As part of our ongoing Caregiver Smile Summit, I recently spoke to Dr. Pamela Pitman Brown, a credentialed professional gerontologist and a fellow in the Academy of Gerontology, about the topic of inappropriate sexual behaviors displayed by a loved one in the throes of dementia.

What Are Sexually Inappropriate Behaviors?

According to Pam, there is no one real definition of those behaviors. From a research perspective what people like Pam look for is disruptive behavior. It might be verbal. It might be physical. It might just be a little creepy.

Sometimes people might say, “Oh, somebody made an advance toward me and it was an old guy.” It’s where people get a little squeamish.

Pam related a story: “My great grandmother had cognitive impairment and we would find her occasionally down the street with no clothes on, having tea with the queen of England in someone’s kitchen. Is this normally what she would have done? Exhibitionism is something we would not consider normal behavior.”

Anywhere from 3–25% of older adults with cognitive impairment may display inappropriate sexual behaviors, sex talk, nudity, comments that are inappropriate, and more.

Think About the Context Before Acting

When you’re dealing with someone with cognitive impairment, they may not know who you are. Think about context. Think about the behavior. Would the person do this in a normal situation? Most of the time the answer is no. Cognitive impairment does affect your judgment.

Pam’s grandmother was the sweet, wonderful little old lady. And then she became cognitively impaired. She was mean as a snake. As you understand this, the same personality changes can affect an older person’s sexual attitude and their behavior, and we also know it affects their judgment.

Consider what medications the person is on because there are some medications that actually inhibit sexual behavior while other combinations may really impair the person’s cognitive ability. Also, consider traumatic brain injury, a big issue we see with aging veterans.

What if the individual has already been diagnosed with bipolar disorder or another mental illness? This also will affect their brain. Alcoholism really changes how your brain operates, particularly if you’ve been a chronic alcoholic.

Often the behavior is a symptom of an underlying issue. It’s not that the individual is choosing to act this way, and that is something that you absolutely have to understand.

Think about this. People are sensitive to their clothing – how it fits, how it feels, the material it’s made of. Older adults are sensitive as well. Is it scratchy? Is it itchy? What do we do when we come home from work? Typically, change our clothes.

Older adults may not have the cognitive ability to realize they have to be in the privacy of their home to take their uncomfortable clothes off. They just want the clothes off, period.

These are some cues that caregivers need to consider before panicking. Maybe it is something as simple as the clothing being uncomfortable. So, address the small things first.

Redirection is a great way to diffuse situations. Tell your loved one something like, “I bet that shirt is itchy. Let’s find you a better shirt.” Another tactic is to look at how the clothing operates. Find things that are difficult to take off.

Find Legal Counsel

Consult with an elder attorney. He/she needs to be aware of what is happening. A lot of times inappropriate sexual behaviors will lead to removing a parent from a home. 

For the person with dementia, these behaviors are not sexual in nature. You are not looking at an individual who is posing harm to society. They’re not a pedophile, and they would never do this if they did not have cognitive impairment.

It is very important to document everything. Is this behavior becoming more aggressive? Discuss the situation with Mom or Dad’s physician.

More Community Education Needed

I asked Pam if she thought law enforcement and communities are being sensitized and educated around the issues. She said that the laws have not caught up with the sheer number of older adults that we have.

You can take away the car keys from your loved one, for example, but will that actually stop an older adult from driving? Maybe not. They can still go to a mall, can go to a store, can go anywhere. And they can act out.

Laws for indecent exposure are on the books. Every state has different ages that they prosecute. So, a loved one could be arrested. Typically, the charges are dismissed, especially if you have been documenting the situation.

Long-Term Care

Sex and seniors is a topic that gets a lot of attention. It happens in senior communities, which boast some of the highest rates of sexually transmitted diseases. Legitimate and consensual is one thing. But what about inappropriate behaviors?

The industry is just starting to recognize and train professional caregivers in this area. If something is going on and you witness it, you need to also make sure that the staff is aware.

Most of the staff has seen a lot more than you have, so this is not going to be shocking to them. What is going to upset them is you seeing it and not reporting it.

Pam described a new term to me called “skin hunger.” It’s the reason newborns are immediately given to their mother. People want to touch people. We want them to touch us. Touch is extremely important.

I never quite understood the need by people living with dementia to have stuffed animals or baby dolls. Now I get it. You can hold them, snuggle them. You have something providing touch.

If a person has a stuffed animal, people are going to want to talk to them. They need that attention. A baby doll gives a person something to care for, and it brings back a piece of their past.

Pam says that sometimes, it’s just simply about making sure that your loved one feels safe and secure.

You can hear Pam during our 2019 Caregiver Smile Summit. We will announce all the speakers on June 1. But you can pre-register here. When the Summit goes live in November, you will have immediate access to 39 sessions featuring 43 experts.

What do you consider a sexually inappropriate behavior? Have you witnessed a scene that would qualify as such? How did you respond? What do you think would have been a better response? Please share your thoughts below.

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