intimacy, sexuality & dementia in long term care

Intimacy, Sexuality & Dementia

Daniel Kuhn, MSW, LCSW

Rainbow Hospice & Palliative Care

Park Ridge, Illinois

dkuhn@rainbowhospice.org

Intimacy

Community

Meaningful

activity

What Do People with Dementia Need?

Intimacy is a Basic Human Need

OBRA ‘87: Rights to dignity, privacy, and free association.

Do these apply to residents with dementia?

Is sexual intimacy legally or morally OK?

Levels of Intimacy

Companionship

Courtship

Overt sexual relations

Benefits & Risks

Benefits Increased self-esteem

Companionship

Less likely to exhibit

mood & behavioral

challenges

Risks Being forced or taken

advantage of by someone

Disapproval by staff, family or other residents

STDs/STIs

Autonomy & 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.

Assessing Capacity & Risk

“Social” competence should be assumed.

Knowledge of each person’s verbal and non-verbal language is paramount.

Can this person resist coercion?

Is there a history of sexual violence or hypersexuality?

Other Sexual Behaviors

Masturbation -- privacy, dignity

Resident to staff – respectful response; firm yet gentle persuasion

Hypersexuality – immediate treatment

Medical Treatment of Hypersexuality

Anticonvulsant mood stabilizers (gabapentin, carbamazepine)

Antidepressants (trazadone, clomipramine, paroxetine, citalopram)

Hormonal agents (antiandrogens, estrogens) Antipsychotics (quetiapine, haloperidol) Antidementias (rivastigmine, memantine) Others (cimetidine, pindolol)

Weighing Different Perspectives

Person with dementia

Family members

Staff members

Organization

The Individual’s Perspective

Might my past values change in light of my dementia?

What is my present behavior telling you?

Can others make choices in my “best interest”?

Family Perspectives

Roles as one’s mate, child, caregiver & advocate.

Diverse opinions.

Does the family trump the person with dementia?

Spouses in the Community

Married, widowed or in limbo?

Monogamy vs. adultery?

What do they need from us to cope?

Staff Perspectives

Our personal values (moral, religious & cultural)

Do they live in our workplace or do we work in their home?

Can we accept or at least tolerate others’ views?

Taking Action

Whose problem is it?

Protect from harm.

Respect their rights.

What are your goals?

Who is your point person?

Communicate with whom?

Organizational Perspective

Leadership and mission.

Legal & financial obligations.

Ethics committees.

Guidelines and Policies

Hebrew Home for the Aged (Holmes, 1995)

Hamilton, Ontario Geriatric Education Cooperative (Schindel Martin, 2002)

www.fhs.mcmaster.ca/mcah/cgec/toolkit.pdf

Illinois Council on Long Term Care (Kuhn, 2006)

Orientation and training

Case discussions

Role playing & games

Videos

Building Knowledge & Skills