Finding humor in absurd situations.

As a family caregiver, dementia-related inappropriate sexual behavior can be shocking and upsetting.  As professional caregiver, it can be confusing and frustrating, as kindness toward a patient with Alzheimer’s and other dementia-related diseases is sometimes misinterpreted. In one my recent caregiving workshops, a woman shared a story about her 83 year-old husband who had developed a fervent crush on his 35 year-old physical therapist. He had suffered a severe stroke, and as the young therapist worked with him to regain the use of his right hand, he misinterpreted her kindness and attention as sexual interest. He talked openly about his sexual desire for her, and when she refused to have sex with him, he went to the facility’s administrator and claimed he was being abused and neglected by his therapist. Understandably, the therapist was upset, and the man’s wife was embarrassed and angry with him.

It was easy for everyone to understand and accept that the problems he had speaking, walking, and using his hand were a result of the stroke. Once his wife and the therapist understood that his inappropriate sexual behavior was also a result of the damage his brain had suffered from the stroke, and that it was dementia related, it was easier to forgive him and accept that his actions were not a reflection of his affection for his wife or a result of any suggestions or advances made by the therapist.

According to Joyce Graves, Program Director for the Southwest Health Center, Senior Behavioral Sciences in Platteville, WI, when working with patients with dementia related illnesses, it is important to maintain a professional relationship with the patient. If a patient starts to express a sexual interest in his professional caregivers, it helps to call them by name – Mr. Smith or Mrs. Brown rather than calling them endearing names such as “sweetie”, “honey”, “darling”, or even their first names. Instead of saying, “Let’s go to bed,” say something like, “It’s time for you to go to sleep now”, or “It’s time for you to rest.” When assisting them in the bathroom, be especially careful of where you position yourself in relation to their body, and be careful of what you say. Comments like, “Let’s get those pants off,” or “Let me help pull those pants down,” can be misinterpreted by a person with dementia.

Appropriate clothing, professional behavior, and firm, consistent responses are helpful. Even so, it may not quell their desire. If the situation continues or escalates, some facilities have found that it is helpful to switch caregivers. One administrator from a memory care facility reassigned the personnel so that an elderly man with an ardent affection for a young CNA got help with his bathing and toileting needs from a big, burly man rather than female staff.  Hormone imbalances can also affect a person’s sex drive.  Doctors sometimes will prescribe antidepressants for a person displaying inappropriate sexual behavior, as these medications can diminish that drive.

(Recorded at the Wisconsin State Conference on Alzheimer’s and Related Diseases, May, 2010.)