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Inappropriate Sexual Behaviors

In my work with persons who have dementia, I often hear reports of “inappropriate” behavior — particularly sexually inappropriate behavior.  One statistic reports that this occurs in about 15% of persons with dementia.  It tends to occur more commonly in long-term care settings.  This behavior can manifest itself in several ways, as can the reasons why such behavior is a concern to family and caregivers.  Here are some of the more common actions that I hear about (or witness):

—  Is no longer interested in sexual activity

—  Is too interested in sexual activity

—  Makes inappropriate remarks (either because of who they are made to, or where they are made)

—  Makes unwanted advances, either to strangers or to familiar persons  (grabs, fondles, or makes suggestive comments)

—  Kisses or hugs more than might be appropriate to express affection

—  Attempts to have sexual intercourse with others

—  Masturbates in public

—  Appears not to be able to give consent for sexual intercourse

—  Appears not to know whether they are having sexual intercourse

When we consider such behaviors, it is important to analyze why we are concerned about it.  I still encounter a fair number of people who think it amusing, or possibly disturbing, that persons of a certain age still have sexual urges — and act on them.  But the truth of the matter is that there are people who, even into their 90s, are involved in healthy sexual relationships.  (And have the right to do so.)  It has also been noted, in the media and elsewhere, that younger persons who are cognitively impaired still have the right, and the desire, to engage in personal intimacy.  One problem arises, in both of these instances, when such urges are acted upon in an inappropriate manner — usually due to where they occur, or with whom.  The other problem has to do with consent, and whether the person with dementia is capable of giving it.  (Or asking for it.)

The most common behaviors that I have observed have to do with persons who display themselves, or who make suggestive remarks or gestures toward caregivers and others (sometimes strangers).  Usually, for some reason, this is usually seen with men — although I have also noted it in some women.  One thing that is important to remember here is that a person with dementia will, at some point, lose the ability to determine what is socially appropriate and what is not, and also to inhibit inappropriate behaviors.  Depending on the type of dementia, this can be seen sooner or later.

Now, the problem arises of how to deal with this behavior.  The first step is to monitor the behavior, and make note of when and where it most frequently occurs.  Record what happens before and after the behavior, and who is present.  Try to do this for a few days, so you can get a better picture of what might be triggering the behavior.  Sometimes, this information might help you to rearrange the person’s day, or inform you as to certain actions or words to avoid when approaching the person.  However, sometimes such environmental modifications are not always helpful, and it may be necessary to consult with a psychologist or another medical professional.

Here are some other strategies that you can try:

—  Instruct the person to stop the behavior, gently and with tact.  Humor is sometimes good in these situations.  Sounding angry or demanding will often not have the desired effect on the person, and may trigger an angry or aggressive reaction.  (I’m reminded of an instance where a man told me that he wanted to go to bed with me.  I just smiled and said, “I don’t think my husband would like that very much.”)

—  Try redirecting the person to another, more appropriate, activity.  (If a man is sitting in the hallway, masturbating, move him to his room or the lounge and turn on a television program he might enjoy.)

—  Consider what environmental modifications might be appropriate.  If a person is known to disrobe in public, try using clothing that makes such behavior more difficult.  I have often seen men dressed in sweatpants, with an elastic waist, to prevent them from unzipping their trousers and displaying themselves.

—  Remember, just because one approach doesn’t work, another might do quite well.

—  Keep the person busy, so that he doesn’t have time to sit around and engage in self-stimulatory behaviors.

—  Sometimes it may be more advisable to simply take the person to another room, and allow him a little privacy.  As much as we may be offended, it may not always be advisable to prevent such behaviors altogether.  (I remember another case where a man and a woman, both in their 90s, became involved in a sexual relationship.  Both of their families were aware, and supportive.  More than once, the staff merely chuckled to themselves and escorted the pair to his room and shut the door, after ensuring that there was no danger of falling.)

In a small number of cases, this sexually inappropriate behavior can be more serious in nature.  It may be that the person with dementia is larger or stronger, or it may be impossible to redirect his behavior.  If you are the target of such behavior, and you feel that you are in real danger, then you must act on your concerns.  Call for help from another caregiver, to perhaps pull the person’s wheelchair back or help to distract the person.  Make use of your facility’s protocol for dealing with aggressive residents.  If necessary, summon the police.  And, most certainly, bring the behavior to the attention of a medical professional.

  1. October 1, 2014 at 5:39 AM

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