It is not uncommon to encounter sexually inappropriate behaviors in dementia care. And while dignity and an allowance for as much natural human behavior are generally accepted, a line must be drawn when patients or staff are at risk for sexual harm. These behaviors may range from flirtation to attempted rape and every place in between.
Generally speaking, the appropriate initial response to such behavior is safety followed by clear documentation of exactly what happened. Any suspected victims should be treated both physically and psychologically after the responsible patient is separated from them.
The patient in question should also be evaluated both medically and psychologically in order to get some sense of why this behavior is happening. For some, there may be a long history of predation while for others it is a totally new behavior. Possible causes of such behavior include medications, particularly antidepressants, infections or any other cause of delirium. It is important to understand that dementia itself, under the right circumstances, may be the lone cause of such behavior.
Treatments start with safety followed by an understanding and treatment of the cause of the behavior. It may be as simple as getting rid of an antidepressant medication or it may be a complicated challenge which lasts years. Low dose mood stabilizers may help and some even resort to hormonal therapies. To be sure, placement options will diminish drastically for any patient having a history of sexual behaviors.
Douglas Wornell is the author of Sexuality and Dementia:Compassionate and Practical Strategies for Dealing with Unexpected or Inappropriate Behaviors. Check out his book for more tips and advice on living with or taking care of a person with dementia.