"In terms of people's rights, if somebody is seen to be intellectually competent then they are entitled to have sexual relationships with adults of their choice. They're also entitled to use their money, so this can be a very contentious issue for families about how older people are spending their money - how they are spending the inheritance.
"But also the duty of care to make sure that people aren't being ripped off or people who are cognitively impaired are not paying all of someone's bills."
Cook and Henrickson's pilot canvassed 14 people in one urban aged care facility in New Zealand. One study participant talked about two residents living with dementia, both in their late 80s, who had found intimate companionship.
"The woman had been widowed, and her daughter just wanted to make sure her mother and the elderly man were happy and safe. And they were finding great happiness with each other. It was lovely," Cook said.
"Sadly, in another case, one woman felt any relationship was not possible due to a lack of privacy and unpredictable intrusions from staff and other residents."
Cook said sexual health - including HIV/AIDS - was also something that needed to be considered, just as it is with younger generations.
"This will become more and more important because apart from all other sexually-transmitted infections, we also have people who are living into old age with HIV and in coming years there will be those people who need staff who understand how the virus is transmitted, so there isn't excessive fear, but also making sure there is a duty of care to other residents about their rights," Cook said.
With little education or guidelines in place, Cook said nursing and other staff generally use their own judgment - calls which are often based on their own moral code rather than on residents' rights.
"What if a man is a widower and it's never actually come out that he is gay, and now in the latter years of his life he wants to express love for another man and gets close to another resident. This may be horrifying for the family, but according to his human rights it may be discriminatory to intervene in that situation," she said.
Embarrassment and mental health issues can often makes sexual conversations awkward for families to have, but while there are a number of complex issues at play, Cook said the right of individuals to be sexual beings needed to be protected and stereotypes linking sex to youth and beauty needed to be broken down.
"Adult children, although often excellent advocates for their ageing parents in all other respects, may be very unsettled with sexuality-related issues. Residential aged care facilities are people's homes and yet there is a lack of true privacy in many facilities. This lack of privacy means that behaviours such as masturbation may be readily interpreted by staff as inappropriate, because staff may lose sight of the understanding that this is a person's home," she said.
"Adult children may be embarrassed about a parent's long-standing preferences of which they had no previous knowledge, such as cross-dressing. Adult children may insist staff put a stop to behaviours they deem 'deviant', and staff are torn with uncertainties, trying to juggle families' wishes and residents' rights, wellbeing and dignity."
And while intercourse and sexual acts are a key part of the conversation, Cook said the subject also involves the basic human need for contact and intimacy in order to tackle loneliness.
"The situation may be able people having intercourse, but it's also about holding hands, sitting on a bench together, kissing, stroking each other's forearm, enjoying time together," Cook said.
"You can imagine what might seem like an innocuous situation, like a couple on a bench sitting holding hands and giving each other a kiss - what if this couple have a degree of dementia, they are not the spouse of each other and there is a living spouse the person no longer recognises. These situations, understandably, can cause enormous distress for families and staff."
New Zealand could learn from examples in America, Canada and Scandinavia, where intimacy and sexuality issues are addressed proactively, Cook said.
"The Hebrew Home in Riverdale, New York, has a sexual rights policy. Staff provide a brochure discussing these issues, and talk openly about sexuality with potential residents and their families even before they move on site," she said. "The whole process is transparent, making it smoother for everyone to navigate, protecting people's rights and safety."
