Intimacy, Sexuality & Dementia  Daniel Kuhn, MSW, LCSW Rainbow Hospice & Palliative Care Park Ridge, Illinois [email_addre...
<ul><li>Intimacy </li></ul><ul><li>Community </li></ul><ul><li>Meaningful  </li></ul><ul><li>activity </li></ul>What Do Pe...
Intimacy is a Basic Human Need <ul><li>OBRA ‘87: Rights to dignity, privacy, and free association. </li></ul><ul><li>Do th...
Levels of Intimacy <ul><li>Companionship </li></ul><ul><li>Courtship </li></ul><ul><li>Overt sexual relations </li></ul>
Benefits & Risks <ul><li>Benefits </li></ul><ul><li>Increased self-esteem </li></ul><ul><li>Companionship </li></ul><ul><l...
Autonomy & Competence <ul><li>Dementia does not constitute incompetency. </li></ul><ul><li>There are many competencies; so...
Assessing Capacity & Risk   <ul><li>“ Social” competence should be assumed. </li></ul><ul><li>Knowledge of each person’s v...
Other Sexual Behaviors <ul><li>Masturbation -- privacy, dignity </li></ul><ul><li>Resident to staff – respectful response;...
Medical Treatment of Hypersexuality <ul><li>Anticonvulsant mood stabilizers (gabapentin, carbamazepine) </li></ul><ul><li>...
 
Weighing Different Perspectives <ul><li>Person with dementia </li></ul><ul><li>Family members </li></ul><ul><li>Staff memb...
 
The Individual’s Perspective <ul><li>Might my past values change in light of my dementia? </li></ul><ul><li>What is my pre...
Family Perspectives <ul><li>Roles as one’s mate, child, caregiver & advocate. </li></ul><ul><li>Diverse opinions. </li></u...
Spouses in the Community <ul><li>Married, widowed or in limbo?  </li></ul><ul><li>Monogamy vs. adultery?  </li></ul><ul><l...
Staff Perspectives <ul><li>Our personal values (moral, religious & cultural)  </li></ul><ul><li>Do they live in our workpl...
Taking Action <ul><li>Whose problem is it? </li></ul><ul><li>Protect from harm. </li></ul><ul><li>Respect their rights .  ...
Organizational Perspective <ul><li>Leadership and mission. </li></ul><ul><li>Legal & financial obligations. </li></ul><ul>...
Guidelines and Policies <ul><li>Hebrew Home for the Aged  (Holmes, 1995) </li></ul><ul><li>Hamilton, Ontario Geriatric Edu...
<ul><li>Orientation and training </li></ul><ul><li>Case discussions </li></ul><ul><li>Role playing & games  </li></ul><ul>...
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Intimacy, sexuality & dementia in long term care

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  • 2 Benefits may include: Increased self-esteem due to the problems with memory, thinking, language and other skills, many people with dementia lose their self-esteem. Having an intimate partner may increase self-esteem by giving them a sense of purpose. Companionship - there is no substitute for one-to-one contact to reduce fear, boredom, or loneliness. Fewer mood &amp; behavioral challenges when residents are happy or content. Risks may include: Being forced or being taken advantage of someone, especially if someone is unable to say no or fend off someone’s physical or sexual contact. Lack of acceptance or disapproval by staff, family or other residents. Sexually Transmitted Diseases (STDs) can occur if sex is unprotected.
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  • Intimacy, sexuality & dementia in long term care

