Sexuality through the life-cycle - The elderly Dementia

1. Dementia presents special difficulties for the older
woman and her partner. Common sexual
consequences of dementia include anhedonia,
depression, impotence, incontinence, and
anorgasmia. During the early and middle stages of
disease, however, sexual intimacy remains a viable
option for couples.
2. Some individuals feel better withdrawing from
their partners prematurely because of guilty
feeling about continuing sex in light of the
cognitive impairment. Role changes, distaste for
sexual intimacy because of poor hygiene, or as a
means of coping with the increasing demands of
caregiving are also reasons for stopping sexual
relationships.
3. Desexualization of the demented spouse often
helps the caregiver meet the personal and intimate
demands of caregiving.
4. As individuals develop dementia, touch may no
longer be perceived as pleasurable or soothing.
Physical touch and intimacy may result in
increasing agitation or anxiety.
5. Individuals who have a minimental status
examination score of less than 15 are unlikely to
understand the nature of sexual activity and,
therefore, may be unable to give consent.
6. While overt and inappropriate sexual behavior of
demented patients is not common, caregivers may
be at risk for sexual abuse by their demented
spouses, or vice versa. Family physicians need to
explore this issue gently with the caregiver. Such
circumstances may result in the filing of elder
abuse charges.

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