Touchy Topics: Older Adults, Dementia and Sexuality

Sex and older adults. It’s the butt of all too many jokes. Dirty old men. Frigid or sex-starved woman. Wrinkled bodies. Impotence.

But as we live longer and social mores evolve, older adults are becoming more vocal about sexual needs and intimate relationships well past 60. Indeed, sexuality is a core human quality, essential to a fulfilling relationship. While illness and infirmities may change the way older adults express their sexuality, the need for intimacy does not fade with age.

When a loved one develops Alzheimer’s or another form of dementia, however, sexuality and the ability to express sexual desires can change radically. For a partner or spouse, as well as for adult children and caregivers, this can lead to much confusion, concern, embarrassment and, sometimes, resentment or guilt.

It’s the Disease, Not the Individual, Causing Changes in Sexual Expression

What’s important to remember is this: Dementia is a symptom of various brain diseases. As the brain changes, so might behavior. Sexual expressiveness is one behavior that might change, but the individual is not acting intentionally. Understanding the dementia process will help all involved to respond in ways that are truly helpful to the patient and those close to him or her.

Here are some ways that dementia can affect sexuality and relationships:

Some individuals may lose interest in sexual relations. Others may lose sexual inhibitions and become overly interested or insistent about having sexual relations with a partner or others. For the patient’s partner, either situation can be deeply upsetting, prompting feelings of rejection or isolation on the one hand, or fear of sexual abuse and a need for new boundaries, on the other. The partner needs support, regardless, and an opportunity to gain insight into his or her reactions as well as coping skills.

It is also possible, however, for sexuality to continue despite dementia. For some couples, this intimacy may be the only form of communication left in a relationship.

Shaming and Blaming Don’t Help

For adult children, coming to terms with a parent’s sexuality, especially when his or her inhibitions are lowered due to changes in the brain, can be confusing and deeply challenging. Knowing what to say or do when your parent forgets how to behave in public and begins to undress or masturbate, or uses vulgar language or becomes sexually aggressive, takes insight and practice—and a lot of patience.

Again, it’s essential to remember that it’s the disease causing the inappropriate behavior. Use this as a framework before responding, to maintain your equanimity and avoid overreacting. Shaming, ridiculing, arguing or yelling at your parent will not teach her to change her behavior; more likely, it will only make the two of you feel worse.

Try a Little Tenderness

A more effective approach is to be matter-of-fact and caring. You can gently remind your parent that the behavior is inappropriate in public as you guide him to a private space or simply distract him.

There may also be some very practical reasons that your parent’s sexual behavior has changed. For example, if she suddenly begins to undress, she may be tired and think it’s time for bed, or feel constricted in too-tight clothes, be too hot or need to use the toilet.

A parent with dementia who becomes sexually aggressive toward others, such as fellow residents in a nursing home, may just be confused and mistake someone else for a spouse or sexual partner.

On the flip side, a sudden loss of sexual desire for a spouse may be due to illness, hormonal imbalance, medication side-effects, depression or sensing the emotional withdrawal of the other partner.

Get the Support That You and Your Parent Need

Any sudden, dramatic change in sexual expression merits a medical evaluation. Sexuality and the need for physical connection are very basic human drives, and a fundamental expression of the need for affection.

If, however, you find that dealing with your parent’s sexuality is simply too difficult, get help—both the emotional support you need to sort out your own feelings and establish appropriate boundaries, as well as the responsible care that your parent needs to feel safe, supported and able to maintain healthy relationships.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsGCM.

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