Companionship, intimacy and sexual expression in dementia

Abstract

Intimacy and sexual expression are not just for the young and beautiful. In the latest in a series on dementia, Aysha Mendes explores relationships between older people living in the care setting and promotes understanding from relatives and staff

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

“…Disinhibition can lead to inappropriate displays of sex expression, such as unwelcome sexual advances toward other residents or staff, which can cause significant distress. 4 –6 Capacity determinations are focused on what faculties the individual has for the decision at hand; questions about whether someone has capacity are separate from whether a resident should be permitted to pursue the decisions they have the capacity to make. After the capacity evaluation, a deeper investigation is warranted regarding whether the sexual lifestyle threatens the well-being of a resident, other residents they might come into contact with, or caregivers.…”

“…Research shows that the onset of dementia does not end sexual desire. 2 –6 Given the import that sexual activity has for many individuals’ sense of self, desire satisfaction, and interpersonal connections, the presence or absence of accommodation on this front can significantly affect residents’ quality of life.…”

“…7 –14 Furthermore, recent research has clarified that those with dementia have sexual interests, which used to be a point of contention. 3 –6,15 However, there has been little attention paid to how to evaluate decision-making capacity regarding sexual activity by those with dementia. There is evidence that resident’s sexual interests are downplayed or ignored because of ageism on the part of staff, involvement of the resident’s family members, or fear of legal repercussions.…”

“…There is evidence that resident’s sexual interests are downplayed or ignored because of ageism on the part of staff, involvement of the resident’s family members, or fear of legal repercussions. 5 –18 Put succinctly, researchers have found thatstaff apprehensions about the abrogation of their duty of care and concerns about unlawful activity, anxiety about potential risks to the resident, and fear of negative repercussions from a resident’s family make many facility managers wary of physically intimate activity among residents. 16 This issue will only become more pressing as the population with dementia increases.…”

“…While it is established that sexuality is an important facet of life, the existing literature does not adequately connect this to a resident’s identity or conception of self explicitly. 3 –6,18 With this conceptual framework, we compare the independence account and relational accounts of autonomy within the context of sexual agency. From a relational perspective, caregivers’ iii obligations are positive as well as negative, and policies should provide mechanisms for different forms of sexual expression.…”