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Sexuality And Dementia Pose Challenges In Nursing Homes

Charlotte Albright
Gayle Doll (r), Kelly Kirkpatrick (c) and Paul Manganiello (l) chat during a conference on Sexuality and Dementia sponsored by Dartmouth-Hitchcock Medical Center.

There’s a growing dilemma facing nursing home caregivers, and it’s not easy to talk about. When, if ever, is it acceptable for patients with dementia to have sex with other patients? That was the focus of a day-long training session for caregivers sponsored by Dartmouth-Hitchcock Medical Center. 

The presentations were candid and provocative.

Gayle Doll directs the Center on Aging at Kansas State University, and she started the conference with a surprising game. She asked half the participants to plan a Tupperware party for nursing home residents. What she didn’t tell them was that the other half of the group was being asked to plan a sex toy party. That helped break the ice for a taboo subject—the benefits of geriatric sex.

“It’s soothing, yes. Calming. That’s exactly right, get the heart rate going,” Doll said, echoing comments from the audience of caregivers.

Doll wants nursing homes to be places where patients who want intimacy can also get privacy, if the sex is consensual. But if there is a mental impairment, consent can be hard to determine. And what if a physical  romance springs up in a facility but one of the spouses is still at home?

That was a fictional scenario presented by an actress and two health care workers, to spur more group discussion.  A woman is upset about her husband’s nursing home infatuation with another patient named Ginger. Both of the lovers have dementia, but she does not.

Wife: “I just can’t do it, I just can’t let him do that and be okay with it.”

Nurse: “When you’re with him do you feel like he still recognizes you and wants to be with you?”

Wife: “Not all the time, but sometimes, and that’s part of why it’s hard just to step back and say ‘go with Ginger,’ I mean that just seems like, we’ve been married for almost 60 years, I just can’t let him do that.”

New romances can combat depression and loneliness as dementia sets in. But sometimes, hyper-sexual behavior is not healthy.

Yet even as they sympathize with distraught spouses, nursing home staff say they also have to consider  their patients. New romances can combat depression and loneliness, as dementia sets in. But sometimes, hyper-sexual behavior is not healthy.  Barbara Mitchell, from Massachusetts, said her aging father became uncharacteristically predatory in a New Hampshire nursing home toward other dementia residents.

“Who don’t necessarily [say]  you know, ‘I want you to stop touching me’ or ‘I don’t appreciate you saying those things or whatever,’” Mitchell said.

Therapy and medication helped him behave more appropriately. Gayle Doll, of the Kansas State Center on Aging, encourages families to talk openly about these thorny issues before they arise. She also advises long term care providers to set clear policies as they build close relationships with the families of clients.

“Can you imagine the sibling or the child or the spouse that is now looking for a home that has a sexual policy? So that they know that their parents or wife - whatever - their sexual preferences can be honored within that home? There aren’t too many of us who think about those things,” she noted.

But, Doll says, more people and providers should think about  “those things.”  She thinks many baby boomers who grew up during the sexual revolution may spend their last years in facilities where they reach for one last fling—even as their memories are failing.

Charlotte Albright lives in Lyndonville and currently works in the Office of Communication at Dartmouth College. She was a VPR reporter from 2012 - 2015, covering the Upper Valley and the Northeast Kingdom. Prior to that she freelanced for VPR for several years.
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