老人福祉施設의 性 관련 環境이 老人의 性에 대한 態度에 미치는 影響 : 施設長, 施設從事者와 施設老人을 對象으로 = Impact of Sexuality-related Environments in Senior Citizens Welfare Institution on Attitude toward Elderly Sexuality : Survey intended for the institutionalized older people and executive officer and nursing staff there in

다국어 초록 (Multilingual Abstract)

The purpose of this research was to investigate impacts of human and physical environment in senior citizens welfare institution or nursing home on attitude toward sexual functioning or sexual expression in older adults, method to respond to sexual desire, also on the state of their depression taking those elderly persons who reside in that institution, including executive officer and nursing staff therein as the subjects for this survey, and to have seniors also enjoy their later life in better environments in the welfare facilities.
To test this, first of all, welfare institutions for seniors were selected from each province: 2 institutions from Seoul, 10 from Gyeonggi, 8 from Chungnam, 10 from Jeonbuk, and 5 from Jeonnam. And then, from each welfare institution in each province, the subjects of this survey; 10 elderly persons, 1 executive officer and 10 nursing staff therein, were selected. Thus, total 352 institutionalized older people and 35 executive officers and 352 nursing staff were sampled.
Data and information were collected between 15 May 2005 and 17 July 2005, and relationships between socio-demographic characteristics of seniors, executive officer and nursing staff, and attitude toward elderly sexuality were carefully examined. Attitude of executive officer and nursing staff toward the elderly sexuality, that is, impacts of facility environment (physical environment and human environment) on the sexuality of elderly people were reviewed. In addition, it was studied if typification could be established according to attitude of executive officer toward the sexuality of aging adults as well as of nursing staff, and institutionalized older people's attitude toward sexual expression, and characteristics of each cluster were grasped. Also, this research was to examine what differences there were between institutionalized older people's responding to sexual desire according to the cluster of attitudes toward elderly sexuality and their depressions also.
Main points of the research results are as follows:
First, in case of executive officers of elderly care institution or nursing home, women officer had more liberal attitude about sexuality of older adults than men, and according to age, the executive officer who were over sixty years marked the lowest point in relation to liberated exuality in the elderly comparing with other groups, and the attitudinal point in relation to conservative sexuality exhibited the highest. The executive officers reported having a graduate degree or more displayed a higher tendency of holding liberal and accepting attitude toward openness about sexuality, and showed a lower tendency in conservative sexuality, and in case of religion, believers in Catholic Church revealed the most liberated tendency toward openness about sexuality and marked lowest scores in the conservative sexuality. The executives officers of free nursing homes or non-paying welfare institutions marked higher points in openness toward sexuality, and marked the lowest scores in the conservative sexuality. When examined according to length of working period, those ones who served for elderly care institutions less than 1 year revealed the most liberal attitude toward openness about sexuality, while the executive officers who served for welfare facilities for seniors more than 1 year displayed a conservative attitude toward elderly sexuality.
The results from examination of sexuality in older adults according to how the executive officer showed attitude toward elderly sexuality in relation to intimate relationship between aging adults revealed that there appeared liberated tendency toward sexuality at the time when the executive officer thought of intimate relationships between elderly persons in a positive manner, showing lower tendency toward conservative sexuality. And, in case respondents thought that sex education was necessary, attitudes about sexuality of respondents who answered to questions of necessity of sex education as by, 'So-So' or 'No Need' revealed conservative tendency. The results from investigation of attitude toward sexuality in older adults according to having or having not received consultation revealed that the executive officer of the institution that performed sex counseling held more liberal and accepting attitude toward the elderly sexuality. however, that there didn't appear any significant differences according to marital status, whether or not receiving sex education, and location of senior citizens welfare institution.
Second, the results from surveys revealed that there were differences of attitude toward elderly sexuality according to socio-demographic features of nursing staff. Regarding characteristics showing a higher inclination to openness about sexuality, men marked greater scores, and those nursing staff who reported having a graduate degree or more showed accepting attitude toward openness about sexuality to a greater extend. Nursing staff who didn't have any religion or believed in other religions displayed the most liberated attitude toward openness of sexuality, and free nursing home staff showed the most accepting attitude toward openness about sexuality, and the nursing staff who were in favor of intimate relationship between aging adult men and women revealed accepting attitude toward sexuality. Examining older adults' attitude toward sexuality according to restrictions of the privacy of the elderly by nursing staff, in case that nursing staff thought that they 'had no interests in seniors' privacy' and 'let older adults enjoy living freely in their later years,' the results revealed that nursing staff had liberal attitude toward elderly sexuality.
Characteristics accompanying a stronger tendency in conservative attitude toward sexuality were found most frequently in women, especially the ones reported have a highschool diploma.
