Preventing and managing sexual disinhibition or inappropriate sexual behaviour

The following scenario describes the recommended approach and responses to preventing and managing sexual disinhibition. Below the flow chart you will find specific strategies to manage inappropriate sexual behaviour.

Managing sexually inappropriate behaviour depends upon the intent of the perpetrator and the perception of the receiver. Effective management depends upon staff maintaining the resident’s dignity and responding to their behaviour calmly and objectively. Management will also depend on what ‘gains’ the person is getting from this behaviour.

The most common forms of behaviour that are regarded as ‘inappropriate’ or ‘problem’ sexual behaviours are:

Indiscreet behaviour:

Description:

A suggestion of sexuality (lewd jokes; flirtatiousness; hugging and / or kissing). ‘Indiscretions’ are generally felt to be inoffensive or acceptable.

Management:
  • Identify the person’s lifetime patterns of behaviour
  • Understand the effect that dementia has on the person’s impulse control
  • Allow opportunities for the person’s need for companionship, affection, intimacy or privacy to be met. Ignoring their needs or preventing fulfilment of needs due to your own distaste will not resolve the issue
  • Identify events that may trigger behaviour

Sexually explicit actions:

Description:
  • Fondling & /or masturbation
  • Urination
  • Disrobing

Carers often perceive the behaviour as being deliberate

Management:
  • Establish if masturbation or sexual fondling are a need for sexual gratification. Provide privacy and quietly redirect the person away from public areas. Maintain persons dignity
  • Behaviour may not be sexually directed but may be a result of infection (e.g. urinary tract infection or thrush); or pain which needs to be investigated by a physician
  • Establish toileting routines; provide orientation cues to toilet
  • Check degree of persons discomfort: e.g.are they disrobing due to tightness of clothing or because they are too hot?

Obscene or explicit language:

Description:
  • Is often difficult not to take personally, or to respond to objectively
Management:
  • Is the behaviour a lifelong habit?
  • Is the behaviour a result of frontal brain damage & / or communication difficulty
  • Identify the triggers. Modify the environment / staff approaches.
  • Refer to aggression cycle

Harassment:

Description:
  • Touching; indecent approaches
  • Often occurs during personal care regimes
Management:
  • Touch fosters a sense of identity, self esteem and meaningful relationships
  • Has a language / communication problem meant they are unable to communicate e.g. : they are unable to find the toilet or indicate they wish to urinate?
  • Establish a management routine that encourages appropriate periods for companionship or intimacy
  • Identify appropriate pleasurable activities and incorporate in client’s management plan to encourage acceptable behaviour

Sexually inappropriate behaviour

Myths about sex and old age
  • Old people can't or don't do it
  • Old people don't enjoy sex
  • Old people are not sexually attractive

(Source: Sherman B. 1998)

Effects of dementia on sexuality

Of all the people with Alzheimer's type dementia:

  • 87% will experience decreased sexual activity
  • 13% will experience increased sexual activity
  • A minority will exhibit a decreased sense of decency or do embarrassing things

(Source: Derouesnee et al 1996)

References and recommended reading

Philo, S.W. Richie, M.F. & Kaas, M.J. (1996). Inappropriate Sexual Behaviour. Journal of Gerontological Nursing, Vol.22:No.11., pp.17-22.

Derouesnee, C. Guigot, J. Chermat, V. Winchester, M. & Lacomblez, L. (1996). Sexual behavioural changes in Alzheimer's Disease. Alzheimer Disease and Associated Disorders, Vol.10:No.2.

Sherman, B. (1998). Sex, Intimacy and Aged Care. Australian Council for Educational Research Ltd. Melbourne.