Older adult sexuality and complications of dementia


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Older adult sexuality and the complications presented by dementia

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  • THINKING ABOUT SEXUALITY IN LONG-TERM CAREFrom “Older, Wiser, Sexually Smarter”
  • “Sexuality at Midlife and Beyond”
  • “Sexuality at Midlife and Beyond”
  • Ages 57 to 85; 3005 people interviewed in their homes
  • Defined as having had sex with at least one partner in the last year.
  • “Social relationships are known to contribute to health and well-being in older men and women.” Richard Suzman, PhD; “ …health is a more important indicator for many aspects of sexuality than age alone.” Stacy Tessler Landau, MD;Study Co-Author, Director of Project
  • Surveyed 5,865 people; Just published in October 2010; will be published in a special edition of the Journal of Sexual Medicine.
  • A study in the British journal Sexually Transmitted Infections, published in 2008, showed STD rates had doubled among people 45 and older in less than a decade
  • Alzheimer’s Association
  • “A Healing Touch” (Boston Globe (8/10/08), www.boston.com/news
  • WHO (“Sexuality and Dementia,” Alz. Scotland); About.com “Alzheimer’s Disease); alz.org “Sexuality”
  • CBS Reporter; Mary Nell lost her husband of 22 years in an accident. We now live together. And before you judge us harshly:"This truly is a case of having to walk in someone's shoes before you make a judgment about how you would react and respond in similar circumstances," she said. Together, we visit Jan, and together we watch over her. Mary Nell understood from the beginning that ours is a relationship of three because it will always include Jan, the woman Mary Nell now calls her friend.
  • “Social relationships are known to contribute to health and well-being in older men and women.” Richard Suzman, PhD; “ …health is a more important indicator for many aspects of sexuality than age alone.” Stacy Tessler Landau, MD;Study Co-Author, Director of Project
  • Older adult sexuality and complications of dementia

    1. 1. Older Adult Sexuality and Complications of DementiaPresenter: Lorie Eber, JD, Gerontologist, NASM CertifiedPersonal Trainer, Senior Fitness Specialist Educator/Public Speaker on Healthy Living, Healthy Aging, Aging-in-Place and Elder Care Instructor of Gerontology, Coastline Community College Website: AgingBeatsTheAlternative.com
    2. 2. *The “Ick FactorWhat is your reactionto people older thanyou having sex?
    3. 3. *Common Depictions of Sexual Expression
    4. 4. *Uncommon Depictions of Sexual Expression
    5. 5. *What are Your Attitudes About Sexuality?
    6. 6. *AARP Sex Surveys Adults 45+1999/2004/2009
    7. 7. 1999 *Are Older People Interested in Sex?• 2/3 of those with partners are extremely or very satisfied with sex lives• 1/4 of those age 75+ who had partners reported sexual intercourse once a week
    8. 8. 2004 * How Important is Sexual Expression? •83% disagreed with: “Sex is only for younger people.” •60%: sexual activity is a crucial part of a good relationship.
    9. 9. 2009 * Men are from Mars, Women are from Venus •Men think about sex more often •Men see it as more important to quality of life •Men are 2xs as likely to admit to sexual activity outside of marriage
    10. 10. * First Comprehensive National Survey2007
    11. 11. *Does Sexual Activity* Decrease with Age? * Sex with at least one partner in the last year•Ages 57-64 73%•Ages 65-74 53%•Ages 75-85 23%
    12. 12. *Why Does Sexual Activity Decrease?•Health is a more important than age•½ reported at least one sexual problem
    13. 13. *What’s Going On Now? Internet survey of 14-94 year-olds:• Increasing sexual repertories• Sexual smorgasbord• Adults 60+ are sexually active; adventuresome• Adults 40+ have lowest rate of condom use2010
    14. 14. *Watch Out: The Baby Boomers are Coming
    15. 15. *Homosexual LifestyleGays and lesbians 65 years+ Currently 3 million By 2030  4 million
    16. 16. *Sexually Transmitted Diseases
    17. 17. *STDs Rising FastNIH report 25% of HIV/AIDS cases in US are in 50+ age group 50+ age group has the fastest growing HIV/AIDS incidence rate
    18. 18. *Why? Delay in Lack of Failure to treatment sex use due toeducation condoms stigma
    19. 19. *Survey of Long-Term- Care Facility Residents 90%:sexual thoughts or fantasies Up to 20%: exhibited sexual behavior
    20. 20. *What Interferes with Sexual Expression? Absence of a partnerSexual Performance Problems Chronic Illness and Disability Adverse Effects of Medications Feelings of Unattractiveness Lack of Privacy Grief and Depression
    21. 21. *POP QUIZWhat percentage of people with dementia exhibit sexually inappropriate behavior? A. 60% B. 20% C. 10% D. 7%
    22. 22. *Attitudes of Assisted Living Owners•“Acceptable behaviors”: holding hands,kissing and caressing•“Unacceptable behaviors”: anythingelse
    23. 23. *Reactions of Assisted Living Staff*Embarrassment*Confusion*Ridicule*Shock*Horror*Uncertainty*Disgust
    24. 24. *SEXUALITY IS A BASIC HUMAN NEED•Does not disappear as we age•Continues to be an important part of life•Critical to physical and psychologicalhealth and well-being
    25. 25. *Care Facilities: A Balancing Act•Permit and encourage residents’ sexualexpression, but•Duty to keep residents safe from unwantedadvances by other residents, and•Duty to protect residents from inappropriatepublic displays of sexuality
    26. 26. *Many Complications•Families may feel that residents’ sexualexpression is “inappropriate”•Staff members have their own prejudicesabout residents’ sexuality•Dementia complicates issues of consent•Facilities don’t have written policies onsexual expression•Licensing agencies don’t have writtenregulations on sexual expression
    27. 27. *Sexuality and DementiaOne out of every two people haveAlzheimer’s by age 85
    28. 28. *One Husband’s Solution“I got into bed with her and loved her upand I got rid of all of my depression.”
    29. 29. *Sandra Day O’Connor “Behavioral changes are symptoms of the disease.”
    30. 30. *Barry PetersenWith wife Jan “New American Family”
    31. 31. *Something to Think About…•Can a person suffering from cognitiveimpairment consent to sexual expression?•Who should assess capacity to consent?•How do you assess capacity to consent?
    32. 32. *Questions•Who should be assessed?•Who should make the assessment?•What criteria should apply?•Should a diagnosis of “mild cognitiveimpairment” preclude all sexual expression?•What if the resident has given a power ofattorney or is conserved?
    33. 33. *Tips to Assess Ability to Consent Talk to the confused person Determine if s/he appreciates risks Examine person’s behavior
    34. 34. *Thank You!