June 26, 2012 -- With single beds behind unlocked doors, nursing homes do little to support sex among seniors, argues an editorial that says the elderly – even those with dementia – retain the right to a healthy sex life.
The editorial, published Monday in the journal Public Health Ethics, tackles the touchy topic of geriatric se as the early baby boomers approach their 70s.
But one in eight Americans over age 65 has Alzheimer's disease, a sobering stat that stokes safety fears among nursing home staff.
"[Nursing home] staff should keep in mind that persons with dementia have lived with their sexuality for much longer than they have lived with dementia," wrote the editorial authors, from the Australian Center for Evidence-Based Aged Care at La Trobe University in Bundoora. "It should not be up to the individuals with dementia to prove that they have the capacity to decide whether or not to engage in sexual behavior, but, rather, the onus is on staff to prove incontrovertibly that they do not."
Alzheimer's disease affects memory, thinking and behavior, raising delicate questions about a person's ability to make important decisions.
"A resident with dementia may not be able to render informed consent to an operation that has a significant risk of death but may be able to decide on what flavor of ice cream he would like for dessert," the authors wrote. And, they argue, "decisions about whether or not to engage in sexual behavior are closer to those about ice cream than surgery."
Sexuality is considered a fundamental human right, say the authors. And intimate relationships can help lessen feelings of loss and loneliness that come with age, says Robin Dessel, director of memory care services and sexual rights educator at the Hebrew Home at Riverdale in New York.
"Older adults need to have pleasures, because that's what helps counterbalance the challenges they face when they become infirmed and move into a nursing home," said Dessel, who in 1995 helped draft the home's policies on sexual expression. "Our general philosophy is that this is still a life to be lived. Your rights carry with you throughout your lifetime. It's not as though you arrive at a nursing home and you vacate those rights."
At the Hebrew Home, residents have access to private rooms, and staff members carefully read cues to ensure sexual relationships are consensual.
"I fully appreciate and never stand in judgment of nursing homes that are reluctant or concerned," said Dessel, explaining how the subject of sex can make some staff, not to mention residents' loved ones, uncomfortable. "We have to safeguard older adults, but that doesn't mean medicalizing their lives."
But relationships can be complicated, a truth compounded by the fleeting memories of dementia. . Harry Levy remembers the shock of hearing that his father, a Hebrew Home resident, had a new girlfriend.
"We decided not to tell my mother," said Levy, who was battling cancer at home as his Alzheimer's-stricken father forged a new relationship with a fellow resident. "My father wasn't my father anymore, and he wasn't cheating on my mother. We just wanted him to be happy."
And happy, he was, according to Levy.
"They spent time in each other's rooms; clothing was transferred back and forth," he said, describing his 89-year-old father's youthful romance. "He thought she was his wife and she thought he was her husband."
Dementia and Sexuality: A Touchy Subject
A similar situation played out for former Supreme Court Justice Sandra Day O'Connor, whose husband had romantic relationships with fellow residents at an assisted care facility in Arizona before he died of Alzheimer's in 2009.
"It was nice for him to have someone there who was sometimes holding his hand and to keep him company," O'Connor told the New York Times. "And I'm totally glad."
Geri Hall, a clinical nurse specialist at the Banner Alzheimer's Institute in Phoenix, applauded O'Connor's "enlightened" response.
"It's hard – very hard – particularly if it was a long, enduring marriage," she said. "But we can't medicalize this. These are very much human decisions."
The incidence of Alzheimer's disease is projected to double by 2050 as more Americans age into their high-risk decades. Nearly half of people over age 85 will be diagnosed with Alzheimer's disease, according to the Alzhiemer's Association. But demented or not, the baby boomers are not going to give up their right to a healthy sex life, Hall said.
"We're not going to put up with it," said Hall, a baby boomer herself. "We need to be open about the fact sex is something that happens wherever people live, and we can't just take away people's rights."