What can I do?
Recognise and respect:
- That older adults can still be interested in sexual expression and be sexually active.
- All relationships (existing and newly formed) without judgement or discrimination.
- That sexuality takes many forms; some may have several partners, connections or romances.
Recognise and support the family of choice of clients and residents and involve them in care planning.
Respect a person’s right to privacy and knock on the person’s door, then wait for an answer before entering.
Treat clients and residents with respect and keep their sexuality needs confidential.
Support clients and residents if sexual harassment or abuse is suspected and report to appropriate staff.
Check if your organisation includes in its policy, matters related to sexual expression for clients and residents.
Be mindful that some older people may have experienced trauma in the past including that due to their sexuality, sexual choices or gender identity.
Use the Mosaic app for tips on more inclusive care of older LGBTI people.
Engaging in the conversation
Talking about sexuality requires sensitivity and training to have the capacity to understand a person’s experience and needs and respond to their questions. Social workers or counsellors may be suitably skilled to help.
You can start a conversation with ‘Has your illness changed your family relationships, your life as a couple, your ability to get physically close to your spouse/another person?’ This signals that you are open to these issues and the person can choose to focus on general family relationships or more intimate emotional and/or physical issues.
In a residential care facility, an initial conversation may include 'My name is xxx and you can call me xxx. How would you like me to address you? Each person is unique in this home. What things could we do to make you feel more included and part of this family? Here in this home, we feel sex is a normal part of ageing. Is there anything that we can do to assist you?'
Use guided and open-ended questions such as 'Many people at your age or with your medical problem report changes or difficulties with sex. Is there anything you’d like to ask me or check with me?' or ‘How has this illness affected the way you feel about yourself or your relationship with your partner?’
Care-related issues that might prompt a conversation
If you suspect the following care issues, it is advisable to talk to the person:
- sexually transmitted infections (STIs)
- suspected sexual abuse
- changed or inappropriate behaviours.
Information and services
You can assist a person to access relevant information and services about:
- sexual dysfunction
- preventing and treating sexually transmitted infections (STIs)
- identifying as older lesbian, gay, bisexual, trans and gender diverse, or intersex person
- sexual harassment and abuse.
Consult the Stocktake of elder abuse awareness, prevention and response activities in Australia (905kb pdf) particularly its Directory of Key Services (p.107) if you suspect sexual abuse of an older person.
Remember that sexual expression for a person with dementia may be a straightforward expression of sexual needs, but there are many other possible reasons for behaviour that seems sexual. For example:
- A person might be expressing a need for closeness and comfort.
- A person might be indicating that they feel bored or physically restless.
- A person who seems to be exposing themselves might be indicating a need to go to the toilet or that they are too hot.
Note that people with dementia and their partners are unlikely to spontaneously raise their experiences of relationship and sexual difficulties. Ask about changes in their relationship to see if they need help expressing intimacy and sexuality.
Provide to older couples living with dementia in the community, practical information regarding services that can assist with daily tasks such as cleaning, cooking, shopping, managing finances etc. This can lessen the burden on the spouse carer and leave opportunity for the couple to do pleasurable activities together.
When working with couples living with dementia, ask them how if they have any challenges associated with communication, and how they manage conflict associated with communication. This can guide the types of support and coping strategies that will help them.
Pass on to families of residents living with dementia Sexuality and people in residential aged care facilities: A guide for partners and families
Check out information and tips in this recorded presentation The Elephant in the Room: Sexual Expression of People with Dementia of Dr Cindy Jones.