films or magazines, doing so again might promote
sexual arousal, either alone or with a partner, and

The more comfortable

the nurse is with the
assessment, the more
comfortable the
patient will be.
the nurse could consider making a specific suggestion about their use.
According to Higgins and colleagues, literature on
sexuality and dementia shows that between 3% and
8% of older patients with dementia who live in community or residential settings exhibit sexual disinhibition or sexually inappropriate behavior toward caretakers and other patients.11 In these cases, specific suggestions may include a recommendation to caretakers
to ensure that the patient has privacy in which to fulfill her or his sexual needs without imposing on others.
Intensive therapy (IT), while not appropriate for
all patients, may be necessary when a sexual problem or dysfunction requires more than nursing care.
For example, psychotherapy might be indicated in
older adults who have been sexually abused, and the
nurse should make the appropriate referral. Intensive
therapy, in the form of behavior modification, might
also be indicated in patients who exhibit hypersexual behavior that may be symptomatic of cognitive
impairment, such as masturbating in public or makAJN July 2008

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How To

try this
Online Resources
For more information on this and other geriatric assessment tools and best practices go to www.ConsultGeriRN.
orgthe clinical Web site of the Hartford Institute for
Geriatric Nursing, New York University College of
Nursing, and the Nurses Improving Care for Healthsystem Elders (NICHE) program. The site presents
authoritative clinical products, resources, and continuing
education opportunities that support individual nurses and
practice settings.
Visit the Hartford Institute site, www.hartfordign.org,
and the NICHE site, www.nicheprogram.org, for additional products and resources.
Go to www.nursingcenter.com/AJNolderadults and
click on the How to Try This link to access all articles and
videos in this series.

ing unwanted sexual advances toward other patients

and staff members.
Interpreting the results. There is no numeric
score for the PLISSIT model; however, after using it
to guide the assessment of patients like Mr. Ford, a
nurse will be better prepared to develop a plan of
care that focuses on interventions to improve sexual
health.
CHALLENGES
Sexuality is not widely addressed in nursing education programs, especially in relation to the care of
older adults, so nurses are often uncomfortable
managing sexual issues. The greatest challenge to the
use of the PLISSIT model may be nurses reluctance
to adopt it.
Nurses should be aware that sexuality is important to older adults. According to Butler and
Lewis,12
Sexualitythe physical and emotional responsiveness to sexual stimuligoes beyond the sexual urge and sex act. For many older people it
offers the opportunity to express not only passion but affection, esteem, and loyalty. It provides affirmative evidence that one can count
on ones body and its functioning. It allows
people to assert themselves positively. It carries
with it the possibility of excitement and
romance; it expresses delight in being alive.
Nursing education and staff development programs should include up-to-date information on
the sexual health of older adults, including both
emotional and physical aspects of healthy sexuality.
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Educational sessions may begin with a discussion

of prevalent misconceptionssuch as the notion
that older adults should not have sexual concerns.
Nurses should be encouraged to discuss their own
feelings about older adults sexuality. Moreover, the
development of policies and procedures to manage
sexual issues of older adult patients is important in
all care settings.
The PLISSIT model may be used with many cultural groups. Because its a model and does not rely
on specific questions, translation into other languages
isnt necessary. However, respect for culture-specific
values should always be demonstrated. Its important to be aware that cultural factors are important
to how older adults perceive themselves as sexual
beings. With patients from certain cultures, nurses

The greatest challenge

to use of the PLISSIT
model may be nurses
reluctance to adopt it.
must exercise great sensitivity in seeking permission
to discuss sexuality. They should consult an expert in
a given culture if theyre unsure of how to approach
the sexual assessment of a patient with that particular cultural background.
Nurses should be sensitive to the various possible
sexual identities of older adults and shouldnt assume
that patients are heterosexual. The PLISSIT model
can be used with homosexual patients, as well as
those with gender identity concerns. If theres uncertainty about the patients sexual orientation, the nurse
can say, Tell me about your partner or ask, What
is your partners attitude about your sexual relationship?
COMMUNICATING THE RESULTS
Older adults are often uncomfortable with their sexuality and may be reluctant to discuss sexual health
needs with nurses. This may be a reflection of their
cultural and moral values, or it may have more to
do with their feelings about aging. For example,
some older adults may view the normal changes of
aging and their effect on appearance as embarrasshttp://www.nursingcenter.com