And respondents who didn't have spouse revealed conservative attitude toward sexuality, and those nursing staff who served at the paying elderly care institutions had most conservative attitude toward elderly sexuality. Particularly, nursing staff who answered to the question about intimate relationship between older men and women as by 'so-so' exhibited most conservative attitude toward elderly sexuality. Many researches have revealed that women look at sexuality with more conservative and negative respect than men. As to sexual desire, each of aging adults has been pursuing the issues from the different perspective, and it is thought that aging adults are pursuing sexuality depending upon varied mind set in relation to surrounding problems. The results from research revealed that elderly people who are difficult to accomodate by group because of long isolated living, and older adults fallen into a fear of death, and seniors having physical impairment, and aging adults who are passive in joining club activities, and older persons having strong individuality pursued sexuality stronger. Other elderly persons have strong inclination to redirect sexual desire into some other activities. Sex drives occurs in all older adults despite their ages by the order of; aging adults having strong religious belief, elderly who are active in joining club activity, aged who enjoy hobby, and aging adults who had showed strong individuality, and so on, and desires to pursue sexual intimacy appeared frequently in all elderly population.
Third, there were differences in the attitudes toward elderly sexuality according to socio-demographic characteristics of the institutionalized older people. Regarding attitude toward liberated sexuality in the elderly, men had more liberated sexual behavior than women. The younger in the age, the higher attitude toward liberated sexuality they had, also the research revealed respondents' lower attitudes toward conservative sexuality. When having examined the level of education in terms of uneducated or educated, uneducated people showed higher attitude toward liberated sexuality, and lower attitude toward conservative sexuality.
Fourth, the results from investigation of relationships among human and physical environments of elderly care institution, and attitude toward sexuality of the institutionalized older people revealed that executive officer's attitude toward sexuality had direct impacts on nursing staff's attitude toward elderly sexuality, and at the same time had positive influences on older adults' attitude toward sexuality. The results from examination indicated that attitude of the executive officer of a senior center toward elderly sexuality had direct effects on nursing staff's attitude toward elderly sexuality as well as elderly persons' attitude toward sexuality, however, that nursing staff's attitude toward elderly sexuality didn't affect directly aging adults' attitude toward sexuality.
Fifth, the results from examination of differences of socio-demographic characteristics according to typification of attitudes toward sexuality revealed that the mixed type marked the lowest attitudinal scores in relation to liberated sexuality in the elderly compared to other groups, and that was the type having highest attitudinal scores in relation to conservative sexuality.
However, executive officers' attitude and nursing staff's attitude toward liberated sexuality or conservative sexuality showed about medium level of scores comparing to other types. In case of the mixed type, although the executive officer and nursing staff marked medium-level scores in their attitudes toward liberated or conservative sexuality, this group showed such socio-demographic characteristics as that respondents had most conservative attitude toward elderly sexuality, and these were mostly aged women, and number of educated older adults was greater than that of uneducated, and most of the elderly were more than 75 years old. There were many free senior centers or free nursing homes, and the ratio of men and women in executive officer position was half and half, and most of them were under 50 having college degree or more. And ratio of respondents who had accepting attitude toward intimate relationship between older adults was slightly higher. Nursing staff belonged to this cluster are women mostly under 40 years, and 90% of them had reported having a high-school diploma or higher education, and 39.7% of them were social welfare worker, and 30.8% of them were medical practicers and nurses, and duration of their works were about 1~3 years, which was the highest percentage at 42.4% in the cluster.
In case of conservative type, this was a group where all attitudinal scores of executive officer, nursing staff and the institutionalized older people about liberated sexuality were lower, and attitudinal scores about conservative sexuality were higher, and as a whole, this was type having conservative inclination toward sexuality.
Also, this was a group in that executive officer, nursing staff and the institutionalized older adults had conservative attitude toward elderly sexuality.
Looking into their distinctive features, executive officers whose age were over 60s occupied 23.1%, and those who didn't have religion were 26.4%, and 90% of them belonged to either paying or non-paying senior centers, so that it was the group that represented by elderly care institution in terms of type of facilities, and their attitudes toward interpersonal relations between opposite sex were negative.
Most of the institutionalized older people were female, and 34.1% of them fell in the age bracket of 66～75, and 37.4% of them were between 76～85, and more than 70% were between 65～85 years. 59.1% of them had no schooling at all, which was higher than that of educated. So then it can be concluded in an opinion that the order of group living will be disturbed in the event that nursing staff oppose. Security facility is a private room, so then privacy can be kept in this private room, and as a result, affairs in this room doesn't have any direct impact on others.
70% of senior centers or elderly care instutions took permissive attitude toward elderly sexuality, although they were not able to keep privacy of the instutionalized older persons in a sfficient manner. 63% of them restricted affairs between elderly within institutions. The reason was that it might disturb the order of group living.
Concerning obscenity, 34% of aging adult men and 54% of aging adult women committed unlawful sexual relationship, so that older adult women had more sexual intimacy than elderly men.
The reasons that most of nursing staff had permissive attitude toward intimate relationship between older adults were that they thought that such a sexual activity might bring vitality or vigor to the aging adults, and that human right to freedom of expression, also that since life expectancy has been continuously increased, preferred sexual activity may be beneficial with advancing age.
In case of respondents having liberal attitudes toward sexuality, they were the type who had most liberated tendency about sexuality, and all attitudinal scores of executive officer, nursing staff and the institutionalized elderly people who belonged to this group were higher, and the addtitudinal scores toward conservative sex of them were lower.
