The Conceptualization and Measurement of Sexual Self-Concept and Sexual Self-Schema: A Systematic Literature Review.

Sexual self-concept and sexual self-schema are multidimensional constructs critical to developing a more holistic theoretical understanding of the sexual self. With an increased amount of research exploring these constructs over the past few decades, a systematic review was warranted to highlight next steps for future research in this area. Therefore, utilizing a staged systematic review, we aimed to explore how these parallel concepts are measured and among which populations they are used. The evaluation of 236 unique manuscripts published 1990-2020 revealed the use of 38 established or constructed measures of sexual self-concept, and 16 established or constructed measures of sexual self-schema. Three distinct measures were used in more than one-fifth of the studies reviewed, although the use of full-form measures vs. subscales differed across studies. Although there was diversity in the samples used in the studies reviewed, these studies were conducted most commonly with samples consisting of individuals who were primarily, if not solely, cisgender, women, heterosexual, White, non-college attending, U.S. residents, and/or had no unique characteristics identified (e.g., cancer patient/survivor, pregnant). The largest proportion of studies reviewed examined sexual self-concept during emerging adulthood, followed by early adulthood and middle adulthood. Suggested directions for future research in this area include (a) reexamining and testing how current measures are capturing these constructs and among whom; (b) expanding samples to include and/or target specifically gender, sexual, and racial/ethnic minoritized groups as well as individuals with unique characteristics that would affect sexual well-being; and (c) utilizing samples in childhood, adolescence, and late adulthood.

Keys to embracing aging: A healthy aging intervention.

Keys to Embracing Aging (KTEA) is a community-based educational program that introduces and reinforces health behaviors that promote healthy aging. Data from 12 distinct KTEA lessons delivered by 42 Cooperative Extension educators to 764 unique participants across one year were examined to determine the program's impact on attitude, diet, physical activity, brain health, belonging, staying up-to-date, safety, health, stress, finances, sleep, and self-care. The most frequent immediate behavior changes occurred in practicing self-care, developing a positive attitude, and making safe choices. And longer-term behavior change was reported in the areas of maintaining a positive attitude, brain health, and healthy eating. Participants discussed challenges related to time, commitment, and maintaining a habitual routine of healthy behaviors. KTEA outcomes indicated a promising community-based educational program and supported continued investigation and development in health promotion within Cooperative Extension. Future research is needed to examine the versatility and long-term effects of the KTEA intervention.

Assessing Public Opinions of Sexual Advance Directives Among Older Adults With Dementia.

This study used a mixed-method research design to examine public attitudes toward sexual advance directives (SADs), a theoretical legal document intended to protect the sexual rights of individuals across the lifespan. Respondents (N = 537) largely indicated that SADs should exist (65.4%) to preserve autonomy and protect resident rights, but they would not sign one right now (60.4%) because they were too young. Linear regression analyses revealed statistical associations between education level, relationship length, and sexual instrumentality for the existence of SADs, while gender, age, perceived importance of sexuality, and sexual self-disclosure were associated with whether a respondent would sign the document now. Overall analyses indicate that valuing sexual expression as a right, autonomy, sexuality in older age, and sexual communication led to a greater amount of general support for SADs. Respondents were sensitive to the concerns of SADs in the context of fluid consent between partners and their safety.

Public Perspectives Toward the Sexual Behavior of an Individual With Dementia Residing in Long-Term Care.

OBJECTIVE: This study examines public perspectives toward sexual behavior within a heterosexually married couple in which one individual has dementia and resides in a long-term care facility. METHOD: Respondents included 318 adults in the Southern United States. Paired sample t tests were used to understand how the diagnosis of dementia statistically influenced participants' responses, and a logistic regression model was used to understand how a vignette character's sex and respondent characteristics influenced attitudes. RESULTS: Fifty-eight percent of respondents believed that a sexual relationship should be permitted for an adult with dementia, and t tests revealed that dementia had a statistical effect on participants' responses. Sex of the vignette character was not a predictor of attitudes. Participant's qualitative rationales are offered for additional insight. DISCUSSION: Respondents who felt that a couple should not engage in a sexual relationship commonly cited consent-related issues as their primary concern. Implications for policy development are discussed.

Public Attitudes Toward Sexual Expression in Long-Term Care: Does Context Matter?

The purpose of this study was to (a) examine how age and sex of long-term care (LTC) residents influence public attitudes toward sexuality in LTC and (b) understand how, in the absence of cognitive decline, residing in LTC influences the perception of sexuality as a basic human right. Attitudes were examined using a factorial vignette with a probability sample of 325 respondents from a southern state. Results indicate that attitudes were not statistically affected by a vignette character's age or sex; but respondent education level, parenthood status, and religious affiliation did have direct bearing on attitudes. The notion of sexuality as a basic human right for residents of LTC was ultimately challenged as 19% of respondents said that LTC residents should not be permitted to have sexual relations with their spouse in the facility.

Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development.

PURPOSE: We examined public opinion of sexual expression and dementia to inform nursing home policy and practice. DESIGN AND METHODS: A content analysis was conducted on public comments (N=1194) posted in response to a New York Times article about a highly publicized legal case involving a husband engaging in sexual acts with his wife who had dementia, living in a nursing home. Researchers utilized constant comparative analysis to code the comments; reliability analysis showed moderately strong agreement at the subcategory level. Data were also coded to indicate whether the commenter thought the couple should or should not have been allowed to be sexual. RESULTS: One primary theme was identified: conditions necessary for someone to be sexual. Six categories were identified within this theme, with the public commentary considering factors such as marital relationships, intimacy needs and several sexual consent-related issues as key conditions necessary to be sexual in a nursing home setting. Overall, the majority of commenters were in support of sexual expression for an individual with dementia in the described situation. DISCUSSION: This study revealed sexual expression among individuals with dementia is a contentious issue with strong public opinions about how this should be managed in a nursing home setting. These opinions should be considered as policy related to sexual expression in nursing homes is developed.