Frisky Alzheimer's residents: 'ew' or 'aw'?

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John O'Connor, editorial director, McKnight's Long-Term Care News
John O'Connor, editorial director, McKnight's Long-Term Care News

Alzheimer's disease is very good at taking. It takes away memories. It takes away personalities. It can be argued that Alzheimer's essentially takes away a person's essence.

And as almost anyone who has spent time in a senior living facility can tell you, it can also take away sexual inhibitions. Clinicians have a fancy term for this development: hypersexual behavior. Up to 17% of people with dementia opt for this particular form of personal expression, according to published reports.

In senior care settings, it can be seen in obvious and subtle ways: jealous accusations that a spouse is being unfaithful, sexual overtures to staff or other residents, extramarital relationships and even public masturbation.

Other less extreme examples include vulgar/obscene language, publicly exposing oneself and other forms of another fancy term: disinhibition. All of these behaviors can raise awkward issues.

The basis for such behavior is not completely clear. But a new study in the April Archives of Sexual Behavior offers some insight. According to investigators, hypersexual behavior may be a particular feature of behavioral variant frontotemporal dementia.

At the risk of sounding overly technical, they are arguing that such behavior is more than just cognitive impairment with frontal disinhibition. Alterations in sexual drive, possibly from right anterior temporal-limbic involvement in this disease are also at work.

That last paragraph is a mouthful. But one takeaway here may be that hypersexual behavior is not just the result of a resident no longer caring about whether behavior is inappropriate or immoral. In a way, the disease is creating a new person who views such actions as being as normal as eating. And if the rest of us don't like it, that's our problem.

Which gives long-term care operators a new twist to deal with. One helpful book on this subject is Sexuality and Long-Term Care by Gayle Doll. One of its features is helping facilities examine policies around relationships and sexual behavior. Major concerns include avoiding any sexual exploitation, abuse or assault and determining the individuals' ability to give meaningful consent.

But if these new findings are correct, facilities may have to expand the way they address residents who are literally becoming uninhibited versions of their former selves. In the past, the strategy at many facilities – and I'm using the term “strategy” very loosely here – has been to divert the demented resident expressing hypersexual behavior into other areas.

But what if those approaches fail because they are not dealing with the root cause – a person who wants to express her- or himself sexually and sees no reason not to? The historic option of choice here has been to bring on the powerful medications.

Anyone notice how much good PR that approach has been generating lately?

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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