Significados psicológicos sobre sexualidad, deseo y placer sexual en la adultez mayor / Psychological meanings on sexuality, desire, and sexual pleasure in seniorhood

Resumen Los significados sobre la sexualidad en la adultez mayor se encuentran sobre la base de una compleja interrelación entre factores sociales, culturales y personales. La presente investigación tuvo como objetivo explorar los significados psicológicos que personas adultas mayores de la Ciudad de México le confieren a la sexualidad, al placer sexual y al deseo sexual, mediante el empleo de las redes semánticas naturales (modificadas). La muestra estuvo constituida por 204 personas: 162 mujeres y 40 hombres, entre los 60 y 100 años, asistentes a centros de educación continua para personas adultas mayores en la Ciudad de México. El estudio fue mixto, descriptivo, no experimental, con muestreo no probabilístico y por conveniencia. Los resultados muestran que los significados psicológicos que las personas adultas mayores estudiadas refieren sobre la sexualidad, el deseo y el placer sexual son predominantemente positivos, y abarcan sentimientos, comportamientos y sensaciones. Se identifican diferencias por género tal como se planteó en la hipótesis de investigación, pero también se encontraron similitudes dentro de dichos significados. En las adultas mayores predomina la interrelación entre significados afectivos y contacto físico, mientras que en los hombres predominan las sensaciones. En general la muestra describe la sexualidad, el deseo y el placer sexual de manera muy similar, lo cual lleva a comprender que las fronteras entre los términos son sensibles, de tal manera que los significados y referentes de las propias personas llegan a permearse.

Abstract The meanings of sexuality in seniorhood are found at the base of a complex interrelation between social, cultural and personal factors. The present research aimed to explore the psychological meanings that senior adults in Mexico City confer on sexuality, sexual pleasure and sexual desire; through the use of modified natural semantic networks. The sample consisted of 204 people: 162 senior women and 40 senior men, between 60 and 100 years old, attending a continuing education centers for senior adults in Mexico City. The study was mixed, descriptive, non-experimental, with non-probability and convenience sampling. The results show how the psychological meanings that the studied senior adults have related to sexuality, desire and sexual pleasure are predominantly positive, encompassing feelings, behaviors and sensations. Differences by gender are identified as proposed in the research hypothesis, but similarities within these meanings were also found. The senior women studied define sexuality from the interrelation between affective meanings and physical contact; the word "love" was the most referenced. In addition, they mentioned "pleasure", "desire", "caresses", "satisfaction", "kisses", "joy", "hugs", "health", "attraction", and "knowledge". Senior men, for their part, consider sexuality mainly as an attraction and include others such as: "satisfaction", "pleasure", "respect", "life", "fidelity", "complete", "unique", "woman", "touch", "important", "love", "knowledge", "passion", "desire", "need", and "affection". Women and men in the sample describe sexual desire and pleasure in a very similar way to their sexuality referents, which leads us to understand that the boundaries between the two terms are sensitive. Regarding sexual desire, senior women cite defining words such as: "caresses", "kisses", "love", "hugs", "pleasure", "desire", "necessary", "satisfaction", "natural", "attraction", "partner", "happiness", and "respect". In relation to sexual pleasure, they include the words: "enjoyment", "tenderness", "affection", "friendship", "joy", "it is the maximum", and "relaxing". For their part, senior men defined sexual desire as: "attraction", "love", "caresses", "satisfaction", "looks", "necessary", "natural", "woman", "kisses", "being alive", "respect", "passion", "libido", "important", "moving", "pleasure", "hug", "energy", "games", "excitement", "communication", "masturbation", "eroticism", and "taste". Sexual pleasure includes: "important", "fullness", "enjoyment", "respect", "pleasure", "joy", and "naturalness". The results show that the stage of sexuality in seniorhood is diverse and it is influenced by gender and social beliefs, which evidences the psychological complexity of this sphere of life.