    1. 1. Intimacy, Sexuality & Dementia Daniel Kuhn, MSW, LCSW Rainbow Hospice & Palliative Care Park Ridge, Illinois [email_address]
    2. 2. <ul><li>Intimacy </li></ul><ul><li>Community </li></ul><ul><li>Meaningful </li></ul><ul><li>activity </li></ul>What Do People with Dementia Need?
    3. 3. Intimacy is a Basic Human Need <ul><li>OBRA ‘87: Rights to dignity, privacy, and free association. </li></ul><ul><li>Do these apply to residents with dementia? </li></ul><ul><li>Is sexual intimacy legally or morally OK? </li></ul>
    4. 4. Levels of Intimacy <ul><li>Companionship </li></ul><ul><li>Courtship </li></ul><ul><li>Overt sexual relations </li></ul>
    5. 5. Benefits & Risks <ul><li>Benefits </li></ul><ul><li>Increased self-esteem </li></ul><ul><li>Companionship </li></ul><ul><li>Less likely to exhibit </li></ul><ul><li>mood & behavioral </li></ul><ul><li>challenges </li></ul><ul><li>Risks </li></ul><ul><li>Being forced or taken advantage of by someone </li></ul><ul><li>Disapproval by staff, family or other residents </li></ul><ul><li>STDs/STIs </li></ul>
    6. 6. Autonomy & Competence <ul><li>Dementia does not constitute incompetency. </li></ul><ul><li>There are many competencies; some are retained longer than others. </li></ul><ul><li>Cognitive tests do not tell the whole story. </li></ul><ul><li>Judgment is highly subjective; no standards exist . </li></ul>
    7. 7. Assessing Capacity & Risk <ul><li>“ Social” competence should be assumed. </li></ul><ul><li>Knowledge of each person’s verbal and non-verbal language is paramount. </li></ul><ul><li>Can this person resist coercion? </li></ul><ul><li>Is there a history of sexual violence or hypersexuality? </li></ul>
    8. 8. Other Sexual Behaviors <ul><li>Masturbation -- privacy, dignity </li></ul><ul><li>Resident to staff – respectful response; firm yet gentle persuasion </li></ul><ul><li>Hypersexuality – immediate treatment </li></ul>
    9. 9. Medical Treatment of Hypersexuality <ul><li>Anticonvulsant mood stabilizers (gabapentin, carbamazepine) </li></ul><ul><li>Antidepressants (trazadone, clomipramine, paroxetine, citalopram) </li></ul><ul><li>Hormonal agents (antiandrogens, estrogens) </li></ul><ul><li>Antipsychotics (quetiapine, haloperidol) </li></ul><ul><li>Antidementias (rivastigmine, memantine) </li></ul><ul><li>Others (cimetidine, pindolol ) </li></ul>
    10. 11. Weighing Different Perspectives <ul><li>Person with dementia </li></ul><ul><li>Family members </li></ul><ul><li>Staff members </li></ul><ul><li>Organization </li></ul>
    11. 13. The Individual’s Perspective <ul><li>Might my past values change in light of my dementia? </li></ul><ul><li>What is my present behavior telling you? </li></ul><ul><li>Can others make choices in my “best interest”? </li></ul>
    12. 14. Family Perspectives <ul><li>Roles as one’s mate, child, caregiver & advocate. </li></ul><ul><li>Diverse opinions. </li></ul><ul><li>Does the family trump the person with dementia? </li></ul>
    13. 15. Spouses in the Community <ul><li>Married, widowed or in limbo? </li></ul><ul><li>Monogamy vs. adultery? </li></ul><ul><li>What do they need from us to cope? </li></ul>
    14. 16. Staff Perspectives <ul><li>Our personal values (moral, religious & cultural) </li></ul><ul><li>Do they live in our workplace or do we work in their home? </li></ul><ul><li>Can we accept or at least tolerate others’ views? </li></ul>
    15. 17. Taking Action <ul><li>Whose problem is it? </li></ul><ul><li>Protect from harm. </li></ul><ul><li>Respect their rights . </li></ul><ul><li>What are your goals? </li></ul><ul><li>Who is your point person? </li></ul><ul><li>Communicate with whom? </li></ul>
    16. 18. Organizational Perspective <ul><li>Leadership and mission. </li></ul><ul><li>Legal & financial obligations. </li></ul><ul><li>Ethics committees. </li></ul>
    17. 19. Guidelines and Policies <ul><li>Hebrew Home for the Aged (Holmes, 1995) </li></ul><ul><li>Hamilton, Ontario Geriatric Education Cooperative (Schindel Martin, 2002) </li></ul><ul><li>www.fhs.mcmaster.ca/mcah/cgec/toolkit.pdf </li></ul><ul><li>Illinois Council on Long Term Care (Kuhn, 2006) </li></ul>
    18. 20. <ul><li>Orientation and training </li></ul><ul><li>Case discussions </li></ul><ul><li>Role playing & games </li></ul><ul><li>Videos </li></ul>Building Knowledge & Skills

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