Development and Initial Validation of the Attitudes Towards Older Adult Sexuality in Long-term Care Scale (AOASLC).

In long-term care facilities where older adults may reside, negative attitudes about later life sexuality can result in restrictive facility policies and staff behaviors that suppress residents' rights to sexual expression. No assessment instrument specifically focuses on the sexual behaviors of long-term care residents and existing measures of attitudes toward older adult sexuality do not include sexual expression in long term care, nor do they assess a full range of sexual behaviors. We developed the Attitudes toward Older Adult Sexuality in Long-term Care Scale (AOASLC). A large, diverse sample of 295 community-dwelling adults in the United States completed an online survey through Amazon Mechanical Turk. The survey included the AOASLC and self-report measures of related constructs. Two-hundred-and-ninety-five participants completed the survey (Mage = 49.16, SD = 14.69, range = 18- 84 years). Of the sample, 50.2% identified as female, 49.5% identified as male, and one person identified as transgender male. An exploratory factor analysis indicated a two-factor structure. Factor 1 represented general attitudes toward sexual behaviors, and Factor 2 represented acceptability of various sexual behaviors. The instrument evidenced good reliability and validity. While further validation research is necessary, the AOASLC is a promising new measure.

Exploring variables related to medical surrogate decision-making accuracy during the COVID-19 pandemic.

OBJECTIVE: Surrogate medical decision making is common in the United States healthcare system. Variables that may influence surrogate decision making have been proposed. Little work has examined relations between these variables and outcomes of surrogate decision making. This study investigated whether surrogates' characteristics, including their knowledge of treatment options, and interpersonal factors predicted surrogates' accuracy and intervention selections. Specifically, predictor variables included: trust in the medical profession, trait-level anxiety, depression, anxiety about COVID-19, religiosity, perceived emotional support, understanding of treatment options, empathy, willingness to accept responsibility for medical decisions, reluctance to burden others, and perceived similarity between oneself and the patient. METHODS: 154 pairs of patients and their surrogates completed an online survey. Patients indicated preferred treatments in hypothetical decision scenarios. Surrogates indicated the treatment that they thought the patient would prefer. RESULTS: When taken all together in a predictive model, the variables significantly predicted surrogates' accuracy, F (6) = 3.03, R2 = .12, p = .008. Variables also predicted selection of intensive interventions, F (4) = 5.95, R2 = .14, p = .00. Surrogates reporting greater anxiety about COVID-19 selected more intensive interventions. CONCLUSIONS: Consistent with prior research, this study found that surrogates' characteristics influence the interventions they choose, with anxiety about COVID-19 having considerable bearing on their chosen interventions. PRACTICE IMPLICATIONS: These findings can inform development of decision-making interventions to improve surrogates' accuracy. Providers may attend to variables highlighted by this study to support surrogates, particularly within the stressful context of COVID-19 and possible future pandemics.