Sentido de vida en personas adultas mayores semi-institucionalizadas

RESUMEN Introducción: El envejecimiento poblacional impone la necesidad de prever servicios de salud de calidad y especializados, así como un soporte psicológico y social adecuado para la promoción del bienestar de las personas mayores. Objetivo: Caracterizar el sentido de vida en personas mayores semi-institucionalizadas de la ciudad de Santa Clara, Cuba. Métodos: Se asumió un enfoque cualitativo con un diseño fenomenológico. Se emplearon como técnicas la entrevista en profundidad, el Registro de la Actividad Método Directo e Indirecto y el Cuestionario PIL. Los datos fueron procesados mediante el análisis de contenido y la triangulación de datos. Resultados: Como principales resultados se señala que, en las personas mayores participantes, se apreciaron limitaciones en las dimensiones experiencias de sentido, metas y tareas y dialéctica destino-libertad. Discusión: El sentido de vida en las personas mayores participantes se configuró en torno a la salud, los contactos sociales y familiares, las metas propias, la necesidad de trascendencia, la libertad, la felicidad y la participación. La ausencia de sentido se asoció a la carencia de un objetivo específico, a la incapacidad de legar sus conocimientos y experiencias de vida; así como a llevar una vida rutinaria.

ABSTRACT Introduction: Population aging imposes the need to provide quality and specialized health services, as well as adequate psychological and social support to promote the well-being of the elderly. Objective: To characterize the meaning of life in semi-institutionalized elderly people in the city of Santa Clara, Cuba. Methods: A qualitative approach with a phenomenological design was assumed. The in-depth interview, the Direct and Indirect Method Activity Record and the PIL Questionnaire were used as techniques. The data were processed through content analysis and data triangulation. Results: As main results, it is pointed out that, in the elderly participants, limitations were seen in the dimensions experiences of meaning, goals and tasks and the destination-freedom dialectic. Discussion: The sense of life in the participating elderly people was configured around health, social and family contacts, their own goals, the need for transcendence, freedom, happiness and participation. The absence of meaning was associated with the lack of a specific objective, the inability to pass on their knowledgement and life experiences; as well as leading a routine life.

Desempeño neuropsicológico ejecutivo de adultos mayores con riesgo cardiovascular: evidencia desde el departamento del Quindío, Colombia / Executive neuropsychological performance of older adults with cardiovascular risk: evidence from Quindío, Colombia

El presente artículo introduce un estudio cuantitativo en el que se compararon los desempeños neuropsicológicos ejecutivos en 20 adultos mayores con antecedentes de riesgo cardiovascular o ACV y sus pares sin dicha condición. Para dicho objetivo se empleó el tamizaje mini mental como criterio de inclusión en la muestra. Igualmente, la investigación indagó la correlación entre el nivel de rendimiento ejecutivo ante la batería neuropsicológica de funciones ejecutivas BANFE 2 y los factores de riesgo cardiovascular. Finalmente, los resultados indicaron que sujetos con historial de ACV presentaron un desempeño más bajo en las funciones ejecutivas orbito frontales y frontal anterior.

The following article introduces a quantitative study in which executive neuropsychological performances were compared in 20 older adults with a history of cardiovascular risk or stroke and their peers without such condition. Mini-mental screening was used as a criterion for inclusion in the sample. The research investigated the correlation between the level of executive performance in the neuropsychological battery of executive functions BANFE 2 and cardiovascular risk factors. Finally, the results indicated that subjects with a history of stroke presented a lower performance in executive functions at the orbitofrontal and frontal lobe.

Sistema penitenciario y vejez: aportes de la evaluación neuropsicológica forense / Penitentiary System and old age: contributions of the forensic neuropsychological evaluation

Resumen Introducción: El envejecimiento poblacional ha impulsado a que su abordaje se convierta en un tema prioritario a nivel mundial, sobre la cual aún existen mitos y discriminación, siendo las personas adultas mayores en privación de libertad en un sistema penitenciario, una población con mayores riesgos de exclusión y que cuentan con características neuropsicológicas que ameritan su atención. Por lo tanto, se realizó en Costa Rica un primer abordaje en el Centro de Atención Institucional Adulto Mayor desde la neuropsicología forense, para mejorar los protocolos disponibles de evaluación de la población adulta mayor. Procedimiento: Se llevó a cabo un trabajo final de graduación en formato de práctica dirigida durante 858 horas tanto de forma presencial como a distancia, en el período de abril del 2017 a abril del 2018, participando de los procesos de evaluación neuropsicológica forense, elaboración de un protocolo de evaluación neuropsicológica forense y participación en procesos psicoeducativos sobre consumo de sustancias y violencia sexual. Resultados: En total se atendieron 40 personas hombres, entre 58 y 85 años de edad. Con variables sociodemográficas y de salud como una baja escolaridad (45%), con antecedentes de trauma craneoencefálico (67%) y en su mayoría cometieron abuso sexual (55%). Se elaboró un protocolo de evaluación neuropsicológica que incluye un módulo de entrevista y observación, evaluación del estado de ánimo y evaluación del funcionamiento cognitivo.

