How sexual health becomes marginalized in long-term care: a scoping review of multi-level barriers

Sexual health is a fundamental component of quality of life across the life course; however, it remains largely neglected in institutional care settings for older adults. In nursing homes and long-term care facilities, sexual health is frequently constrained by a range of individual, institutional, sociocultural, and ethical factors, which are often examined in isolation within the existing literature.

This scoping review aimed to map the barriers affecting the sexual health of older adults living in nursing homes and long-term care facilities and to examine how these barriers interact across multiple levels, contributing to complex and reinforcing mechanisms within institutional care contexts.

A scoping review methodology was employed in accordance with the Joanna Briggs Institute framework and reported following the PRISMA-ScR guidelines. Systematic searches were conducted in MEDLINE, CINAHL, PsycINFO, Embase, Web of Science, ASSIA, and relevant grey literature sources. Qualitative, quantitative, and mixed-methods studies addressing barriers to sexual health among older adults in institutional care settings were included. Data were charted and synthesized thematically.

Nineteen studies met the inclusion criteria. Four interrelated themes were identified: (1) individual-level barriers, (2) institutional and environmental barriers, (3) sociocultural barriers, and (4) ethical and legal barriers. The findings indicate that these barriers do not operate independently; rather, individual vulnerabilities are often amplified through institutional regulations and ethical uncertainties, while sociocultural norms and family expectations further legitimize restrictive practices. This interaction contributes to the systematic marginalization of sexual health within long-term care environments.

The review highlights that barriers to sexual health among older adults in institutional care are shaped by interacting and mutually reinforcing processes, rather than isolated factors. Addressing sexual health in nursing homes therefore requires approaches that move beyond single-level interventions and consider the relational and systemic nature of these barriers. Future research should focus on empirically testing these mechanisms and developing multi-level, person-centred interventions to support sexual health in long-term care settings.