Managing sexual behaviors in dementia can present a number of challenges for caregivers.

The need for close connection through sexual behavior changes as dementia progresses. Understanding the needs and the motivations for sexual behaviors can make it easier to manage them as the disease progresses.

“Sexuality is often mislabeled as a behavior in memory care. A person with dementia may not be able to express their sexual needs, or may express them in socially inappropriate ways,” said Jaime Cobb Tinsley, vice president of dementia and caregiver education at the James L. West Center for Dementia Care. 

“In fact, sexuality is a continuing human need common to all people. As we age, we have little change in our interest in sex and intimacy,“ Cobb Tinsley says.

James L. West’s education team offers education sessions for family and professional caregivers on dementia and sexuality to raise awareness and provide suggestions for how to manage these sometimes challenging behaviors.

Common changes in sexual expression

Those living with dementia may experience a decrease in or loss of interest in sexual activity. Their partner may notice them becoming more awkward or skipping a step in their normal progression of intimate activities or requesting forms of sexual behaviors or intimacies that are outside the normal repertoire of their relationship.

In determining whether it’s appropriate to engage in intimate activities, the person with dementia and their partner should consent to engage in sexual activity and have the capacity to engage in the activity. Changes to regular routines may be signs of impaired capacity and if the person with dementia is inactive, all sexual activity should stop.

The person living with dementia loses their awareness of the needs, rights and wishes of others. They no longer understand the consequences of their actions on themselves or how their actions impact others. They lose social skills that may have made their company desirable and become unable to return in any meaningful way the same measure of affection and attention. 

These factors may lead to the spouse becoming less interested in being intimate or feeling guilty about initiating sexual activity because they are concerned they are taking advantage of the spouse with dementia. Joining a support group with other spouses of those living with dementia or speaking to a trusted counselor can help process these feelings of guilt and grief.

Defining and managing sexual behaviors

As the disease progresses, the person with dementia may seek out comfort and intimacy in socially inappropriate ways.

Among those are touching, hugging or kissing strangers; getting undressed in public; using sexually laden language; engaging in suggestive behavior or using suggestive language; exposing themselves during personal care tasks; aggressive or repeated sexual overtures; and seeking physical fulfillment in public.

Managing sexual behaviors in dementia requires consistency and calm.

“It’s important that you respond appropriately to these behaviors,” Cobb Tinsley says. “Do not scold, shame or ridicule. Don’t yell at them or panic. It’s a desire or an urge they are having, and they don’t have that filter to stop the behavior.”

She offers a number of suggestions for managing sexual behaviors in dementia:

• If they’re undressing or seeking physical fulfillment, throw a blanket or jacket over them, and move them to a more private location.
• If they’re touching you or someone else inappropriately, offer a more positive or appropriate way to act and leave it at that.
• Praise and encourage acceptable behaviors. 
• Be sensitive and reassuring
• Use delaying tactics and redirection using food, music, animals, stuffed animals, etc. to distract them from the behavior.
• Use non-sexual touch in everyday routines to provide intimacy and closeness.
  

“Share intimate moments that do not require touching, but invoke strong feelings of belonging together, such as reminiscing, sharing a meal, going on a date, watching a movie,” Cobb Tinsley says. “Try to give them more attention and more reassurance and use other types of affection to meet those emotional needs.”

If the sexual behavior is aggressive or predatory, there are some medications that can be used appropriately to moderate the behavior on a temporary basis.

Adjusting to community life

When someone with dementia moves into a communal living setting, it is not uncommon for them to form new relationships. This can be upsetting to family members and spouses.

“They are usually seeking reassurance and comfort in a new environment,” Cobb Tinsley says. “Community caregivers are trained to observe residents and determine the answers to some basic questions. Are they aware of the person who is initiating the relationship? Do they believe it is a spouse, or are they aware of the person’s identity? Are the behaviors consistent with former values? Do they have the ability to communicate refusal?”

Residents are entitled to express themselves sexually as long as the expression is not a public display, is consensual between residents and does not harm the resident or others.

“Persons with dementia have a right to form new relationships,” Cobb Tinsley says. “Communities have policies and guidelines in place to help protect and support the residents living there.”

Senior living staff are charged with following facility policies and procedures, taking into account the resident’s rights. Staff are responsible for protecting residents from harm and documenting forms of sexual expression. They are required to report information regarding the resident’s sexual expression to family members and to provide the resident with privacy.

“Our loved one living with dementia deserves respect,” says Cobb Tinsley.

Staff members in every department at the James L. West Center for Dementia Care receive initial and ongoing training in all aspects of memory care for many types of dementia disorders. Every resident is different, and our staff is skilled in discovering each one’s needs and abilities, at every stage of their journey.