Intimacy
and Sexuality
Background
Everyone
has a need for companionship and physical intimacy. People
with Alzheimer's disease or a related dementia are no different.
They may fill this need through marriage, partnership
or friendship. Whatever the relationship, it will be
affected by the changes brought on by the disease, including
changes in the need for companionship and physical intimacy.
Expressions
of physical intimacy between two people can range from
a handshake and pat on the back between two colleagues,
to hugs and strokes between friends, to sexual relations
between lovers. The closer one moves towards the more
intimate forms of expression, the greater the need for
privacy.
Relationships
with partners are unique. Each person has chosen the
other for different reasons. Relationships can be straightforward
or become more complex with the passage of time and life
experiences. Regardless of the type of relationship,
it is important that it is satisfying for both people.
Note:
For
ease of reading, the term "partner" is used
throughout this document to describe the person with
whom the person with Alzheimer's disease has chosen to
meet the needs for companionship and physical intimacy,
whether it is a spouse, partner, lover or friend.
The
issues
For
people with Alzheimer's disease:
Meeting
needs for physical intimacy: The changes in the
brain caused by Alzheimer's disease increase some people's
need for sexual relations, which may create conflict
in their relationship with their partner. For some
people, this increased need for sex is constant. If
this sexual energy is expressed in inappropriate places
or directed towards non-consenting people, medication
may be required to lessen its intensity.
Others
with the disease may find that their sexual energy and
interest are reduced due to depression. With treatment
of depression, sexual interest often returns.
The
changes in relationships and in needs of both the people
with the disease and their partners can be frustrating.
A lack of understanding and insight into the issues may
cause people to find ways to meet their needs that may
not be considered acceptable or appropriate.
Seeking
companionship with a new partner: As the disease
progresses, people may no longer recognize or remember
their partners, and may seek companionship and physical
intimacy with a new partner in a long-term care facility.
Due to the sensitivity of this issue, family members
and staff may try to prevent people from fulfilling
their needs outside of previously existing relationships.
Disinhibition: The
disease process may cause some people to lose their inhibitions
and act and behave in ways that they did not before,
or in ways that others might consider inappropriate.
This is because the usual mechanism to keep activities
in check may no longer be working. For example, a woman
may become flirtatious towards men other than her partner.
Misinterpretation
of behaviour as sexual: Some people with the disease
will react to situations in ways that are interpreted
as inappropriate sexual behaviour when the person may
actually be trying to communicate a need or convey
a response. For example, a man may remove his pants
in public to indicate that he has to go to the bathroom,
but someone may view his action as a sexual expression.
For
partners of existing relationships:
Meeting
needs for physical intimacy: The changes Alzheimer's disease causes in a person's interest in sex may conflict
with the partner's needs. Partners may feel guilty
or not know how to respond. Also, as partners take
on more of a caregiving role, the idea of physical
intimacy may become less appealing.
Seeking
companionship with someone new: Partners may have
needs for companionship and physical intimacy that
are not being met by the person with Alzheimer's disease,
and may seek to meet their needs outside the relationship.
This can create dilemmas and concern.
For
health-care professionals:
Balancing
needs: Those who provide care in long-term care
facilities may be aware of situations where a person
with Alzheimer's disease has sought companionship and
intimacy with a new partner. Health-care professionals
face challenges in determining if both parties are
willing participants and have given consent to the
new relationship, and in assisting families with adjusting
to the change.
Recommendations
It
is recommended that the needs for companionship and physical
intimacy of people with Alzheimer's disease and their partners
be met, wherever possible, and treated with respect and
dignity.
When
the physical intimacy needs of the two people in the
relationship differ, it may take open and honest discussion
and creative thinking to find ways to meet each person's
needs.
As
the disease progresses, people with Alzheimer's disease
may no longer be able to recognize their partners. The
partners will need a lot of support and understanding.
If the person with Alzheimer's disease chooses a new partner,
it is important to ensure that those involved agree to
the relationship, whatever form it takes.
For
family members and staff of long-term care facilities,
an awareness of their own feelings and attitudes toward
sexuality, sexual expression and later-life relationships
may help them to support others. Also, learning about
a person's patterns of sexual expression and intimacy
over a lifetime may give insight into current behaviour.
As well, it would be helpful for family members and staff
to look at the needs of the person with the disease and
the needs of the partner as priorities.
Staff
in long-term care facilities may also need to find ways
to provide privacy or to help partners deal with changes
in their relationships. This can include:
- finding
enjoyable activities a partner can share with the person
during visits;
- drawing
attention away from a new relationship that might upset
a partner;
- providing
overnight private accommodation for couples wishing
to be alone.
Some
partners of people with Alzheimer's disease may want to
meet their companionship and physical intimacy needs
with someone else, especially if the partner is no longer
recognized. If so, they will need support and understanding
to work through their feelings and to find ways of meeting
their needs that make them comfortable.
In
closing...
Relationships
are complex at the best of times. Add to this the changes
brought on by Alzheimer's disease and you get the kinds
of dilemmas that partners and families face. Talking
about intimacy and sexuality is not always easy but it
is a good starting point for resolving issues relating
to companionship, intimacy and sexuality in Alzheimer's disease.
Resources:
- Intimacy,
Sexuality and Sexual Behaviour in Dementia (How to
Develop Practice Guidelines and Policy for Long Term
Care Facilities). McMaster University, Hamilton,
Ontario.
[To view this PDF file, you need  Adobe Reader, available free from the Adobe website.]
- Sexuality
and the Alzheimer's Patient. E. Ballard and C.
Poer, Duke University Press, 1993.
- A
Thousand Tomorrows: Intimacy, Sexuality and Alzheimer's
Disease [videotape]. Terra Nova Films, 1995.
- Disability
Online. Victoria, Australia.
|