Abstract Introduction: Population ageing has become a priority between the attention and care systems but still deals with myths and discrimination, being the older adults incarcerated in the prison system a population with a greater risk of exclusion and that have neuropsychological characteristics that need attention. Therefore, a first approach was carried out in Costa Rica in the Institutional Adult Care Center from the forensic neuropsychology, to improve the available protocols for the evaluation of the older adult population. Method: A final graduation work was carried out in a guided practice format for 858 hours both in person and remotely, in the period from April 2017 to April 2018, participating in the processes of forensic neuropsychological evaluation, preparation of a protocol of forensic neuropsychological evaluation and participation in psychoeducational processes on substance use and sexual violence. Results: In total 40 male people, between 58 and 85 years of age, were attended. With sociodemographic and health variables such as low schooling (45%), with a history of cranioencephalic trauma (67%) and most of them committed sexual abuse (55%). A neuropsychological evaluation protocol was elaborated that includes an interview and observation module, evaluation of mood and evaluation of cognitive functioning module.

Intervención psicológica en adultos mayores / Psychological intervention in elderly adults

El objetivo de este artículo es plantear una propuesta de intervención psicológica dirigida a adultos mayores institucionalizados y no institucionalizados; para ello se tomó como referencia la situación actual del adulto, los estudios realizados entorno a esta etapa y específicamente lo relacionado con el diseño de programas de intervención, para finalmente exponer la propuesta de intervención psicológica que pretende no solo mejorar la calidad de vida del adulto mayor, sino abarcarlo desde sus diversas áreas de funcionamiento.

The objective of the present article is to raise a proposal of psychological intervention directed to older adults making a distinction between the institutionalized adults from the noninstitutionalized ones, taking as reference the present situation of the adult, the studies developed at this stage and specifically those related to the design of intervention programs. We expose the proposal of psychological intervention that tries not only to improve the quality of life of the older adult but to include them from their diverse areas.

Enfermedad crónica en adultos mayores / Chronic disease in older adults

Objetivo. Describir la frecuencia de la enfermedad crónica en adultos mayores de la ciudad de Cali, Colombia. Metodología. Se seleccionó una muestra de 500 adultos mayores, entre los 60 y 96 años de edad. Se utilizó un cuestionario de factores psicosociales para el adulto mayor diseñado por Baca, González y Uribe. Resultados. Se observó que la hipertensión, la diabetes y la osteoporosis son las enfermedades más comunes en los adultos mayores, aunque el mayor porcentaje de esta población se encuentra sin ningún tipo de enfermedad. Asimismo, se observó que los adultos mayores casados y viudos presentaban más enfermedades en comparación con los que se encontraban solteros, separados o en unión libre. Conclusiones. La enfermedad crónica continúa siendo un problema en los adultos mayores y su presencia está relacionada, no sólo con la disminución de la funcionalidad del ser humano, sino también, con el control y la prevención de las enfermedades y la dificultad para acceder a los sistemas de salud...

Objective: To describe the frequency of the chronic disease in older adults in the city of Cali (Colombia).Methodology: A sample of 500 older adults was selected, between 60 and 96 years of age. A questionnaire of psychosocial factors in older adults designed by Baca, Gonzalez, and Uribe was used. Results: Hypertension, diabetes and osteoporosis were the most frequent diseases in older adults, although the greater percentage of this population did not refer any pathology. Married and widowers individuals presented more diseases as compared to unmarried, separated and people who live together. Conclusions: Chronic diseases are still a problem in older adults, their presence is related not only with the decrease of functionality of the human being, but also with the control and prevention of pathologies and the difficulty for accessing to health systems...

