Older adult sexuality and the complications presented by dementia

1. Older Adult Sexuality
and Complications of Dementia
Presenter: Lorie Eber, JD, Gerontologist, NASM Certified
Personal Trainer, Senior Fitness Specialist
 Educator/Public Speaker on Healthy Living, Healthy
Aging, Aging-in-Place and Elder Care
 Instructor of Gerontology, Coastline Community College
 Website: AgingBeatsTheAlternative.com

2. *The “Ick Factor
What is your reaction
to people older than
you having sex?

3. *Common Depictions of
Sexual Expression

4. *Uncommon Depictions
of Sexual Expression

5. *What are Your Attitudes
About Sexuality?

6. *AARP Sex Surveys
Adults 45+
1999/2004/2009

7. 1999 *Are Older People
Interested in Sex?
• 2/3 of those with partners are extremely or
very satisfied with sex lives
• 1/4 of those age 75+ who had partners
reported sexual intercourse once a week

8. 2004
* How Important is
Sexual Expression?
•83% disagreed with: “Sex is only for
younger people.”
•60%: sexual activity is a crucial part of a
good relationship.

9. 2009
* Men are from Mars,
Women are from Venus
•Men think about sex more often
•Men see it as more important to quality of
life
•Men are 2xs as likely to admit to
sexual activity outside of marriage

10. * First Comprehensive
National Survey
2007

11. *Does Sexual Activity*
Decrease with Age?
* Sex with at least one partner in
the last year
•Ages 57-64 73%
•Ages 65-74 53%
•Ages 75-85 23%

12. *Why Does Sexual
Activity Decrease?
•Health is a more important than age
•½ reported at least one sexual problem

13. *What’s Going On Now?
Internet survey of 14-94 year-olds:
• Increasing sexual repertories
• Sexual smorgasbord
• Adults 60+ are sexually active; adventuresome
• Adults 40+ have lowest rate of condom use
2010

14. *Watch Out: The Baby
Boomers are Coming

15. *Homosexual Lifestyle
Gays and lesbians 65 years+
Currently
3 million
By 2030
 4 million

16. *Sexually Transmitted
Diseases

17. *STDs Rising Fast
NIH report
25% of HIV/AIDS cases in US
are in 50+ age group
50+ age group has the fastest
growing HIV/AIDS incidence rate

18. *Why?
Delay in
Lack of Failure to
treatment
sex use
due to
education condoms
stigma

19. *Survey of Long-Term-
Care Facility Residents
 90%:sexual thoughts or fantasies
 Up to 20%: exhibited sexual
behavior

20. *What Interferes with
Sexual Expression?
 Absence of a partner
Sexual Performance Problems
 Chronic Illness and Disability
 Adverse Effects of Medications
 Feelings of Unattractiveness
 Lack of Privacy
 Grief and Depression

21. *POP QUIZ
What percentage of people with
dementia exhibit sexually
inappropriate behavior?
A. 60%
B. 20%
C. 10%
D. 7%

22. *Attitudes of Assisted
Living Owners
•“Acceptable behaviors”: holding hands,
kissing and caressing
•“Unacceptable behaviors”: anything
else

23. *Reactions of
Assisted Living Staff
*Embarrassment
*Confusion
*Ridicule
*Shock
*Horror
*Uncertainty
*Disgust

24. *SEXUALITY IS A
BASIC HUMAN NEED
•Does not disappear as we age
•Continues to be an important part of life
•Critical to physical and psychological
health and well-being

25. *Care Facilities:
A Balancing Act
•Permit and encourage residents’ sexual
expression, but
•Duty to keep residents safe from unwanted
advances by other residents, and
•Duty to protect residents from inappropriate
public displays of sexuality

26. *Many Complications
•Families may feel that residents’ sexual
expression is “inappropriate”
•Staff members have their own prejudices
about residents’ sexuality
•Dementia complicates issues of consent
•Facilities don’t have written policies on
sexual expression
•Licensing agencies don’t have written
regulations on sexual expression

27. *Sexuality and
Dementia
One out of every two people have
Alzheimer’s by age 85

28. *One Husband’s Solution
“I got into bed with her and loved her up
and I got rid of all of my depression.”

29. *Sandra Day O’Connor
“Behavioral changes are
symptoms of the disease.”

30. *Barry Petersen
With wife Jan
“New American Family”

31. *Something to Think
About…
•Can a person suffering from cognitive
impairment consent to sexual expression?
•Who should assess capacity to consent?
•How do you assess capacity to consent?

32. *Questions
•Who should be assessed?
•Who should make the assessment?
•What criteria should apply?
•Should a diagnosis of “mild cognitive
impairment” preclude all sexual expression?
•What if the resident has given a power of
attorney or is conserved?

33. *Tips to Assess Ability to
Consent
 Talk to the confused person
 Determine if s/he appreciates risks
 Examine person’s behavior

34. *Thank You!