Sexuality Among Institutionalized Elderly Patients with Dementia

Abstract

The subject of sexuality among elderly patients with dementia was examined, focusing on two main aspects: the sexual behaviour of institutionalized elderly people with dementia; and the reactions of other patients, staff and family members to this behaviour. The behaviour was found to be mostly heterosexual and ranged from love and caring to romance and outright eroticism. Reactions varied, being accepting of love and care but often objecting to erotic behaviour. Understanding of the sexual needs of elderly people should become an integral part of the training and continued education of health care staff, thus helping to resolve conflicts and clarify common misconceptions.

Improper Sexual Behaviors in Elders with Dementia Living in Residential Care

“…If we take the median of all estimates to date, together representative of diverse care settings, the overall prevalence of improper sexual behaviors in dementia is about 6%. A majority (66.7%) of our subjects with disinhibited behaviors were male, replicating prior observation that most subjects ( 1 90%) manifesting 'in-appropriate sexual behaviors' were men [18] , while two others did not find gender differences [1,17] . We did not find age to be associated with improper sexual behaviors, consistent with an earlier report of a community-based survey [1] .…”

“…One group reported that 54% of their 41 subjects (primarily disinhibited) had vascular dementia, 22% had AD and 9.8% a mild cognitive syndrome [28] . In the study most comparable to ours (because it examined phenomenological distinctions) association with dementia type was not examined [18] . Thus, our data may reasonably be considered the first evidence that the form of improper sexual behavior may differ according to the type of dementia suffered.…”

“…Nagaratnam and Gayagay [7] classified 8 neuropsychiatric inpatients admitted from a nursing home into three groups, but their data are difficult to compare with ours since all 8 were essentially disinhibited. Ehrenfeld et al [18] observed 48 residents with moderate dementia selected from nursing homes in Israel for 14 weeks, and categorized the sexual behaviors on the basis of expert opinion: (1) loving and caring, reflecting affectionate behaviors; (2) romance, reflecting courting behaviors, and (3) eroticism, reflecting abnormal behaviors such as compulsive masturbation, intrusive overtures and aggressive acts. Since differences in behaviors referred to as 'loving and caring' and those comprising 'romance' are not readily apparent, we interpret their data as providing support for two categories -one denoting strivings for intimacy and companionship, and another that captures intrusive and disruptive behaviors.…”

“…Improper sexual behaviors appear to be manifested equally by men and women [1,17] , although some suggest that disinhibited behaviors are more likely to be expressed by men [for example 18 ]. Generally, studies have noted correlation of these behaviors with the severity of cognitive impairment [2] .…”

Enabling self, intimacy and a sense of home in dementia

“…This human need for intimacy, for touch, hugs and kisses and the desire to feel connected to others does not diminish with age. Yet, aspects of closeness, intimacy or even sexuality are often overlooked in discussions about the well-being of clients with dementia in hospital or care settings [11,18]. People with dementia have the same psychosocial needs as other individuals: "They need stimulation and companionship, they need to feel secure, to feel they are unique and valued individuals, and to feel a sense of self-esteem" [3].…”