Highlights
- •We explore barriers to enjoyment of human rights to sexuality of persons with dementia and remedies for addressing these.
- •Persons with dementia living at home or in care face systemic barriers to enjoyment of sexuality fueled by ageism, apathy and ignorance, compounded by complex legal barriers relating to consent. This can be tackled with awareness raising and education of care staff, families and physicians, including training for capacity assessment using a dimensional, noncategorical conceptualization of capacity, leaving room for supported decision-making.
- •Stakeholder education strengthened by legislative and human rights frameworks catering to the specific needs of older people may allow people to exercise their human rights to enjoy sexuality in a safe and lawful manner.
Abstract
We explore barriers to enjoyment of human rights to sexuality of persons with dementia
and remedies for addressing these. Enjoyment of sexuality is contingent upon actualization
of rights to dignity, autonomy, respect for will and preferences, abuse safeguarding
and equitable access to highest standards of sexual health. Persons with dementia
living at home or in care face systemic barriers to enjoyment of sexuality fueled
by ageism, apathy and ignorance, compounded by complex legal barriers in relation
to consent. Such challenges can be tackled with awareness raising and education of
care staff, families and physicians, including training for capacity assessment with
dimensional, noncategorical conceptualization of capacity, leaving room for supported
decision-making. These measures, together with strengthened legislative and human
rights frameworks to cater to the specific needs of older people, may allow people
to live well with dementia and exercise their human rights to enjoy sexuality in a
safe and lawful manner.
Key Words
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References
World Health Organization. Sexual and reproductive health and research (SRH), including the Human Reproduction Programme (HRP). Sexual Health. Available at: https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health. Accessed April 16, 2021.
- Attitudes of elderly women regarding the expression of their sexuality.Aquichan. 2019; 19: e1934
- Chapter 2 Capacity and relationships.Capacity and the law. 3rd ed. Australasian Legal Information Institute (AustLII) Communities, 2019 (Available at:) (Accessed April 30, 2020)
- Convention on the Rights of Persons with Disabilities.(United Nations) Office of the High Commissioner, Human Rights, United Nations2006 (Accessed April 20, 2021)
LB Tower Hamlets v NB & AU [2019]EWCOP27 at [41]
European Court of Human Rights. Guide on article 8 of the European Convention of Human Rights Available at: echr.coe.int/Documents/Guide_Art_8_ENG.pdf. Accessed April 20, 2021
- Citizenship, human rights, and dementia: towards a new embodied relational ethic of sexuality.Dementia. 2016; 15: 315-329
- IPA and WPA-SOAP joint statement on the rights of older persons with mental health conditions and psychosocial disabilities.Int Psychogeriatr. 2021; (Online ahead of print): 1-5https://doi.org/10.1017/S1041610221000454
- Ageism & Sexuality. In: Liat Ayalon & Clemens Tesch-Römer (eds) Contemporary Perspectives on Ageism.Int Perspect Aging. 2017; 19
Srinivasan S, Glover J, Tampi RR, et al Sexuality and the older adult current psychiatry reports. Curr Psychiatry Rep 2019; 21: 97.
