When de­men­tia im­pacts sex­ual be­hav­iour

Toronto Star - - LIFE - Nira Rit­ten­berg Nira Rit­ten­berg is an oc­cu­pa­tional ther­a­pist who spe­cial­izes in geri­atrics and de­men­tia care at Bay­crest Health Sciences Cen­tre and in pri­vate prac­tice. She is co-au­thor of De­men­tia A Care­giver’s Guide avail­able at bay­crest.org/dacg. Email

My dad has re­cently been do­ing sex­u­ally in­ap­pro­pri­ate things in pub­lic. I can’t cope. Signed, hor­ri­fied

You just wrote the most com­mon words when some­one is deal­ing with a rel­a­tive be­hav­ing sex­u­ally in­ap­pro­pri­ately.

Sex­ual be­hav­iour can be af­fected by de­men­tia. This is an area that fam­i­lies, friends and care­giv­ing staff find most dif­fi­cult to con­tend with.

Fam­i­lies of peo­ple with de­men­tia are of­ten em­bar­rassed by this be­hav­iour, as it is not a topic they ever imag­ined deal­ing with. Ad­di­tion­ally, this is not a topic that most chil­dren have dis­cussed — or even want to dis­cuss — in re­la­tion to a par­ent.

What is im­por­tant to re­mem­ber is that sex­ual be­hav­iour and in­ter­est is a nor­mal hu­man phe­nom­e­non. It is ex­pressed dif­fer­ently in dif­fer­ent peo­ple, but many be­lieve that older adults are not sex­ual be­ings.

This idea has been dis­proven time and again. We know that older adults are sex­u­ally ac­tive in their later years.

How­ever, de­men­tia may re­sult in dam­age to parts of the brain that gov­ern sex­ual be­hav­iour (frontal, tem­po­ral or lim­bic sys­tem) and may re­sult in a per­son act­ing out sex­u­ally in pub­lic, with strangers or staff.

A fa­mil­iar-look­ing face can trig­ger an un­suit­able re­sponse, such as climb­ing into the wrong bed, un­dress­ing or mas­tur­bat­ing. Flirt­ing is also not un­com­mon, but some find it dif­fi­cult to deal with.

Com­ing to terms with this type of be­hav­iour in your rel­a­tive is of­ten not easy.

The side ef­fects of cer­tain med­i­ca­tions can be a con­tribut­ing fac­tor to the be­hav­iours, so it is im­por­tant for a physi­cian to review the sit­u­a­tion. More of­ten than not, the be­hav­iour is driven by en­vi­ron­men­tal fac­tors and by changes oc­cur­ring in the brain.

Try not to panic. Dis­cuss the is­sue with the in­di­vid­u­als be­ing im­pacted by the be­hav­iour, such as the nurs­ing home staff, or the care­givers. Find a pro­fes­sional you can share your con­cerns with.

Staff may be feel­ing they can­not bring this sub­ject up with you, espe­cially if they are un­der your em­ploy. De­ter­min­ing the sever­ity of the be­hav­iour is a good first step.

Some­times, redi­rect­ing the per­son to the pri­vacy of his or her own room is a suf­fi­cient so­lu­tion. Clos­ing a door or al­low­ing the per­son to be alone can help, as can a firm-but-- kind re­minder that this ac­tiv­ity is in­ap­pro­pri­ate in pub­lic.

As­sess­ing the trig­gers for the be­hav­iour is also im­por­tant. Does the man whom mom is vis­it­ing at night in an un­wanted man­ner look sim­i­lar to her hus­band?

Scold­ing, anger and up­set are not the way to cope, since the in­di­vid­ual is not aware of their trans­gres­sions or their im­pli­ca­tions.

Con­duct­ing staff train­ing to deal with this is­sue is im­por­tant, and dis­cus­sions with spe­cial­ists who work in nurs­ing homes can help man­age this care is­sue.

Some staff are more af­fected and up­set than oth­ers.

Some will find the be­hav­iour just a nui­sance.

Con­sis­tency is key when deal­ing with the mes­sages around this is­sue. Med­i­ca­tion is some­times used, but it is not usu­ally the first line of treat­ment, as it may have un­wanted side ef­fects.

As a rel­a­tive, you may feel that this be­hav­iour re­flects on you, but sup­port­ing rea­son­able in­ter­ven­tions is cru­cial, as is com­mu­ni­cat­ing and ad­vo­cat­ing for help.

This is an­other hur­dle in the dif­fi­cult task of de­men­tia care­giv­ing.

As a rel­a­tive, you may feel that this be­hav­iour re­flects on you, but sup­port­ing rea­son­able in­ter­ven­tions is cru­cial

DREAM­STIME

Sex­ual be­hav­iour can be af­fected by de­men­tia and is one of the most dif­fi­cult ar­eas for fam­i­lies, friends and care­givers to con­tend with.

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