Issue Number 10, Revised 2007

Series Editor: Marie Boltz, PhD, APRN, BC, GNP

Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing

Sexuality Assessment for Older Adults

By: Meredith Wallace, PhD, APRN, Fairfield University School of Nursing
WHY: Although it is commonly believed that sexual desires diminish with age, several researchers have identified that sexual patterns
persist throughout the life span. The landmark study by Masters and Johnson (1986) indicates that older adults continue to enjoy
sexual relationships throughout each decade of their lives. The expression of sexuality among older adults results in a higher quality
of life achieved by fulfilling a natural desire. Although the need to express sexuality continues among older adults, they are more
susceptible to many disabling medical conditions such as cardiac problems and arthritis, as well as normal aging changes that may
make the expression of sexuality difficult. In addition, the treatments used for medical conditions may also hinder the older adults
sexual response. Nurses are in an ideal position to assess these normal aging changes, as well as disabling medical conditions and
medications, and to intervene at an early point to prevent or to correct sexual problems.
BEST TOOL: The PLISSIT model has been used to assess and manage the sexuality of adults (Annon, 1976). The model includes
several suggestions for initiating and maintaining the discussion of sexuality with older adults. Suggested questions to guide the
discussion of sexuality are also provided.
TARGET POPULATION: The PLISSIT model and the questions suggested on the reverse page may be used with older adults in a
variety of clinical settings. The goal of the assessment is to gather information that allows the client to express his or her sexuality
safely and to feel uninhibited by normal or pathologic problems. It is common for healthcare professionals to feel uncomfortable with
assessing the sexual desires and functions of all clients. Regardless, a sexual assessment should be performed as a routine part of the
nursing assessment. Knowledge, skill, and a sense of ones own feelings and sexuality will provide the comfort necessary for the nurse
to assess the sexuality of older adults.
VALIDITY AND RELIABILITY: Despite the findings that sexuality continues throughout all phases of life, little material, scientific
or otherwise, exists in the literature to guide nurses toward assessing the sexuality of older adults. Consequently, validity and
reliability to support the PLISSIT model or the suggested questions are not available. Further research in the area of sexuality among
older adults is imperative.
STRENGTHS AND LIMITATIONS: The PLISSIT model and suggested discussion questions are not diagnostic in any manner but
rather provide guidance for further work-up or referral. As sexuality is discussed, the model and questions provided help initiate and
maintain discussions of sexuality.
MORE ON THE TOPIC:
Best practice information on care of older adults: www.ConsultGeriRN.org.
Annon, J. (1976). The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems.
Journal of sex education and therapy, 2(2), 1-15.
Butler, R.N., & Lewis, M. I. (2002). The new love and sex after 60 (Revised ed.). NY: Ballantine Books.
Drench, M.E., & Losee, R.H. (1996). Sexuality and sexual capacities of elderly people. Rehabilitation Nursing, 21(3), 118-123.
Ginsberg, T.B., Pomerantz, S.C., & Kramer-Feeley, V. (2005). Sexuality in older adults: Behaviours and preferences.
Age and Ageing, 34(5), 475-480.
Johnson, B. (1997). Older adults suggestions for healthcare providers regarding discussions of sex. Geriatric Nursing, 18(2), 65-66.
Wallace, M. (2003). Sexuality in Long Term Care. Annals of Long Term Care, 11(2), 53-59.

Permission is hereby granted to reproduce, post, download, and/or distribute, this material in its entirety only for not-for-profit educational purposes only, provided that
The Hartford Institute for Geriatric Nursing, College of Nursing, New York University is cited as the source. This material may be downloaded and/or distributed in electronic
format, including PDA format. Available on the internet at www.hartfordign.org and/or www.ConsultGeriRN.org. E-mail notification of usage to: hartford.ign@nyu.edu.

ajn@wolterskluwer.com

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PLISSIT MODEL
P
LI

obtaining Permission from the client to initiate sexual discussion

providing the Limited Information needed to function sexually

SS
IT

giving Specific Suggestions for the individual to proceed with sexual relations
providing Intensive Therapy surrounding the issues of sexuality for that client

This article originally appeared in the Journal of Sex Education and Therapy, a publication of the American Association of
Sexuality Educators, Counselors and Therapists (AASECT).

QUESTIONS TO GUIDE SEXUALITY ASSESSMENT AMONG

OLDER ADULTS
Can you tell me how you express your sexuality?
What concerns or questions do you have about fulfilling your continuing
sexual needs?
In what ways has your sexual relationship with your partner changed as
you have aged?
What interventions or information can I provide to help you to fulfill your
sexuality?

Adapted from Wallace, M. (2000). Intimacy and sexuality. In A. Lueckenotte (Ed.). Gerontological nursing (Revised ed.). St. Louis:
Mosby Year Book, Inc.

