1. An Intimate Look at Dementia: Examining Issues Surrounding Intimacy, Sexuality, and Ethics for PWD Ann Marie McDonald MBA. M.ED

2. Let’s Talk About Sex! What do “sex” and “sexuality” mean to you? What are your attitudes & beliefs on sex and sexuality?

3. Objectives Examine one’s own beliefs about sexuality. Identify myths about sex and the elderly. Name possible causes of inappropriate sexual behavior that PWD may exhibit. Give examples of interventions that can be used to address inappropriate sexual behavior. Discuss positive ways to meet the physical and emotional needs of PWD.

4. Facing the Truth

5. Myth Busting: Sex and Aging Older adults are not sexually desirable. Older adults are not sexually desirous. Older adults are not sexually capable. Older adults have no interest in sex.

6. What are the needs of PWD? Intimacy – The need & ability to experience emotional closeness with another human being and to have that emotional closeness predictably reciprocated. (Deacon, Minicheiello, Plummer, 1995) Community – The need to feel apart of something, the need to still belong to something. Meaningful Activity – Being able to participate in something that gives meaning and purpose to who you are as a person, as a person with dementia. The person with dementia relies on family, facility, friends to help provide this as the disease progresses.

7. There are Different Levels of Intimacy Companionship Courtship Sexual Relationships

8. Benefits vs. Risks Risks Being forced or taken advantage of by someone Disapproval by staff, family, other residents Sexually Transmitted Diseases Benefits Increased self-esteem Companionship Increased feeling of comfort and safety Mood & behavioral advantages

9. STD Risk Rising Among Seniors According the CDC, close to 2,550 cases of syphilis were reported among adults between the ages of 45 and 65 in 2010 -- up from around 900 cases in 2000. And the number of reported chlamydia cases in the age group almost tripled, from around 6,700 in 2000 to 19,600 a decade later. In its 2010 report “Sex, Romance, and Relationships,” the AARP surveyed a nationally representative sample of middle-aged and older people about their sex lives. Findings: Close to 3 out of 10 respondents (28%) said they had sex at least once a week, including almost half of those who were single but dating or engaged, and 36% of those who were married. Eighty-five percent of men and 61% of women said sex was important to their quality of life. Just 12% of single men who were dating and 32% of single women who were dating reported always using condoms during sex.

10. What About Competence? Dementia does not constitute incompetency. There are many competencies; some are retained longer than others. Cognitive tests do not tell the whole story. Judgment is highly subjective; no standards exist.

11. Competency and Risk Assessment - Knowledge of each person’s verbal and non-verbal language is very important. - Can this person resist coercion? - Is there a history of sexual violence or hyper sexuality?

12. What to Consider When Creating a Care Plan Facility Regulations regarding intimacy and sexual relationships. The person with dementia. Family wishes, views, and beliefs. Staff considerations. Balancing safety and quality of life.

13. Addressing Inappropriate Sexual Behaviors Possible Causes: Clothing is hot, itchy, or tight Need to use restroom Boredom, frustration Mistaken identity Expressed need for touch or human connection Misinterpret others Behaviors: Clothing removal Self exposure Masturbation in public Excessive masturbation Inappropriate touching of others Requests for kisses Attempts to fondle others

14. Possible Causes for ISB - Underlying medical problems - Aggressive response to environmental stressors - Lack of impulse control - Need for intimacy - Reenacting previous encounters

15. Additional Possible Causes Dementia/Depression/Anxiety - Misunderstanding of environmental cues - Disturbance in memory, judgment - Frustration, confusion - Psychological conflicts acted out through sexual behaviors - Boredom

16. Suggestions for Basic Interventions

17. Problems With Judgment and Memory Reorient to person and place Use short simple instructions to direct to room or redirect behavior Label rooms to help locate privacy If unwanted behavior persists, use alternative clothing: - Pull-over shirt - Elasticized pants - Back closing shirts

18. Meeting the Basic Human Need for Affection Assign same caregiver consistently Spend time with patient/resident Provide tactile stimulation (touch, toys, texture) Encourage verbalization (if possible) of sexual frustration Reward for appropriate requests for attention – smile, hug, spending extra time

19. Ethical Considerations Views on sexuality and the elderly are often not a reflection of the values of the resident, but rather the values and attitudes of the staff, the facility and the family.

20. The Truth of the Matter People with dementia have lived with their sexuality longer than they have lived with dementia.

21. In Conclusion…