Looking into their characteristics, 83.3% of the executive officers were less than 50 years old, and 43% of paying or non-paying nursing homes were operated by these executive officers. 69.1% of them responded that they 'think positively' about intimate relationship between older men and women, and this group of executive officers of senior centers showed very affirmative tendency about elderly sexuality. 60% of resident in these institutions were older adult women, slightly larger than men, 42% of them were in the age of 66～75, and 45% of them, 76～85 years.
In case of the elderly care institution having young executive officer, elderly sexuality has related to health problems in many ways. In many cases, the reason is that the elderly persons becoming negative about sexuality has something to do with their health.
Nursing staff take permissive attitudes about sexual relationship within facilities. This is because residents had private rooms that enabled them to enjoy their privacy not disturbing neighbors, and at the same time, without having caused any troubles to institution due to sexual explicitness, etc.
Sixth, the results from investigation revealed that there were differences between older adults' way of responding to the sexual desires and their depressions according to the attitude toward sexuality. Regarding attitude toward sexuality, the liberal type was mostly affirmative in responding to their sexual desires, and the mixed type responded to their sexual desires in the most negative manner.
As to depression of the elderly persons, the point of depression of the conservative type was the highest, and the point of the mixed type was the lowest. So then it was found that older adults' depression and the way to respond to sexual desires had been varied and changed according to under what environments they lived.
In the meantime, it was also found that the most conservative type in relation to attitude toward sexuality scored the highest points, therefore, that the elderly who belonged to that type had carried on the lowest quality of life.
Particularly, the results of this research revealed that older adults having liberated attitudes responded to sexual desires in the most affirmative manner, however, their depressions revealed higher scores than that of the mixed type.
This result will be a good example to display the fact that our society has generally been viewed as in restrictive situation in order to overcome social and cultural prejudice and negative myths about sexuality in later years, although the instutionalized older people, the executive officer of senior center and nursing staff therein all have a positive attitude toward elderly sexuality, especially in case of liberal type.
Specifically, not like normal life in community, in case of the institutionalized older people who should carry on group living in a single space sharing with other male or female figures, in spit of liberated atmosphere, a sense of obligation itself in that they should take care of sexual desires themselves may play a big role in giving them a stress, and it can also be thought that this have been acted as a mechanism that increases depression in older adults.
A thesis submitted to Committee of the Graduate School of Hanseo University in partial fulfillment of the requirements for the degree of Doctor in February, 2006.

목차 (Table of Contents)

• 목차 = ⅰ
• Ⅰ. 서론 = 1
• 1. 연구의 필요성 = 1
• 2. 연구의 목적 = 5
• 3. 연구과제의 제기 = 6
• 4. 용어의 정의 = 7
• Ⅱ. 이론적 배경 = 8
• 1. 노인복지시설 = 8
• (1) 노인복지시설의 실태 = 8
• (2) 노인복지시설 노인의 삶 = 11
• 2. 노년기의 성에 대한 태도 = 15
• (1) 성의 개념 = 15
• (2) 노년기의 성적 욕구 = 18
• (3) 노년기의 성의 실태 = 19
• (4) 노년기의 성에 대한 편견 = 23
• (5) 노년기의 성과 대처행동 및 우울감 = 26
• 3. 노인복지시설의 환경과 노인의 성 = 28
• (1) 노인복지시설에서의 노인의 성 = 28
• (2) 노인복지시설의 인적 환경 = 29
• (3) 노인복지시설의 물리적 환경 = 33
• Ⅲ. 연구방법 = 38
• 1. 연구 대상자 및 자료수집 = 38
• 2. 측정도구 = 39
• (1) 노인복지시설의 인적 환경 = 39
• (2) 노인복지시설의 물리적 환경 = 40
• (3) 성욕구 대처행동 = 40
• (4) 우울감 = 41
• 3. 분석방법 = 41
• Ⅳ. 연구 결과의 해석 = 43
• 1. 연구 대상자의 사회인구학적 특성 = 43
• 2. 노인의 성태도와 사회인구학적 특성과의 관련성 = 47
• (1) 시설장의 사회인구학적 특성과 노인에 대한 성에 대한 태도 = 47
• (2) 시설종사자의 사회인구학적 특성과 노인에 대한 성에 대한 태도 = 53
• (3) 시설노인의 사회인구학적 특성과 노인의 성에 대한 태도 = 59
• 3. 시설의 인적 및 물리적 환경과 시설노인의 성에 대한 태도 = 61
• 4. 시설장, 시설종사자, 시설노인의 성에 대한 태도에 따른 유형화 = 65
• (1) 시설장, 시설종사자, 시설노인의 성에 대한 태도에 따른 유형화 = 65
• (2) 성에 대한 태도 유형에 따른 사회인구학적 특성의 차이 = 67
• 5. 성태도 유형에 따른 노인의 성욕구 대처방법과 우울감의 차이 = 77
• Ⅴ. 논의 및 제언 = 79
• 1. 논의 = 79
• 2. 제언 = 87
• 참고문헌 = 90
• Abstract = 102
• 부록 1. 노인의 성에 대한 태도 요인분석표 = 114