People with dementia have rights, including the right to sexual expression. To understand sexual expression among people with dementia, we must become familiar with sexual expression among older adults in general.

Sexual Expression in Older Adults

Studies show that older adults continue to enjoy intimate relationships throughout their lives.

Sexual health is an essential part of mental and physical health. Sadly, stereotypes about aging, ageism, and lack of education about sexual health in older adulthood for older adults and professionals create a perfect storm keeping older adults from getting their sexual health questions answered, including older adults living with dementia.

People all throughout their lives enjoy sex and intimacy. In fact, a recent survey¹ of more than 1,000 adults between 65-80 years old, found that 50.9% of men and 30.8% of women reported being sexually active. Yet, in this same survey, when it came to discussing sexual health with health care providers, only 17.3% of adults aged 65–80 reported speaking to their health care provider about sexual health in the past two years and of those, the vast majority (60.5%) initiated the conversation.

Researchers² have found that sex among older adults is often viewed as stereotypically “shameful, disgusting, laughable, and nonexistent”, which can lead to internalized stigma and increased sexual problems for older adults.

It’s time we shift the narrative about aging and sexuality toward a more accurate and holistic view. There are many benefits to sexual relationships over 50, including physical, cognitive, relational, psychological, and spiritual³. The sooner we can remove negative beliefs about aging from conversations around intimacy and sexual health, the better.

Sexual Expression in Adults with Dementia

Older adults with cognitive disorders, like dementia, who may experience declines in
functioning, often maintain a need for intimate connection. And, in fact… benefit from intimacy.

Benefits of Intimacy in Long-Term Care Communities

• Brings happiness, joy, & meaning to a person’s life
• Provides a sense of “home”
• Creates shared trust, warmth, humor, touch, comfort, and safety
• Enhances quality of life
• Reduces risk of depression
• Improves behaviors
• Enhances general health
• Improves well being

Risks of Sexual Expression among People Living with Dementia

Along with benefits, sexual intimacy among older adults with diminished capacity (as is common with dementia) has many associated risks and complications, like concerns about a person’s judgment and capacity to consent, questions about the person with dementia misidentifying their sex partner for another, concerns about hypersexuality, sexual exploitation, limits on privacy, and risk for falls and skin tears (to name a few).

Personal values, family values, staff values, and system values also influence decision making
as it relates to sexual expression in older adults.

For these reasons, and more, assisted living communities and families often find themselves facing complex ethical dilemmas related to intimacy, especially in the context of community care settings where two people with dementia are more likely to be in an intimate relationship.

It’s quite common that when we start to think about sex and dementia, we have many questions with no clear answers.

So often, these interpersonal, moral, and ethical dilemmas lead to professionals and assisted living communities avoiding the topic all together. Yet, this avoidance strategy may be causing more harm than good. Assisted living and memory care communities may be missing an important opportunity to honor a person living with dementia’s rights and dignity while at the same time assessing for and protecting against risk and safety for all involved.

It’s imperative Assisted Living and Nursing Home Administrators have opportunities to enhance their awareness, knowledge, and skills related to understanding risks and benefits of sexual expression among older adults in community care settings, resources for providing education to stakeholders, and tools for resolving ethical dilemmas.

Gain evidence-based tools and guidelines on navigating dementia and sexual health in the only Dementia and Sexual Health Certification program here.