Dementia and sex in aged care

The sexual health of people living with dementia needs to be considered in aged care settings, according to a US sexologist.

Dr Nathalie Huitema — who advocates for universal sexual consent guidelines for people living with dementia in long-term care — said that due to ageism, sexual and intimate behaviour considered normal in broader society is often categorised as abnormal and unacceptable in residential aged care. Cognitive impairment accompanying dementia further complicates the question of consent.

Unlawful sexual contact or inappropriate sexual conduct in residential aged care homes in Australia are reportable incidents under the Serious Incident Response Scheme (SIRS). There were 2320 Priority 1 incidents for unlawful sexual contact or inappropriate sexual conduct in the most recent 2023–24 period. However, Huitema believes a significant number of the approximately 50 sexual assaults reported every week may be consensual.

“Many people wrongly think that cognitive decline means you can’t give sexual consent,” she said.

“But studies show that the brain area responsible for attachment, love and lust is actually quite basic, which challenges the idea that high-level thinking is needed for love and intimacy.

“Older adults in long-term care need an environment that affirms and promotes sexual health. So, it is crucial for care staff and managers to recognise their vital role in supporting the sexual health of residents. We all need closeness, friendships, love and intimacy, throughout our whole lifetime. Even in our golden years, even when we have cognitive issues.

“Sexual health is fundamental to the overall health and wellbeing of older adults, as it can elevate mood, improve cardiac health and reduce pain, among other benefits. Depriving older adults of that seems almost counterproductive to what health care stands for,” Huitema said.

“I advocate for a more dementia-friendly approach, where older adults with dementia are considered autonomous individuals with personal needs and wants.

“I hope Australian health care is ready to focus on potential instead of deficits, promoting sexual wellbeing and overall quality of life.

“By understanding that individuals retain their emotional depth, we can better appreciate their full humanity, ensure they live with dignity and respect, and allow them to express their love and attachment to others.”

Huitema is a keynote speaker at the International Dementia Conference, to be held in Sydney on 5–6 September, with an address, ‘Sex on the brain — the battleground of consent, privacy and personal rights’.

Image credit: iStock.com/bluecinema