Nearly half of men and 18% of women with dementia were sexually active, according to results of a new study involving 3,200 seniors and recently  published in the Journal of the American Geriatrics Society.

A research team of gynecologists, gerontologists and palliative care specialists estimated that at least 3.2 million Americans living at home with suspected or diagnosed dementia are sexually active. Forty-one percent of those ages 80 to 91 were still sexually active. However, few men (17%) and almost no women (1%) with dementia had talked with a doctor about sex.

The study found the more cognitive impairment a participant had, the less likely he or she was to have had an intimate partner. In addition, 12% of women and 17% of men with dementia said they had sex out of obligation; 10% said they felt threatened or frightened by a partner.

“People with more severe cognitive impairment are at higher risk of sexual victimization, a concern that has driven restrictive policies and even legal action against spouses of people with dementia,” researchers wrote. They suggested better guidelines be created for elder abuse screening and standards of consent.