As we age, our lives change and it’s impossible to know how these changes will affect us until they happen to us (or to the elderly loved ones in our care).
Take sex, for instance. In our youth-worshiping culture, older people aren’t seen as sexual beings, yet research shows that many seniors enjoy physical relationships of all kinds well into old age. But what happens to a person’s sex life when cognitive capacity changes? Spouses, family members, caregivers, long-term care facilities, and society at large are all grappling with thorny sexuality-related issues caused by age-related changes. The courts can even get involved.
Here are just a few of the many difficult questions confronted by families.
- An older man moves in with an elderly widow whose children become concerned that he is taking advantage of her even though he is providing most of her care. What should they do?
- A person with dementia whose cognitive capacity comes and goes is discovered having sex with a family friend. Is it possible to determine whether the decision to consent to sex was made during a lucid moment? If not, it is rape?
- A person in a nursing home who has lost inhibitions is exposing himself to residents and touching them in unwanted ways. Should the “offender” be punished as the family of the person touched inappropriately wants him to be?
- A married man with Alzheimer’s disease is living in a nursing home while his wife lives independently in the family home. If the man begins an emotional or physical relationship with a woman in the nursing home, is it infidelity? What should be done?
- If a nursing home resident with the type of dementia that causes hallucinations claims that another patient or an employee of the facility behaved inappropriately, how do you determine whether the incident actually happened?
- An Alzheimer’s patient claims that she’s having a sexual relationship with a resident of her memory care unit. Is it real or is she imagining it?
- The children of a woman in a nursing home stop by for an unannounced visit. They walk in on their mother during an intimate encounter with another resident. What rights do the children have to stop the relationship just because they don’t agree with it, even though their mother is mentally competent?
Most families don’t encounter these problems until elderly loved ones reach a certain level of cognitive impairment or frailty. As a result, long-term care facilities often end up being the first-responders as staff members strive to balance patient autonomy with the facility’s legal obligation to provide a safe environment for residents. Some examples:
- How does a long-term care facility protect patients from unwanted contact from residents who have lost inhibitions due to cognitive impairment? How do staff members stop the behavior without interfering with patients’ rights? How do staff members balance the needs of both residents and families?
- When a resident makes a complaint about inappropriate behavior by another resident, how can staff members know for sure what is reality and what is not, especially when a person making a complaint has a chronic condition that includes hallucinations which are common with some forms of dementia?
- How does a facility balance residents’ needs for physical intimacy with the reality that one or both parties may not always be capable of giving consent?
- What can a facility do to limit the spread of sexually-transmitted diseases?
- If a patient has some competency remaining yet staff members restrict his or her behavior, how can they do so without reducing the patient’s sense of independence and control?
Every attempt to answer these questions creates more questions. What should be done? Opinions vary widely on each issue, with as many different viewpoints as there are people. For every person who thinks it’s wonderful that seniors are finding love and companionship in old age, there is someone who thinks it’s abhorrent and needs to be stopped.
Unfortunately, there are no easy answers. Every situation is different. Every situation is complicated. If you’re caring for an elderly loved one—or you happen to wake up and find yourself elderly one day—you will probably be asking these questions yourself.
As families, long-term care facilities, society, and the courts work through the issues created by changes in seniors’ sexuality, it’s important to remember that older people are just like everybody else. Just because a person is aging or dealing with a chronic illness doesn’t mean that everything in their world needs to change. In fact, for some seniors, new found love may be the very thing that makes life worth living.
For a completely irreverent take on sexuality in order adults, it’s hard to beat this clip from the Daily Show that originally aired on Comedy Central which drives home the point that sexuality among senior citizens is an issue that won’t be going away anytime soon.
