intimacy, sexuality & dementia in long term care
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Intimacy, Sexuality & Dementia
Daniel Kuhn, MSW, LCSW
Rainbow Hospice & Palliative Care
Park Ridge, Illinois
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