Relational autonomy in action: Rethinking dementia and sexuality in care facilities

Abstract

This analysis establishes the need for more research and discussion on this sensitive topic. Future research should investigate the specific responsibilities of caregivers in furthering the sexual interests of residents, how exactly to modify existing capacity instruments, and how best to support historically marginalized patients in their sexual identities.

Sexuality, Aging, and Dementia

“…Residents living in facility settings are subjected to the beliefs, values, and biases held by staff. In many cases, caregivers act as gatekeepers in how much autonomy residents may have in most areas of their lives (27). In a study of 100 nursing home staff from three facilities in Alabama, knowledge and perceptions of sexuality among older adults in residential care settings were analyzed (7).…”

“…It is important to consider this when determining how to handle issues of consent and supporting the autonomy and sexuality of those experiencing dementia. Victor et al (27) define this transition as the "twilight of identity". Confusion and concern from family and health care providers can occur when an individual diagnosed with dementia begins to express themselves in a sexual way that is different from how they were pre-diagnosis (25,27).…”

“…Victor et al (27) define this transition as the "twilight of identity". Confusion and concern from family and health care providers can occur when an individual diagnosed with dementia begins to express themselves in a sexual way that is different from how they were pre-diagnosis (25,27). Sexual advanced directives have been proposed as an intervention to assist in consent issues and changes in sexual behavior that can arise as dementia progresses (31).…”

“…Family members often include those who have legal decisionmaking responsibilities for the residents with dementia, but healthcare staff cannot be positive that family members will act in the best interest of the person with dementia (25). Victor and Guidry-Grimes (27) argue:…”

Navigating Tensions About Resident Sexual Expression in Alberta’s Continuing Care Homes: a Qualitative Study of Leaders’ Experiences

“…There is a particularly restrictive approach in cases of residents with dementia because staff and family are rightly worried that sexual behavior may be non-consensual or abusive (Di Napoli, Breland, & Allen, 2013;Roelofs et al, 2015;Villar, Celdrán, Fabà, & Serrat, 2014). While these are very legitimate concerns, there are approaches available to ensure that persons with dementia engage in safe, consensual, and nourishing sexual activity (Tarzia et al, 2012;Victor & Guidry-Grimes, 2018;Kontos, Grigorovich, Kontos, & Miller, 2016). We suggest that, rather than the traditionally restrictive approach that favors the views of staff and family members, a more nuanced conversation that prioritizes consideration of residents' rights, along with those of staff, family, and other residents, is needed.…”