A SERIES PROVIDED BY

The Hartford Institute for Geriatric Nursing

EMAIL : hartford.ign@nyu.edu
HARTFORD INSTITUTE WEBSITE : www.hartfordign.org
CONSULTGERIRN WEBSITE : www.ConsultGeriRN.org

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Medications and Sexuality

Several classes of drugs can have unwanted effects.
ing or indicative of illness, which can result in a negative body image and a reluctance to pursue sexual
health. Its important for nurses to consider the
impact of normal and pathologic changes of aging
on body image.
Communicating with families. Ideally, family
members are present and capable of acting as an integral part of the interdisciplinary team. However, for
older couples, especially those in relationships with
new partners, its often difficult for family members to
understand or accept that their grandparent or parent
or aunt or uncle, for example, has a sexual relationship with someone other than a long-time spouse or
other familiar partner. A family meeting, with a counselor if needed, is appropriate in order to help family
members understand and accept the older adults
relationship. In such a case, the nurse might encourage
the older patient to be forthcoming about the new
relationship in order to help relatives understand his
continuing emotional and sexual needs.
Communicating with staff. Once the sexual assessment of the patient is complete, communication
with other health care providers is necessary. In the
case of Mr. Ford, one approach to documentation is
the SOAP mnemonic, which could be used in the
following way:
S [subjective]The blood pressure pills dont let
me work down there when I need to, so I stopped
taking them.
O [objective]Blood pressure is 210/110 mmHg
upon admission to ED.
A [assessment]Diminished sexual function is
related to adverse effects of amlodipine.
P [plan]Speak with the patients physician or NP
about alternative medication or adding an oral erectile dysfunction drug to the plan of care.
CONSIDER THIS
What evidence supports the use of the PLISSIT
model to assess sexual health among older adults?
PLISSIT is a model, not an instrument or tool; there
are no psychometric testing results. But since the
PLISSIT model was developed in 1976, it has been
used extensively. For more on the use of the PLISSIT
model, see Erectile Dysfunction and Its Discontents, Sexually Speaking, December 2006, and
Do Ask, Do Tell, Sexually Speaking, July 2005.
Has this model been used with older adults with
dementia? No. However, in patients with mild cognitive impairment, several areas of the model may
be helpful, including asking permission (P) to discuss sexuality and providing limited information
(LI) and specific suggestions (SS). Intensive therapy
(IT), in the form of behavior modification, can also
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here are numerous barriers to achieving sexual health

among older adults, including normal changes of
aging and an increased incidence and prevalence of illness. An added barrier in older adults is the frequent use of
medications to treat the illnesses associated with aging.
Many of the most commonly taken medications can affect
sexual function, including those in the following drug
classes (note: this is not a comprehensive listing of all such
medications):
1. antihypertensives, including angiotensin-converting
enzyme inhibitors, -blockers, -blockers, calcium
channel blockers, and thiazide diuretics
2. antidepressants, including selective serotonin reuptake
inhibitors, tricyclic antidepressants, and monoamine
oxidase inhibitors
3. cholesterol-lowering medications, including statins and
fibric acid derivatives
4. other medications such as antipsychotics (such as the
phenothiazines and the atypical antipsychotics such
as risperidone [Risperdal]), seizure medications (such as
carbamazepine [Tegretol]) and H2 blockers (such as
cimetidine [Tagamet])

be appropriate. The information and suggestions

must be part of the patients plan of care and clearly
communicated to the nursing staff. Moreover, the
patient may need to be reminded frequently of the
information and suggestions given. Its important to
note that the older adult with dementia may not
remember or recognize a spouse or long-term sexual
partner and may not be capable of making decisions. Therefore, participation in sexual relationships
must be carefully monitored in order to prevent
coercion. A good treatment of these issues can be
found in Kamel and Hajjars Sexuality in the Nursing
Home, Part 2: Managing Abnormal BehaviorLegal
and Ethical Issues.13
Can I use this model to gather information from
older men with erectile dysfunction? The incidence
of erectile dysfunction rises greatly with age. Araujo
and colleagues followed a group of 1,085 men
between the ages of 40 and 70 for nine years and
found that the number of erections they experienced
per month declined by three, nine, and 13 among
men in their 40s, 50s, and 60s, respectively.14 In my
clinical experience, Ive found that the PLISSIT
model is appropriate for addressing sexual concerns
about erectile dysfunction with older men, and Ive
used it extensively for this purpose.
Meredith A. Wallace is an associate professor at Yale University School of Nursing, New Haven, CT. Contact author:

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meredith.wallace@yale.edu. The author has disclosed no significant ties, financial or otherwise, to any company that might
have an interest in the publication of this educational activity.
How to Try This is a three-year project funded by a
grant from the John A. Hartford Foundation to the Hartford
Institute for Geriatric Nursing at the New York University
College of Nursing in collaboration with AJN. This initiative
promotes the Hartford Institutes geriatric assessment tools,
Try This: Best Practices in Nursing Care to Older Adults:
www.hartfordign.org/trythis. The series will include articles
and corresponding videos, all of which will be available
for free online at www.nursingcenter.com/AJNolderadults.
Nancy A. Stotts, EdD, RN, FAAN (nancy.stotts@nursing.
ucsf.edu), and Sherry A. Greenberg, MSN, GNP-BC (sherry@
familygreenberg.com), are coeditors of the print series. The articles and videos are to be used for educational purposes only.
Routine use of a Try This tool may require formal review
and approval by your employer.