Estructura de pérdidas en la adultez mayor: una propuesta de medida / Loss structure in elderly adults: A measurement proposal

The term <> in this article refers to the lack of a significant adaptive resource that is a central part of the affective world of the subject. The absence of such resource can generate psychological distress. Old age is seen as a time in which numerous changes occur that are associated with losses in important areas of life and which, as a whole, constitute a major source of stress. These losses involve a series of physical, social and psychological changes that affect and define old age and that require the subject to develop a process of adaptation to many intense stressors. Loss structure can be defined as a set of significant objects (that can be grouped under different loss categories), perceived as being under threat of being lost, effectively lost, or whose existence is uncertain or ambiguous (conceived of as types of loss), and whose influence continues to define cognitions, affection and behaviors. The unprecedented loss structure found in elderly adults could set up different routes of maladjustment. Maladjustment appear in three fundamental areas: psychological, physical and social. Hence, frustration can lead to depression. Successive losses seen as a series of failures can generate feelings of despair; losses related to sources of affection can produce loneliness, etc. The Loss Structure Scale (LSS), proposed here is an instrument for exploring losses that usually occur in old age. It also allows a systematic exploration of a wide range of losses previously validated in the Mexican context as a first approach to possible psychosocial causes of psychological maladjustment in old age. Method The project was divided into two phases. The first corresponded to the design of the LSS, and the second to a psychometric evaluation. Four samples were used with subjects chosen by availability in Mexico City. One model of the scale was explored that consisted of 60 items linked to experiences of loss with three reply options for each item: No loss, Ambiguous loss, and Definite loss in a final sample of 193 subjects (69.34% women, N = 134). The following instruments were used: The Center of Epidemiological Studies Depression Scale; Beck's Anxiety Inventory; Hunter Opinions and Personal Expectations Scale; the perceived disease subscale of WHOQoL- Brief; The World Health Organization Quality of Life Assessment, Brief; the Lack of Emotional Wellbeing subscale of the Multifaceted Loneliness Inventory and the Anxiety About Aging Scale. Results Factor structure. A factor analysis was carried out using the principal components method with varimax rotation and eigen values greater than one. The final factor structure showed nine well defined factors covering 36 items with an internal alpha consistence of .91 explaining 67.4% of the variance. Alpha values for the internal consistence of the 9 factors fluctuated between .74 and .83. Construct validity. 1) Moderately high correlations were obtained between total score on the Loss Structure Scale and all psychological maladjustment variables (between r=.50 and r = .66; p<.01), with the exception of aging anxiety, which seems to point to the important pathogenic role of losses suffered in most of the maladjustment variables, 2) a negative association was found between the frequency of no losses and the afore mentioned variables, with depression (r = -.70, p<.01) and loneliness (r = -.68, p<.01), 3) ambiguous loss frequency correlated positively with depression (r=.54, p<.01), loneliness (r = .47, p<.01), anxiety (r = .42, p<.01) and aging anxiety (r = .40, p< .01), 4) the frequency of definite losses correlated strongly with loneliness (r = .53, p<.01), depression (r = .50, p<.01) and perceived disease (r=.47, p<.01). Predictive ability. In order to determine the degree to which the loss categories can predict psychological maladjustment, a multiple regression analysis was carried out taking these categories as independent variables. The better predicted variables were depression (R²adjusted=.487, gl=9, F = 21.22, p<.000), perceived disease (R²adjusted =.443, gl=9, F = 17.97, p<.000), loneliness (R²adjusted = .423, gl=9, F = 16.62, p<.000), anxiety (R²adjusted =.347, gl=9, F=12.33, p<.000) and despair (R²adjusted =.311, gl = 9, F=10.61, p<.000). Discriminant validity. The scale's ability to discriminate subjects with high and low levels of psychological maladjustment was analyzed. The scale proved to be useful for significantly discriminating the subjects in each type of loss in each maladjustment category. Normalization. Standard deviation ranges were calculated for the total natural scores on the LSS. Subjects with a natural score equal to or greater than 66, could be considered as having a higher loss structure than the majority of elderly adults that could, very well, be associated with high levels of psychological maladjustment. In regard to the empirical evidence reported here, the LSS provide a theoretical definition of a multivariable loss structure with stressor effects for the elderly adult that is closely linked to psychological maladjustment and can vary from subject to subject. This is a useful contribution to empirical knowledge of old age in Mexico and to research about health psychology, because it could contribute to evaluate the impact of losses in models that explore the effects of stress in elderly adults. The Loss Structure construct developed for the purpose of this research was the result of an analysis of the experience generated by losses suffered in old age. Elderly persons have to face losses which, as they accumulate, will demand constant readjustment of life conditions. The nine areas resulting from the Loss Structure Scale attempt to cover a broad spectrum of possible losses that can occur in old age.

