Inappropriate Sexual Behaviour
| Management Strategies
- Redirection. Rather than a "you must never do that again" approach - for which all the person might remember is shame or anger.
- A sense of humour. It is said that the formula for humour equals pain plus distance; when a socially painful episode fades, humour can creep in. This is especially true of the "gallows humour" that helps many caregivers cope. For example, a humorist made his audience squirm through a story about his catching his demented father masturbating and the laughter that filled the room with the ending of the story was a mixture of glee and relief. But, the point was made that the difficult times will pass and that some of them will allow the expression of a loving tenderness, even when at the time the emotions were more at the pity and even humiliation part of the scale.
- Like everything else in this area, there is another side to humour. For example, some nursing staff use humour very effectively to deflect a person's verbal or physical inappropriateness (e.g. "You'd never be able to handle me." or "I'd spoil you for all other women."). In their view, they give as good as they get, and they are not bothered by the behaviour.
- In a nursing home or long term care setting, humour can sometimes be used as a means of caregivers coping with something that they find troubling. It is impossible to expect that someone whose own attitudes towards sexual activity and desire are not fully resolved to have a fully resolved attitude towards sexual behaviour - especially inappropriate behaviour - on the part of others. This is an instance where the family and the caregivers can support each other. Sometimes, this behaviour must be accepted with a certain equanimity because there is little that a family can do.
- Inappropriate sexual behaviour is a very difficult symptom to manage. Family and caregivers alike can feel embarrassed and inadequate as providing intimate care to a person who is sexually disinhibited is a difficult task that requires a high degree of skill.
- Family members and paid care providers sometimes feel a sense of shame or guilt themselves at somehow being responsible for the inappropriate behaviour of the person with dementia. This can happen with many behaviours, but more often so with sexual ones.
- As human beings, we are hard wired to treat our burdens by sharing them. By all means find someone - a trusted friend, or a health care professional, to whom you can talk about having to cope with inappropriate sexual behaviour.
- A variety of medications have been tried. These include drugs that alter sex-hormone levels, as well as drugs that are otherwise used as anti-depressants, anti-epileptics or antipsychotics. Drug treatment can be effective, but controlled clinical trials are lacking, and because any drug has side effects, there still is not a good understanding of the likely potential for a drug to help a person with this problem, in relation to its potential to harm that person with a side effect.
- It is very tricky to both reassure and help the person who has been offended, while also dealing with the person who is behaving inappropriately. This is especially the case if the person who has been offended is a stranger, or if there is any real threat to that person's safety. In those situations, the emphasis must be on protecting the offended person. But, in many circumstances, it is possible to recognize that the person with dementia really does not intend to give offense; they are as unwitting a participant as the person who has been offended. A card that says, for example, "My husband has Alzheimer's disease " can sometimes be passed to a person (or a helpful bystander) so that the focus can be on the person with dementia.