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Dementia and Sexuality

September—October   2011

Why is dementia and sexuality a timely issue? Persons with dementia are constantly trying to make sense of the world around them; they often become confused trying to understand the meaning of what others are saying or doing. However, this individual retains his/her need for love and belonging and the feeling of closeness and comfort. The following stories illustrate situations where both the person with dementia and their care partner may be challenged in understanding the message which may have elements of sexuality.

AIN’T NO CURE FOR LOVE

A wife reports, “My husband Howard has always been such a gentle and passive man. Since Howard’s diagnosis of Alzheimer’s, he is so focused on sex, and in fact, he wants it at any time of the day or night; even if we are in the kitchen. If I reject him, he gets furious. I don’t know what to do.”

At Memory Care Manor, care partners working night shift report that Isabelle and Bill will join one another in the night to share one common bed. When making their night rounds, the care partners discover this couple holding one another and snuggling, while both are sleeping soundly. Isabelle and Bill are in their late eighties and are not married.

Harry and Myrtle share the same table in the dining room at Tick Tock Manor. They each have a diagnosis of Alzheimer’s dementia and have lived here at Tick Tock Manor for well over a year. During the lunchtime serving, Harry’s hand rests under the table on Myrtle’s knee. However, somewhere between the serving of dessert and tea, the hand wanders under her dress creeping further up her leg. Myrtle doesn’t seem to mind. The care partners do not know what to do.

Jean and Harry have been married for 57 years. Jean has cared for Harry at home for the last several years, but now that Harry’s care has become too heavy for Jean, she has had her Harry admitted to Memory Care Manor, where she visits him everyday, sometimes twice a day. One day when Jean arrived at Memory Care Manor, she discovered Harry was walking down the hallway holding hands with one of the female residents. One can well imagine Jean’s sense of sorrow and despair. My Harry!

(see Living Dementia Approach, chapter 13, “Where is Harry?” for What Works and What Does Not Work)

Stories such as these are frequently heard in dementia care. Both family and professional care partners are frustrated in not knowing how to manage this behavior. The person with dementia who is already confused, may have the act of sexual intercourse and the need for love and belonging all confused in his/her mind. One thing for certain, persons with dementia have the same need for love and belonging as do mentally alert individuals.

Dementia care is very much about emotional caring. Feelings matter most. The person with dementia communicates with feelings and not words, and may well be expressing an unmet need.

What should these care partners have done differently?

What works

  • In the first situation, this wife needs support and advocacy. Her husband, Howard has everything all mixed up, and does not realize that his expectations are unrealistic. Also, the literature points to the fact that Howard’s behavior may be due to a hormonal imbalance (see below - RELATED ARTICLES)
  • In the second situation, Isabelle’s daughter was absolutely furious when she learned that her mom was sleeping with Bill. In fact, she requested to have her mother transferred from Memory Care Manor. Naturally, Isabelle could not understand her daughter’s concern; being with Bill makes her happy. So whose problem is this? Isabelle? Or her daughter’s?
  • In the situation with Harry and Myrtle, it is perfectly normal behavior that Harry feels connected to Myrtle as he places his hand on her knee. This touch is an expression of love and belonging.

What does NOT work

  • Any amount of logic or reasoning with Howard will not work. He is expressing a natural emotion.
  • In my practice I find that the care partners may scold and even enforce punitive measures such as removing a cigarette from Bill. Scolding and utilizing logic with Isabelle and Bill is not productive, as they only are expressing a natural feeling of love and belonging.
  • Naturally, others in the dining room at Tick Tock Manor may feel offended by Harry’s overt expression of touching Myrtle in this manner. The couple should be moved to the privacy of their room. Once again, scolding is non-productive.

RELATED ARTICLES

Pharmacologic Treatment of Sexual Inappropriateness in Long–Term Care Residents with Dementia.
Although behavioral symptoms associated with dementia in geriatric long–term care (LTC) residents are common, sexual inappropriateness (sexual disinhibition) remains one of the least understood and most difficult to treat aspects of this disease. This article proposes a practical approach to the use of pharmacologic intervention for the management of sexual inappropriateness in LTC dementia residents based on the available medical literature. Authors: Shilpa Srinivasan, MD, and Andrew D. Weinberg, MD, FACP.

The Last Taboo
This guide focuses on dementia and sexuality, intimacy and sexual behaviour in care homes – a subject which remains one of the last taboos of long–term care. The onset of old age or a cognitive impairment does not erase the need for affection, intimacy and/or relationships and yet this aspect of ageing has often been ignored and sidelined in policy and practice.

Nursing Management of Disturbed Behaviour in Aged Care Care Facilities
An Algorithm has been developed detailing, in order of priority, nursing assessment and management of aggression, delirium, depression/or other mental disorder and dementia, plus an outline of ways to develop a consistent care plan for supportive communication and care. The Algorithm is presented as a colour coded poster with an explanatory education workbook.

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