La estructura de pérdidas puede ser definida como el conjunto de objetos significativos (susceptibles de ser agrupados en diferentes clases de pérdidas), percibidos bajo amenaza de ser perdidos, efectivamente perdidos, o cuya pertenencia es insegura o ambigua (concebibles como tipos de pérdidas), en una etapa determinada de la vida, y cuya influencia define cogniciones, afectos y conductas ante ella. La estructura de pérdidas presente en la adultez mayor, sin precedente en la vida del sujeto, podría definir diferentes rutas de desajuste. La Escala de Estructura de Pérdidas (EEP) propuesta aquí, es un instrumento cuyo propósito es permitir la exploración de las pérdidas que suelen ocurrir en la adultez mayor. La EEP permite la exploración sistemática de un abanico de pérdidas previamente validadas en un contexto latinoamericano, mexicano, como una primera aproximación a las posibles causas psicosociales del desajuste psicológico en la adultez mayor. La EEP propuesta aquí, obtuvo una estructura factorial compuesta de nueve factores bien definidos que en conjunto incluyeron 36 reactivos, con una consistencia interna alfa de .91 que explicó 67.4% de la varianza. La consistencia interna de los nueve factores fluctuó entre valores alfa de .74 y .83. Además, se obtuvieron correlaciones moderadamente altas entre el total del puntaje de la EEP con todas las variables de desajuste psicológico (entre r = .50 y r = .66; p<.01), excepto con la ansiedad ante el envejecimiento. Así, se encontró una asociación negativa entre la frecuencia de no pérdidas y dichas variables, destacando la depresión (r = -.70, p<.01) y la soledad (r = -.68, p<.01). La frecuencia de pérdidas ambiguas se correlacionó positivamente con Depresión (r=.54, p<.01), Soledad (r = .47, p<.01), Ansiedad (r = .42, p<.01) y Ansiedad ante el envejecimiento (r = .40, p<.01). La frecuencia de pérdidas consumadas se correlacionó de manera importante con soledad (r=.53, p<.01), depresión (r = .50, p<.01) y enfermedad percibida (r = .47, p<.01). La escala fue útil para discriminar sujetos con altos y bajos niveles de desajuste psicológico. Adicionalmente, se incluyeron valores normalizados de los distintos puntajes de la Escala de Estructura de Pérdidas. Asimismo, la EEP permitió definir teóricamente, a partir de la evidencia empírica reportada aquí, la existencia de una estructura multivariable de pérdidas, con efectos estresores para el adulto mayor, íntimamente ligada al desajuste psicológico y que puede variar de sujeto a sujeto. Esta es una aportación útil al conocimiento empírico de la vejez en nuestro país, y a la investigación en psicología de la salud, porque permite evaluar el impacto de las pérdidas en modelos de exploración de los efectos del estrés en adultos mayores. El constructo de Estructura de Pérdidas, desarrollado para esta investigación, fue resultado del análisis de la experiencia generada por las pérdidas sufridas en la adultez mayor. El viejo se enfrenta a pérdidas (a una estructura de pérdidas) que de manera acumulada exigirá de él un reajuste constante a sus condiciones de vida. Por lo tanto, las nueve áreas resultantes de la Escala de Estructura de Pérdidas pretenden cubrir un amplio espectro de las posibles pérdidas susceptibles de ocurrir en la adultez mayor.