REFERENCES
1. Lindau ST, et al. A study of sexuality and health among
older adults in the United States. N Engl J Med 2007;
357(8):762-74.
2. Harvard Health Publications. Sexuality in midlife and
beyond: A special health report from Harvard Medical
School. Cambridge, MA: Harvard Medical School; 2007.
3. Addis IB, et al. Sexual activity and function in postmenopausal women with heart disease. Obstet Gynecol
2005;106(1):121-7.
4. Rockliffe-Fidler C, Kiemle G. Sexual function in diabetic
women: A psychological perspective. Sexual and Relationship Therapy 2003;18(2):143-60.
5. Montejo AL, et al. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter
study of 1022 outpatients. Spanish Working Group for the
Study of Psychotropic-Related Sexual Dysfunction. J Clin
Psychiatry 2001;62 Suppl 3:10-21.
6. Girerd X, et al. [Medical management of libido disturbances
in treated hypertensive patients: differences between men
and women]. Arch Mal Coeur Vaiss 2003;96(7-8):758-62.
7. Nagaratnam N, Gayagay G Jr. Hypersexuality in nursing
care facilitiesa descriptive study. Arch Gerontol Geriatr
2002;35(3):195-203.
8. Alagiakrishnan K, et al. Sexually inappropriate behaviour in
demented elderly people. Postgrad Med J 2005;81(957):463-6.
9. Annon JS. The PLISSIT model: A proposed conceptual
scheme for the behavioral treatment of sexual problems.
J Sex Educ Ther 1976;2(2):1-15.
10. Taylor B, Davis S. Using the extended PLISSIT model to
address sexual healthcare needs. Nurs Stand 2006;21(11):
35-40.
11. Higgins A, et al. Hypersexuality and dementia: dealing with
inappropriate sexual expression. Br J Nurs 2004;13(22):
1330-4.
12. Butler RN, Lewis MI. The new love and sex after 60. 3rd
revised ed. New York: Ballantine Publishing Group; 2002.
13. Kamel HK, Hajjar RR. Sexuality in the nursing home, part
2: Managing abnormal behaviorlegal and ethical issues.
J Am Med Dir Assoc 2003;4(4):203-6.
14. Araujo AB, et al. Changes in sexual function in middle-aged
and older men: longitudinal data from the Massachusetts
Male Aging Study. J Am Geriatr Soc 2004;52(9):1502-9.

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Continuing Education

EARN CE CREDIT ONLINE

Go to www.nursingcenter.com/CE/ajn and receive a certificate within minutes.

GENERAL PURPOSE: To highlight for registered professional

nurses the best practices for assessing the sexual health of
older adults using the PLISSIT model.

LEARNING OBJECTIVES: After reading this article and taking

the test on the next page, you will be able to
discuss the importance of assessing the sexual health of
older adults.
assess the sexual health of older adults and plan appropriate interventions.
TEST INSTRUCTIONS
To take the test online, go to our secure Web site at www.
nursingcenter.com/CE/ajn.
To use the form provided in this issue,
record your answers in the test answer section of the CE
enrollment form between pages 48 and 49. Each question has only one correct answer. You may make copies
of the form.
complete the registration information and course evaluation. Mail the completed enrollment form and registration
fee of $24.95 to Lippincott Williams and Wilkins CE
Group, 2710 Yorktowne Blvd., Brick, NJ 08723, by
July 31, 2010. You will receive your certificate in four to six
weeks. For faster service, include a fax number and we will
fax your certificate within two business days of receiving
your enrollment form. You will receive your CE certificate of
earned contact hours and an answer key to review your
results. There is no minimum passing grade.

DISCOUNTS and CUSTOMER SERVICE

Send two or more tests in any nursing journal published by
Lippincott Williams and Wilkins (LWW) together, and
deduct $0.95 from the price of each test.
We also offer CE accounts for hospitals and other health
care facilities online at www.nursingcenter.com. Call
(800) 787-8985 for details.

PROVIDER ACCREDITATION
LWW, publisher of AJN, will award 2.5 contact hours
for this continuing nursing education activity.
LWW is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Centers
Commission on Accreditation.
LWW is also an approved provider of continuing nursing education by the American Association of CriticalCare Nurses #00012278 (CERP category A), District of
Columbia, Florida #FBN2454, and Iowa #75. LWW
home study activities are classified for Texas nursing
continuing education requirements as Type 1. This activity
is also provider approved by the California Board of
Registered Nursing, provider number CEP 11749, for
2.5 contact hours.
Your certificate is valid in all states.

TEST CODE: AJNTT19

http://www.nursingcenter.com