Existential loneliness, intimacy and end of life in residential aged care

Julie Letts1

1Lettsconsulting, Sydney, Australia

“Intimacy – a place for solace, privacy, confiding, telling and retelling one’s story – is the lathe upon which the challenge of death can be answered.”(1)  This is even more poignantly so when the ageing, isolated person in a long-term residential aged care is considered. Social connection and human touch, including but not limited to sexual expression, are essential to avoiding the depression and loneliness experienced by many residents. Yet at a time when this is most required, as end of life approaches, it can be most elusive.

Many factors in aged care facilities still work counter to creating an environment conducive to intimacy. These include the primacy of staff care-giving and supervisory roles in such facilities; emphasis on managing illness; the communal environment and practices that negate privacy; predominating concerns about protecting individuals with cognitive decline; fear of legal liability and conflicts with families of residents; and attitudes of staff and residents’ families based on fears and biases around sex and ageing.

This presentation will focus on some of the ethical concerns in creating environments that are more conducive to the possibility of intimacy for residents, even in the current climate that strongly, and appropriately values protection from elder abuse. And it will explore how lifting barriers to intimacy as end of life approaches might transform quality of care at this profoundly human time.

  1. Miles SH, Parker K. Sexual Intimacy in the Nursing Home: Iatrogenic Loneliness. Generations 1999;23:36-44.


Julie Letts, Director LettsConsulting is currently a freelance policy writer to the health and aged care systems specializing in clinical, public health and organisational ethics. She has a 37-year career in the public service. She worked as a specialist Intensive Care nurse and educator for 18 years. Another 15 years followed in senior policy roles, including as Manager, Clinical Ethics and Policy, NSW Ministry of Health that entailed a strong focus on end of life issues. She has a Masters of Bioethics degree and is an Advisory Board member for the Centre for Agency, Values and Ethics at Macquarie University.