Sexual behaviors in dementia patients
Teodoro, T1; Martins, M2; Salgado, J1
1: Centro Hospitalar Psiquiátrico de Lisboa, NOVA Medical School, Portugal; 2: Centro Hospitalar Psiquiátrico de Lisboa, Portugal
Objectives: Review of literature about the sexual behaviors in dementia, including inappropriate sexual behaviors (ISB), in patients living in nursing homes, assisted-care facilities and patients admitted to acute inpatient units.
Material and Methods: Non-systematic review of literature using PubMed database with the following keywords: “dementia”, “cognitive decline” and “sexual behaviors”.
Results: In clinical practice, when discussing sexuality in this group of patients the focus tends to be on the so-called ISB. This concept is ill-defined and due to prejudice may be misleading in the sense that patients’ sexual interests are often perceived as behavioral problems. In fact, against popular perception, hypersexuality is a rare event and increase of sexual demands more often express misunderstood normal affective needs. Indeed, sexual dysfunctions are more common, namely sexual indifference related to blunted affect and apathy. Changes associated with major neurocognitive decline (disinhibition and apathy) may account for much of the distressing behaviors, including difficulty in adapting to the environmental context and accounting for the feelings of others. In healthcare and residential settings the expression of sexuality and apparently inappropriate sexual expression are often source of concern and distress for caregivers. Non-pharmacological interventions appear to be more effective although several drug treatments have also been proposed when there is insufficient response. There is currently no empirically established treatment algorithm for dementia-related ISB.
Conclusions: Sexuality and its expression are essential human needs throughout the life cycle, including in older patients with cognitive decline. The overall stigma associated with ageing (ageism) includes a simplistic view of the role of sexuality in older adults that should be diminished by psychoeducation of patients and caregivers. Further studies dedicated to this subject are also necessary to further clarify what is considered normal and provide better care for patients themselves, families and professionals who care for these people as well as to develop appropriate clinical guidelines.
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