Question: My father who has dementia is living in a nursing home and has recently been inappropriately touching a woman who resides on his unit. He has been warned many times that this is unacceptable and it has gotten to the point where they have called the police (by the request of the other family of the lady). What should or can we do?
Answer: Alzheimer’s disease does not change the need for love and affection. It is not that uncommon for opposite sex friendships to occur from time to time, or for sexual relationships to be sought and carried out. This topic often creates heightened emotional reactions in families and staff and needs thorough examination and discussion.
The person with dementia often loses judgment for correct behavior and may no longer understand that their behavior is inappropriate or they may be no longer able to express their affection in comfortable and appropriate ways. This is extremely difficult for caregivers to witness and to remember that this is being done by someone who is no longer responsible for their actions.
With that being said, clarifying the nature of the touch, the response of the other person that was touched, and ensuring that there is not misinterpretation of the situation should be established. Sometimes anything with sexual connotations often becomes sexually inappropriate to staff and family when it may not be sexual behaviour at all. In some care facilities sexuality for persons with dementia is ignored, misinterpreted or restricted. For example, a woman who climbs into another person’s bed might be doing this out of loneliness or simply from being used to sleeping beside a warm body for the past 50 years. Likewise, this area of discussion cannot be adequately addressed without recognizing a resident’s right to sexuality. Our response to what is appropriate and inappropriate is often influenced by long-held beliefs and feelings about how, where and who people should express sexual interest with. Family objections are sometimes based on the failure to recognize/admit the parent’s need for an intimate relationship, and/or the need to protect the “interests” of the parent. As Lori Schindel Martin wrote, “ Imagine what life would be like for you if the friendships of intimacy that you cherish were subjected to scrutiny and subsequently forbidden?”
Nevertheless, there also needs to be a balance between residents’ rights to make decisions about sexual expression and with the long term care home’s duty to prevent harm. Clearer guidelines for Long Term Care homes are needed to ensure that they are encouraging a culture of tolerance, understanding inquiry and dialogue, not one of surveillance, judgment and censorship (Schindal Martin, 2006). Assuming that in this case the touching is unwanted by the female individual, and to ensure the dignity, security, safety and comfort of the other female resident, several strategies can be considered by family or staff of the long term care facility to prevent sexual inappropriate behaviour:
Determine the meaning behind the behaviour. Why is your father attracted to this particular resident and when did this attraction start? What was your father like before being admitted to the nursing home? If you can determine the meaning then it is easier to determine creative strategies to compensate for the unmet need. For example, providing opportunities for appropriate touch and expressions of affection that are non-sexual (through foot, back and hand messages, dancing, sensory activities, pet therapy, hand over hand activities and hugs) can sometimes offset the behaviour. Often individuals with dementia are anxious and need reassurance through gentle and loving communication. Also consider physical things like warm blankets, hot water bottles or body pillows at night in bed. Observe what triggers the behavior by monitoring when and where it occurs, (time of day and location). Long Term Care homes can help by using tracking tools such as the Dementia Observational Screen (DOS).
If a pattern can be established, then staff or family may be able to put in distractions and redirect during that period of time, by involvement with activities, for instance. Praise and encourage acceptable behavior rather than scolding. Scolding unacceptable behavior is non-effective due to the fact that the person with dementia most likely will not remember or recognize what they are doing is wrong.
Have frank discussions between caregivers, staff and other families through meetings about how to promote the sexual health of older adults in their care while protecting exploitation. For example rather than forbidding relationships begin looking for newer ways of thinking and supporting.
As a very last resort, there are medications that can be used to lower libido and speaking with the physician is advised. Finally, remember that the person with dementia has forgotten what is appropriate behaviour and console yourself with the knowledge that these behaviours and situations are usually temporary.
The Alzheimer Society of Muskoka believes the sooner we improve our understanding, the better we’ll be able to provide care. Please call or email with your questions or concerns and we will try to get them published in an upcoming column. Call 1(800) 605-2075 or (705) 646-7694, or email firstname.lastname@example.org.
Karen Quemby is presently the Education and Family Support Coordinator for the Alzheimer Society of Muskoka as well as a part time instructor for Georgian College and Nipissing University.