Living with dementia magazine February 2011

Your questions

Our National Dementia Helpline handled nearly 20,000 enquiries last year. Every month, we publish frequently asked questions and situations our callers need help with, along with advice from trained members of the team. This month, Alex Clay addresses sex and dementia.

Dementia causes many changes in people's lives. One area in which there are often changes, but which is seldom discussed, is that of intimate relationships.

People with dementia often experience confused thoughts and feelings. As the 'control centre' for behaviour and emotion, the brain determines sexual feelings, good manners and inhibitions. This means that in a person with dementia, sexual feelings can change unpredictably.

Depending on which parts of the person's brain have been damaged, and what medication they are taking, a person may experience more or less interest in sex, changes in their inhibitions and sexual 'manners', and more or less ability to perform sexually.

It can be difficult for couples to adapt to such changes. Many carers feel a mix of emotions as a result, ranging from upset and loss to guilt, anger and frustration.

However, everyone is a sexual being, regardless of their age, ability or sexual preference, and has the right to express their sexuality without fear of disapproval. This is no less the case for people with dementia.

Knowing where to start

Helping someone manage their sexuality may be as important as helping them to manage any other area of life, such as hygiene or personal interests. However, prejudices around sex, older people and dementia can create obstacles, particularly for people with dementia in residential care.

Anti-social sexual behaviour can be quite surprising and appear invasive. It is often perceived as 'challenging' behaviour, and it can be unhelpful when care professionals linger on the 'inappropriate' or 'shocking'. Prejudices can make it hard to realise that issues of intimacy, sensuality and identity are all mixed up in sexuality.

Following the principles of person-centred care - that is, seeing the person as an individual and focusing on their experience and perspective, is a good starting point in establishing how the person's thoughts may be triggering any unusual behaviour.

Much can be done to help the person live well in their environment through care strategies and awareness of their personal history, relationships and sexual orientation.

A caller's question

'My brother has dementia. He keeps pinching the care workers' bottoms, and he's even got into a female resident's bed. The home say they can't have him again. Please help!'

Possible strategies

• An understanding of your brother's personal history and his life with his current/previous partners will help. Is he confusing someone with a life partner, or under the impression that certain residents are proposing sex?
• Is he missing sociable physical affection, such as hugs or interaction with others? Are people 'connecting' with him?
• Music, art, reminiscence and massage therapies, and magazines or visual aids can re-channel energies through creativity, memory or stimulation.
• Is your brother dressed in the way he is used to? Maintaining a person's appearance can help anchor them to their sense of self and previous behaviour.

Our factsheet, Sex and dementia (514), has good advice for carers and care professionals. For a free copy, call Xcalibre on 01628 529240 or read it at alzheimers.org.uk/factsheets