- Dementia, sexuality and the law: the case for advance decisions on intimacy".Gerontologist. 2020; (Online ahead of print): gnaa139https://doi.org/10.1093/geront/gnaa139
- Their only privacy is between their sheets: privacy and the sexuality of elderly nursing home residents.J Gerontolog Nurs. 1999; 25: 37-41
- Sexual behavioral changes in Alzheimer disease.Alzheimer Dis Assoc Disord. 1996; 10: 86-92
- Sexual problems in older adults.in: Kar N. Kar G.C. Comprehensive Textbook of Sexual Medicine. Jaypee Brothers Medical Publishers, India2013
- Sexual aging: a systematic review of qualitative research on the sexuality and sexual health of older adults.Qual Health Res. 2019; 29: 1239-1254
- Cognitive functioning and its influence on sexual behavior in normal aging and dementia.Int J Geriatr Psychiatry. 2014; 29: 441-446
- The influence of organizational factors on the attitudes of residential care staff toward the sexuality of residents with dementia.BMC Geriatr. 2019; 19 (8)https://doi.org/10.1186/s12877-018-1023-9
- ‘We need to know what's going on’: Views of family members toward the sexual expression of people with dementia in residential aged care.Dementia. 2014; 13: 571-585
- New relationships and intimacy in long-term care: the views of relatives of residents with dementia and care home staff.Dementia. 2018; 17: 405-422
- Intimacy and sexuality in institutionalized dementia care: clinical-ethical considerations.Health Care Analysis. 2014; : 1-20
- Love, intimacy and sexuality in residential dementia care: a spousal perspective.Dementia. 2019; 18: 936-950
- Cognitive impairment, sexual activity and physical tenderness in community-dwelling older adults: a cross-sectional exploration.Gerontology. 2018; 64: 589-602
- When it faded in her…it faded in me”: a qualitative study exploring the impact of care-giving on the experience of spousal intimacy for older male caregivers.Ageing Soc. 2021; 41: 29-50
- A caregiver perspective of how Alzheimer's disease and related disorders affect couple intimacy.Aging Mental Health. 2011; 15: 950-960
- Variability of judgments of capacity: experience of capacity evaluators in a study of research consent capacity.Psychosomatics. 2011; 52: 346-353
- Consistency of physician judgments of capacity to consent in mild Alzheimer's disease.J Am Geriatr Soc. 1997; 45: 453-457
- What do doctors know about assessing decision-making capacity?.New Zealand Med J. 2018; 131: 58-71
- Physicians' response to sexual dysfunction presented by a younger vs. an older adult.Int J Geriatr Psychiatr. 2017; 32: 1476-1483
- Sex for seniors: how physicians discuss older adult's sexuality.Israel J Health Policy Res. 2020; 9: 1-9
- Piloting the Global Capacity Education e-Tool: can capacity be taught to health care professionals across different international jurisdictions.Int Psychogeriatr. 2019; (Online ahead of print): 1-4https://doi.org/10.1017/S1041610219000723
- Older people in care homes: sex, sexuality and intimate relationships.R Coll Nurs. 2018;
Care Quality Commission. Relationships and sexuality in adult social care services Promoting sexual safety through empowerment A review of sexual safety and the support of people's sexuality in adult social care 2020; Available at:www.cqc.org.uk/sites/default/files/20200225_sexual_safety_sexuality.pdf. Accessed June 21st, 2021.
- Supporting residents' expression of sexuality: the initial construction of a sexuality assessment tool for residential aged care facilities.BMC Geriatr. 2014; 14: 82
- Nurses’ experiences and reactions towards intimacy and sexuality expressions by nursing home residents: a qualitative study.J Clin Nurs. 2019; 28: 836-849
- Sexuality and intimacy in the nursing home: a romantic couple of mixed cognitive capacities.J Clin Ethics. 2000; 11: 309-313
- Rendering visible the previously invisible in health care: the ageing lesbian, gay, bisexual, transgender and intersex (LGBTI) communities.Med J Australia. 2018; 209: 106-108
- Assessments of institutionalized dementia patients' competencies to participate in intimate relationships.Gerontologist. 1990; 30: 117-120
Peisah C. Tiwana Benbow SM. Sexual expression, consent and capacity in residential care: a person-centred, human rights approach Book of Proceedings of the 1st Annual International Capacity Conference http://capacityaustralia.org.au/wp-content/uploads/2014/10/printed-Hong-kong-Booklet.pdf
- Sexuality and dementia: for better or worse.Old Age Psychiatrist. 2014; 58 (Sex Dementia 1- 11)
- Embregts PJCM: love, intimacy and sexuality in residential dementia care: a client perspective.Clin Gerontol. 2019; https://doi.org/10.1080/07317115.2019.1667468
- Personal services or dangerous liaisons: should we help patients hire prostitutes?.J Barrett Br Med J. 2004; 329: 985
- Sexual advance directives.Alabama Law Rev. 2016; 68: 1-48
Article info
Publication history
Published online: May 30, 2021
Accepted:
May 22,
2021
Received:
May 20,
2021
Identification
Copyright
© 2021 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
