Dementia and Sexuality: Breaking the Silence on an Overlooked Topic

For many years, the topic of sexuality in dementia care has been overlooked or treated as a taboo subject. Conversations around sexually inappropriate behaviour or language in dementia care often make people uncomfortable, yet these issues are something caregivers regularly face. Having worked in the care sector for many years, I have witnessed how these matters can be misunderstood or mishandled. It’s time we discuss this sensitive issue with compassion, education, and a focus on the well-being of those living with dementia.

The Challenges of Discussing Sexuality in Dementia Care

One of the most common challenges caregivers face is dealing with sexually inappropriate behaviour or language in individuals with dementia. This can range from inappropriate comments to physical actions that are out of character for the individual before their diagnosis. These behaviours are often a result of changes in the brain caused by dementia, and it's important to understand that they are not intentional, nor do they reflect a person’s true desires. Instead, they are symptoms of cognitive changes.

Despite these challenges, sexuality in dementia care is often avoided or ignored, leading to confusion, shame, and frustration for both caregivers and those they care for. However, avoiding the topic does not make the issue disappear—it can actually make it harder to offer the support people with dementia need.

The Language We Use Matters

The language caregivers use can have a significant impact on the behaviour of someone with dementia. Simple, affectionate phrases like “darling,” “dear,” or “my lovely” might seem harmless, but they can unintentionally encourage sexual behaviour or create confusion. These terms could lead the individual to misinterpret these interactions as flirtation or romantic interest, even if the caregiver did not intend that.

Caregivers need to be mindful of their language and how it might influence the behaviour of the person with dementia. By being careful with our words, we can help reduce the risk of unintentionally encouraging behaviours that might not align with the person’s needs or comfort levels.

The Role of Clothing in Sexual Expression

Another area where caregivers might unintentionally encourage sexual behaviour is through the clothing choices made for individuals with dementia. Tight-fitting clothing, revealing outfits, or even simple actions like adjusting clothing can sometimes trigger unintended sexualised responses. It's essential to choose clothing that makes the person feel comfortable, dignified, and respected, while also being aware that certain types of clothing or physical contact might affect their emotional state.

Caregivers should also maintain a professional appearance themselves, avoiding revealing clothing, overly bright makeup, or distracting attire. Dressing someone with dementia requires sensitivity and understanding—what might seem like a harmless adjustment to clothing could trigger discomfort or lead to unwanted sexualised behaviour.

Understanding Non-Verbal Communication

Many people with dementia may struggle to communicate verbally as their condition progresses. However, they still have emotions and can express themselves through non-verbal cues such as body language, facial expressions, and physical responses. A lack of words does not mean a lack of desire or emotional need.

Caregivers must become skilled at recognising these non-verbal signals to understand what the individual may need or feel. Whether it’s a gesture, facial expression, or a shift in posture, the person with dementia may still be communicating, and it's vital we learn to listen to these subtle cues with empathy and respect.

The Importance of Education and Support

Sexuality in dementia is often overlooked, but it is an important aspect of overall well-being. Just as we care for the physical health and emotional needs of individuals living with dementia, we must also consider their sexual and emotional well-being. Educating caregivers on these topics is essential for providing the best care possible.

Training programs should be developed to help caregivers understand the complexities of dementia and sexuality. These should include recognising that sexual behaviour may differ from what was typical before the onset of dementia, how to communicate appropriately, and how to respect the dignity of those in their care.

In addition to training, caregivers should have access to support networks and counselling. This support can help them navigate the challenges they may face when addressing issues related to sexuality in dementia care, reducing stress, building confidence, and ensuring they can approach these sensitive topics effectively and compassionately.