July 1, 2015
Senior sexuality represents possibly the last remaining taboo. No one wants to talk about it. In a 2013 survey conducted by Home Instead, Inc., fewer than one-third of adult children said they were even the slightest bit comfortable talking to their parents about senior sex.
And that’s a problem, because certain medical conditions—like dementia and Alzheimer’s disease—can cause seniors to engage in inappropriate sexual behavior. This development can be disturbing for adult children and caregivers alike, and it can be difficult to manage. As a senior care professional, you can help your clients address these behaviors by sharing some tips and resources.
Defining Inappropriate Sexual Behavior
Let’s be clear about one thing: not all sexual behavior by seniors is “inappropriate.” Many seniors enjoy healthy sex lives well into older age. A study by the New England Journal of Medicine found 25 percent of seniors over age 75 are having sex, and about 50 percent of those between ages 65 and 75 are also sexually active.
No matter the age of the adult participants, consensual sexual behaviors can be considered normal and healthy—as long as the participants retain the cognitive ability to consent.
When Sexual Behavior Becomes Inappropriate
Unfortunately, cognitive decline can cause seniors to engage in inappropriate sexual behaviors outside of a loving relationship or in unsuitable environments. These behaviors can cause distress for family members and caregivers who may feel ill-equipped to deal with them.
Let’s look at three common situations and how to cope with them.
1. Masturbating in public
“My father had vascular dementia. He started masturbating in public. Of course, I was appalled when I was told this and then I witnessed it. (I guess a part of me was hoping that I was being told incorrect info.)”
So begins the story of an anonymous family caregiver in the Alzheimer’s Reflections community.
If a family caregiver asks you for guidance regarding a senior loved one who is fondling himself in public, you might advise them to start with a medical examination. In seniors who can’t communicate well, public masturbation may signal a medical issue, such as pain or a urinary tract infection. These medical causes may be ruled out (or treated) with a physical exam conducted by a skilled geriatric practitioner.
In our anonymous family caregiver’s case, a trip to the doctor did the trick. She said, “I involved his MD, who examined him, and then gave him a low dose of an anti-depressant medicine. The behavior stopped.”
2. Inappropriate or unwelcome touching of others
“My mom seems to have a problem sometimes. My hubby will give her a hug as he always has. But occasionally she puts her hands where they shouldn't be. So hubby tries to avoid her… which confuses her when she wants that hug.”
Sexual inappropriateness with dementia certainly is not limited to men. As this comment illustrates, women can develop wandering hands, too.
One way to cope with wandering hands during embraces is to develop a new way to hug. Follow these steps:
- As you approach the senior, stop a short distance away and raise both hands in front of you in a “stop”-like gesture. Smile and make eye contact.
- Verbally encourage the senior to raise her hands in the same position.
- Move forward and place your palms against hers. Quickly interlace your fingers to hold onto her hands.
- Now that the senior’s hands are secured, you can guide their hands toward your shoulders as you lean in for a ‘hug,’ to touch cheeks or to give your loved one a kiss.
- When the embrace is finished, back away and release the senior’s hands.
This method allows seniors to enjoy the physical touch of family members while ensuring hands don’t inadvertently wander where they shouldn’t go.
3. Stripping in public
Because Alzheimer’s disease and related dementias reduce a person’s inhibitions, seniors with these conditions may not realize it’s inappropriate to take their clothes off in public. If a family member seeks your guidance on this issue, it’s important to point out this behavior may not be sexual in nature at all.
Seniors with dementia may disrobe in public for a variety of reasons, from feeling too warm to experiencing an urgent need to urinate. If family members can figure out what triggers the behavior, they may be able to resolve the underlying issue.
In the meantime, family members can manage the activity as it occurs. Advise them to always take a shawl or throw with them to cover their family member as the clothes come off. Help your clients find resources for clothing that is difficult to remove, such as items with fasteners in the back. Encourage family members to stay calm and not to shame their loved one. Be sure family members know their loved one cannot necessarily control this behavior.
Keep the Conversation Going
As a senior care professional, you have the opportunity to bring senior sexuality out into the open. While adult children report reluctance to talk about this subject, they seem to feel relieved when someone broaches the topic to them. As another member of the Alzheimer’s Reflections community put it:
“I have been a caregiver for the past 18 years. In all that time I have never had that issue come up. It actually had never even occurred to me! How awesome that you have brought this subject to the forefront for discussion if the need arises!”
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