The Expression of Intimacy and Sexuality in Persons With Dementia

Abstract

Sexuality in dementia is infrequently addressed. Dementia is characterized by a progressive deterioration in all domains of functioning, including loss of sexual function. However, the diagnosis of dementia does not mean an immediate or complete cessation of sexuality in the person, or a loss of the ability to consent to sexual activity with a partner. A discussion of sexuality in dementia occurs infrequently in clinical care for several reasons. These include (a) a discomfort in discussing sexuality in older adults, (b) the fear of causing social or cultural offense, and (c) the assumption that the cessation of the reproductive period implies the end of sexual life in older adults. There is also a tendency to focus on the preservation of cognition and independence, with relative neglect of the need for physical and emotional intimacy or quality of life. Patients with dementia are more likely to be sexually active than not. The most common change is a lack or loss or sexual desire. Inappropriate sexual behaviors occur in a minority of patients (28%) and can be usually managed with behavioral measures, with the use of pharmacotherapy for symptomatic management in refractory cases. Other clinical and ethical concerns in dementia include the capacity to consent to sexual intimacy, the formation of new relationships, sexuality in long-term residential facilities, and vulnerability to sexual abuse. Dementia care guidelines recommend a low threshold of suspicion for abuse, with a focus on patient safety. These must, however, be counterweighed by respect for patient autonomy and wishes.

Dementia and its impacts on the intimate, sexual couple relationship: A systematic review of qualitative research studies

“…The intimate sexual activities of people with dementia have often been referred to in the literature as “inappropriate,” “improper,” and “hypersexual” (Benbow & Beeston, 2012). Studies highlight the difficulty of destigmatizing sexuality when considering couples affected by dementia, and the difficulty to understand and place sexual intimacy as a changing need throughout an individual’s lifespan, irrespective of a dementia diagnosis (Bartlett & O’Connor, 2010; D’cruz, Andrade, & Rao, 2020; Sandberg, 2020). As a result, this construction of sexual intimacy as pathological ignores the complexity of the feelings of couples living with the disease.…”

Companionship and Sexual Issues in the Aging Population

“…The literature regarding sexuality in people with dementia is sparse for various reasons such as discomfort in discussing issues of sexuality with this population, fear of adverse sociocultural implications, and unscientific assumption of the end of sexual life with the onset of dementia. 50 Studies have shown that up to 50% of the patients with Alzheimer’s disease have one or the other sexual dysfunction, majority of which is erectile dysfunction which is independent of age, cognitive decline, physical illness, or medications. 51 The English Longitudinal Study of Aging, which was conducted on persons with dementia with an age group of 50 to 90 years living in the community, has reported that those with milder dementia severity and better physical activity levels were more sexually active.…”

“… 57 Sexual abuse in dementia needs to be managed by a multidisciplinary team with appropriate safety measures and legal assistance. 50 …”

“…This is issue-specific (having the knowledge of the nature of activity in general) and situation-specific (whether the person can consent to sexual activity with a particular person at a particular time). 50 , 58 One must also consider the fluctuating capacity to consent in older individuals.…”

Registered Nurses’ experiences of caring for persons with dementia expressing their sexuality

“…Nurses need to adopt a supportive approach when dealing with these highly sensitive situations (Thys et al, 2019). There is a tension between ensuring the autonomy of the person with dementia and their right to express their sexuality, and protecting family and other residents from harm (Wiskerke & Manthorp, 2019; D’cruz et al., 2020). Issues related to sexuality combined with consent and ethical demarcation can be complicated to handle and put a heavy burden on nursing staff and relatives (Mahieu et al., 2014).…”