Sexual needs of dementia patients ‘no-go area’

Discussions and policies around how to meet the sexual needs of people with dementia who are in residential care need to be put on the agenda to afford them the same rights and entitlements as everyone else.

This was one of the messages to health care professionals attending a “Living Well with Dementia” conference in Cork yesterday, delivered by speaker Eileen O’Keeffe, who said Ireland lags way behind countries like Australia “where double beds and shared rooms” are often provided to meet residents’ needs.

“We are at the total other end of the spectrum here,” Ms O’Keeffe said.

Ms O’Keeffe, a clinical nurse manager in the dementia unit at St Luke’s Home in Mahon, said older people, particularly women, were often viewed as “asexual” and any sexual behaviour among the elderly was deemed “unacceptable” by the general public. This reluctance to view older people as sexual beings acted as “a barrier to expression of sexuality in long term care”, a problem compounded by dementia. Ms O’Keeffe said all nursing homes should have a policy dealing with sexuality and staff should be educated and trained in its application.

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She said the conversation around the sexual needs of a resident should start at the point of admission to the home and continue as part of their ongoing care and involve the family. She said “embarrassment or lack of confidence” often prevented staff raising the issue and that training was essential because “staff have a huge impact on how people can live that part of their lives”.

Retired consultant geriatrician, Professor Cillian Twomey, said the sexual needs of those with dementia in long-term care was “a subject that needs to be discussed”. “Not only discussed, but we need to facilitate those who are in residential care to have the opportunity, if it is their wish, and their partner, if it is their partner’s wish, to engage in the normal sexual activity that you or I would engage in at home,”he said.

However the reality was in his own clinical experience, discussing the sexual needs of residential care patients was “a total no-go area”.

“In my experience I would have said overt sexual activity — willing consensual sexual activity in a residential care setting — just didnt happen, and we as workers and as care professionals in those facilities didn’t give it any great thought either, which is an indictment of us. So I think today’s presentation was about saying ‘Hold on here, maybe we need to be more open about this and we need to facilitate it’,” Prof Twomey said.

During a Q&A session after the presentation, one member of the audience asked what should staff do if the person with dementia was no longer interested in sexual activity but the spouse or partner was.

“What if there is no consent, could that person be abused?,” she asked.

Ms O’Keeffe said there was “always a possibility of abuse, as there is in every situation”. Her advise was to engage with the spouse/partner from the outset rather than backing off out of fear or embarrassment. She said there was “generally a sense of relief” when the issue of sex was raised with spouses.

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