Coping with Disinhibited and Inappropriate Sexual Behavior
There have been a number of questions on OurAlzheimer's.com about the difficulties of coping with disinhibited and inappropriate sexual behavior exhibited by people with Alzheimer's disease. I thought it might be helpful to try to address some of the issues surrounding this sensitive subject and to give some caregiver tips on how to cope.
There is not much research into sexuality and dementia, so estimating the number of people with Alzheimer's whose inappropriate sexual behavior causes concern is difficult to judge. What we do know is that a lot of inappropriate and aggressive sexual behavior seen in people with Alzheimer's tends to be both short term and in the later states of the disease. Most people with Alzheimer's disease lose sexual drive as the disease progresses
A significant point, of course, is that we all have the right to express our sexuality and that includes people who have dementia and other types of brain damage or injury. It is the way in which sexuality is expressed, and the reactions of those it affects, that can lead to enormous embarrassment and increased social isolation of the person with Alzheimer's and his or her family.
Most commonly, inappropriate sexual advances include lewd remarks, touching, or public masturbation. Sometimes inappropriate sexual behavior combines with aggression and this is obviously a much more serious problem that can be very difficult to manage, especially when the caregiver is an older spouse.
Tips for Coping with Sexually Inappropriate Behavior
Coping is often a matter of trial and error. First, it may be best to monitor the behavior and keep a diary. Record what is happening, at what time, where the behavior is occurring, and the antecedents (anything that occurs before the behavior). Take notes about who is present, what are they saying or doing, in fact anything that helps put together a profile. If you can manage do this for a few days with minimal intervention it may help when you analyze the information. The information may also help a doctor or psychologist should the behavior be serious enough to seek their help.
Sometimes this information can help you rearrange a persons' day, or avoid contact with a person that may be the target of the behavior. Maybe change the time of day a visit takes place, getting someone else to take over an activity, and so on.
There are a few more general caregiving tips you can try:
Use a kind instruction to stop the behavior. Humorous sentences can be good. Try not to sound demanding or angry as this generally has the opposite effect to the one you want. Some people do however require firmer instructions than others.
Try redirecting the person to another activity.
Try different approaches, and just because an approach did not work once, does not mean it will not work again.
Try using different instructions, saying it in a different way, if they do not respond to being asked to stop. Use simple, short sentences as complexity generally adds to confusion.
Offer a program of activities that includes more physical exercise.
You can take the person to a different room for some privacy to masturbate if they are insistent or you think it helps.
Do not use physical force to move or push away unless you feel you, or they, are in danger.
Alcohol can make people more disinhibited, as can some drugs, such as valium. A doctor may need to review medications.
If you find these strategies do not work talk to your doctor. Do not carry the burden of dealing with this alone. A referral to a psychologist or health care team specializing Alzheimer's disease will be best. You need support too.
Coping with Serious Sexual Assault.
In a small number of cases inappropriate sexual behavior can be of a serious nature. Sometimes this may be because the person with Alzheimer's disease is bigger and stronger than their caregiver, other times it is because the level of confusion is so severe that the resultant inappropriate behavior can be defined as a serious sexual assault.
If the level of violence is severe and/or persistent and the person with Alzheimer's does not respond to verbal instruction or redirection then you must consider the following:
*If you believe you are in danger you must call for assistance, either from a relative or from the police.
*Make sure the environment is as safe as you can make it. Decrease clutter, increase lighting. Never have weapons in the house. Stay near the exit so you can make a quick, safe get-away.
*Involve your doctor or seek a referral to a psychologist or psychiatrist or gerontologist who can do an assessment, offer appropriate treatment, help and advice. Sometimes it may be the person with Alzheimer's requires admission to hospital.
Medications are available that can be used short or long term to stop aggressive sexual behavior.