Daddy did what ?

Dementia and sexual behavior

Although a great deal of the media we consume on a daily basis is saturated with sexually charged messages, as a general rule, we keep our own sexual fantasies, desires, and habits private. That’s why it can be extremely shocking and upsetting when a family member learns that their loved one is displaying inappropriate sexual behavior in a public setting.

Such was with case with Dorothy, a lovely woman who put Stan, her 83 year-old husband, into a long-term care facility after he suffered a debilitating stroke. Everyone understood and accepted the problems Stan had with speaking, walking, and using his hand.  They knew these issues were a result of the stroke.

But when Stan developed a fervent crush on his 35 year-old physical therapist, his family’s sympathy and compassion quickly turned to disgust.

Every time Stan saw the therapist she was cheerful, encouraging, and friendly, which he interpreted as flirtatious. One day he asked her to have sex with him. When she said she liked him, but not in that way, Stan went to the facility’s administrator and claimed that she was abusing him and neglecting his physical needs.

Understandably, the administrator was concerned, the therapist was upset, and Stan’s wife Dorothy was furious.

In a different memory care facility, the staff thought 92 year-old Sadie, their newest resident, was going to be docile and easy to care for. She loved to sit in the reception area where she would quietly watch visitors come and go. Then one summer afternoon a buff UPS delivery man came charging through the door wearing shorts and a short-sleeved shirt. Sadie evidently appreciated his well-muscled arms and legs. She smiled sweetly and asked him if he’d like to see her dance. He said, “Sure I would.”

Imagine everyone’s surprise when Sadie stood up, wrapped herself around the nearest column and started gyrating and stripping off her clothes.

When the administrator called Sadie’s daughter and told her what had happened, the daughter exclaimed, “My mother would never do such a thing! She is a good Christian woman!”

Understandably, Stan’s passion for his therapist and Sadie’s pole dance were upsetting events for their families. (If you watch the video attached to this article, you will see how Madelyn reacted when her husband Quentin asked her to arrange a “sex date” for him with the girl he’d taken to his high school senior prom sixty years earlier.)

These events are usually surprising and sometimes very funny, but it is important to remember that when a people have Alzheimer’s or other dementia-related diseases, their erratic behavior is generally a result of the damage that has been done to their brains. Their inhibitions are lowered and they often lose awareness of what qualifies as socially acceptable behavior. It has nothing to do with the affection they have for their spouse/partner, and it is not in any way a rejection of their relationship.

Inappropriate sexual behavior is usually a result of an unmet need that the person can not adequately express. It can be brought on by pain, hunger, or thirst. Sometimes a person will grab ahold of him/herself because of a need to use the bathroom. They could be acting out because they have a urinary tract infection. It may be that they are longing for some kind of comfort, and they associate sex with their memories of feeling good.

Joyce Graves, Program Director at Southwest Health Center, Senior Behavioral Sciences in Platteville, WI gives these tips for caregivers in a professional setting:

• Assess if the behavior is harmful to anyone else. Is the resident making unwanted advances, climbing into other people’s beds, or acting in a way that is upsetting or offensive to other people?
• Develop a plan to respond to inappropriate behavior and to protect other residents. Educate all caregivers so the response is consistent
• Sit down with the resident and try to have them name what they are feeling.  Are they needing to be held or cuddled? Are they in pain, hungry, or thirsty?
• Wear appropriate clothing, act in a professional manner, and employ firm, consistent responses.
• Address residents by their proper names. Refer to them as Mr. Smith or Mrs. Jones and avoid endearing names such as “honey”, “sweetie”, “darling”, etc.
• Be aware of where you place your hands and your head in relationship to their body when you are helping them use the toilet, take a shower, or change clothes.
• Be specific when you are explaining your actions, and be selective with your words.  Avoid phrases that could be misinterpreted, such as, “Let’s go to bed now,” or “Let’s get you out of those pants.” Instead, say something like, “It’s time to get you dressed for bed so you can sleep.” or “We need to get your clothes changed so you’ll look nice for breakfast.”
• It may be helpful to switch caregivers. One administrator from a memory care facility reassigned the personnel so that an elderly man with an ardent affection for any female CNA got help with his bathing and toileting needs from a big, burly man.
• If a person is aggressive, medication management should be considered and a behavioral health expert consulted.
• Hormone imbalances can also affect a person’s sex drive. The introduction of estrogens can reduce sex drive.
• Doctors sometimes will prescribe antidepressants for a person displaying inappropriate sexual behavior, as these medications can diminish that drive.
• If all else fails, inpatient hospitalization may be needed so that the person can be closely monitored.

Frequently residents develop a genuine affection for one another. This can be a source of great joy to the residents and a source of huge stress and unhappiness to family members, especially if there is a living spouse.

Retired Supreme Court Justice Sandra Day O’Connor exhibited incredible grace and compassion when she learned that her husband John had developed a romance with another Alzheimer’s patient in his assisted living facility.

Although it must have hurt her heart on some level to see him sitting on a swing holding hands with another woman, she understood that it did not diminish their marriage or the relationship they had shared through the years. In an interview with KPNX in Phoenix, their son Scott O’Connor said, “Mom was thrilled that Dad was relaxed and happy.”

Understanding  and dealing with sexual behavior in persons with Alzheimer’s and other dementia-related diseases takes a lot of patience and understanding on the part of the caregiver's spouse, children, and friends as well as their professional caregivers.

While you would never want to make fun of someone, a sense of humor can go a long way toward diffusing a potentially upsetting situation.

We are born sexual beings, and no matter how old or how sick we become, we never lose our desire for affection and comfort. Respecting that and remembering that this behavior is due to the loss of judgment and inhibition that comes with Alzheimer’s and other dementia-related diseases, can help all caregivers honor the unique and sometimes surprising needs and desires of those individuals in our care.