Breaking the Taboos

How carers respond to erotic touch and touching to further intimacy between people with dementia reflects the wider culture of care. A care service team who is able to view the possibility of people continuing to enjoy sexual and romantic experiences as they age in a positive way is demonstrating true person-centredness in action.  

Unfortunately, many care providers struggle to put this philosophy into practice when it comes to people’s sexual needs. In failing to recognise the need for sexual intimacy as a basic human need, carers often stumble at the very first hurdle.

Overcoming this hurdle involves us breaking the taboo and talking about sex, old age and dementia. Honest and open discussions with all the parties concerned lay the foundations for a person-centred approach to the sexual needs of an older person or a person with dementia. Without this important bit of groundwork, it is much more likely that carers will see a problem to suppress when people express their sexuality.

In framing erotic touch such as masturbation or the need for intimacy with others as a behavioural problem, carers will also struggle to understand the kind of relationships and emotional needs these types of touch convey. 

The formation of a new physically intimate relationship between two people with dementia can be a precious and valuable thing – precious because it involves overcoming the challenges to forming relationships that old age, cognitive impairment and care settings can impose; valuable because it can be a profound source of security and well-being. Sexual intimacy between people with dementia must have a place in person-centred dementia care.

To help you begin this conversation in your care setting here are some possible questions to get you started –

For care teams:

• How much do you think sexual expression continues as we age and if we develop a dementia?
• Why do you think we might sometimes find it difficult to talk about these things with people?  What are the messages we received whilst we were growing up about the topic of sex?
• What can we do better to support couples to still enjoy private time together?

For people we support

• How has dementia/your illness/living in a care home affected your close relationships?
• How can we support you to still enjoy closeness with your spouse/partner if you miss this?
• It can be hard not having much physical closeness with people other than when you are receiving personal care.  Are touch, hugs and sexual closeness important to you?   

For spouses/partners of people you support

• I hope you don’t mind me asking but do you feel able or want to discuss the intimate aspects of your relationship?
• In what ways is your relationship different now to before your partner had dementia/became ill?
• Are there ways in which we can support you to still have some private time with your wife/husband?

Not everyone in the team will feel able to start up these conversations and it is important to know the right time and place to do this sensitively.  But by breaking the taboos, we can start to create an atmosphere of openness where people can feel safe to share more.