Addressing inappropriate sexual behaviours in dementia

Jan 21, 2019

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Addressing inappropriate sexual behaviours in dementia

Addressing inappropriate sexual behaviours in dementia

At times dementia can lead to challenging behaviours, including inappropriate sexual behaviour. Changes in behaviour can be amongst the most difficult aspects of dementia care that families have to deal with. In the previous blog I discussed what can cause such behaviours, and this week I will look at how we can address them. With all challenging behaviours in dementia, it is key to understand the underlying cause. Only when we understand why a person is behaving in a certain way are we able to help. Although there has been very little systematic review of the different treatment options for inappropriate sexual behaviours, there is evidence that some approaches and treatments can be effective.

Some general advice

  • Remember that the person with dementia is not behaving inappropriately on purpose – it is the disease that is causing them to behave in a certain way
  • Try to stay calm and seek advice and support if needed
  • Identify and avoid triggers, such as for example overstimulating TV
  • If a person is being rude, then do not attempt to argue
  • Try to gently distract them if they persist with a behaviour
  • At times it may be good to explain to others why a person with dementia is behaving inappropriately – other people may be able to provide advice and support
  • Make sure the person with dementia stays socially active as boredom can lead to inappropriate behaviours

Dealing with difficult situations

If a person with dementia misinterprets social cues or confuses the identity of people, they may behave inappropriately.

Tip: In this case, provide simple and repeated explanations of why such behaviours are unacceptable.

At times the person with dementia may undress in public, because they are confused about the time of day or forget where they are. They may for example need to urinate, but have forgotten where the bathroom is or how to use it.

Tip: Lead them to a private space if possible and try to understand why they were for example undressing. If they have forgotten where they are or what time it is, gently remind them. Check if they are too hot, cold or need to go to the bathroom.

A person with dementia may tend to touch themselves or masturbate in public, because they may be confused about where they are, what is socially inappropriate or attempting to fulfill their sexual needs.

Tip: Ensure the person with dementia has enough privacy and is able to fulfill physical needs. Involvement in crafts to occupy hands can prevent inappropriate touching or public masturbation. You may consider practical solutions such as clothing that opens at the back or lacks zippers, however, this restricts an individual’s freedom and should be carefully considered.

Dementia can affect a person’s sexual feelings, which can be extremely challenging for their partners. Because dementia can significantly impact memory, a person with dementia may forget that they have just had sex. They may also show reduced or increased interest in sex or in rare cases behave sexually aggressively.

Tip: Gently remind them that they have just had sex and if the sexual demand is overwhelming try to distract them. Seek practical support from nurses or doctors if you are struggling with the situation. Alzheimer’s Society also provide some excellent advice on how to deal with these difficult changes.

Medications

It is best to try and treat challenging behaviours using non-medical interventions, and medication should remain a last resort. All drugs that are being used to treat inappropriate sexual behaviours can have adverse side effects, including stomach problems, headaches and sedation. Medications that cause disinhibition, like benzodiazepines, should be avoided as they can contribute to inappropriate behaviours.

Because every individual responds uniquely to medication, oftentimes a drug may not work, and several different drugs need to be tried out. Currently, there are no randomised controlled trials for any of the drugs that are commonly prescribed to treat inappropriate sexual behaviour. All existing evidence comes from individual case reports. There are a number of drugs that a doctor may prescribe. These include:

  • SSRI Antidepressants (e.g. Paroxetine, trazodone, buspirone, lithium): These can decrease inappropriate behaviours, as well as treating comorbid anxiety or depression.
  • Antipsychotics (e.g. Haloperidol, quetiapine, risperidone): These drugs are thought to decrease inappropriate behaviours through their dopamine-blocking effects. However, they can impair cognitive functioning and increase the risk of stroke or heart problems in people with dementia.
  • Hormonal agents: These affect the levels of different hormones in our bodies that play an important role in sexual functioning, including testosterone. As a result they can alter sexual behaviours, however they tend to have significant side effects.
  • Cholinesterase inhibitors (e.g. Donepezil, rivastigmine, galantamine): These drugs have been used to treat challenging behaviours in dementia, however, there are no specific reports of their effectiveness in treating inappropriate sexual behaviours.

Polypharmacy, i.e. taking lots of different drugs at the same time, is a serious issue, especially for the elderly population. This is because sometimes drugs can interact and cause negative side effects. If you have any concerns about the medication that the person you care for is being prescribed, you should always speak to your doctor.

Remember that you are not alone, and many others are in the same situation. As a carer you should ensure to take care of yourself, and ask for support when you need it.

This article is based on research publications and information from well-known organisations in the dementia space. Sources include:

 

 

 

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