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Sexuality and Alzheimer disease

Talking about sexuality has always been a vexed issue. When combined with prevailing cultural attitudes about sexuality and aging, the subject matter becomes even more difficult. Nevertheless, whether one is 28 or 88, we are all sexual beings, and a diagnosis of Alzheimer’s disease doesn’t change that fact. Even the most confused individual with Alzheimer’s is still a sexual being. When sexuality is combined with dementia however, it can become quite problematic. Dementia does not just mean memory loss, as is the common perception. It is a form of brain damage that affects personality, motor skills, functioning and behaviour. www.examiner.com/examiner/x-31385-Montreal-Caregiver-Examiner~y2009m11d30-The-many-faces-of-dementia'  The majority of those caring for affected individuals however, are women and most of them are spouses. Since Alzheimer’s is an age-related disease most spousal caregivers are elderly and often have their own health problems. This compounds the situation even further.
Alzheimer’s disease affects every aspect of the marital relationship. The long course of the illness presents many challenges to the caregiver including a major increase in responsibility and corresponding role changes that occur in the relationship as the disease progresses. Within the context of these changes, sexuality is an important aspect that the disease ultimately changes. Contrary to popular belief, older people maintain an interest and capacity in sex. As the disease makes inroads into the affected persons behavior and judgment it is the expression of the person’s interest that often cause difficulties for the well spouse. Your partner may no longer remember how to satisfy you, or may become self centered or overly demanding. Men may experience frustration due to difficulty maintaining an erection, and women may have difficulty with lubrication.
Most individuals with Alzheimer’s disease tend to become more of who they were, as previous character traits become exaggerated. It could therefore be assumed that married couples facing AD are probably struggling with sexual issues as the disease ultimately changes this particular dynamic of their relationship. Unfortunately, very little is really known about the affects of Alzheimer’s disease on sexuality. It has been theorized that decreased and/or increased sexual interest in affected people is due to damage in specific parts of the brain. http://fhs.mcmaster.ca/mcah/cgec/toolkit.pdf
Both partners in a marriage affected by Alzheimer’s disease face many losses over a long period of time. Every aspect of the relationship is affected by the diminished abilities of the spouse with AD and the increased caregiving responsibilities of the well spouse. Marriage as a couple may have known it is changed forever by the long course of AD. The cognitive and behavioral changes alter the essence of an affected persons identity. All the person’s memories, perceptions, social skills and behavior undergo a radical change. The inability to care for oneself leads to needing total assistance from others. Basic needs for grooming, toileting and eating eventually require total supervision and management. The well spouse inevitably becomes tired and distressed over the growing emotional and physical demands of care. A blurring of roles ensues between intimate partner and caregiver. The core of the relationship begins to center around coping with this debilitating disease. Those who have had a high degree of intimacy in their relationship prior to the onset of the disease however will be better able to make the necessary adjustment in their sexual relationship.
 http://www.gilbertguide.com/articles/sexuality-dementia-alzheimers-bedroom/
 Four types of patterns have been identified among couples facing AD:
1-Hypo sexuality-in which there is less interest in sex, and contact is rarely initiated.
2-Hyper sexuality -in which there is an increased desire for sexual contact, often without regard for the partner’s needs. This occurs most frequently in men.
3-Inappropriate behavior- in which the person may become disinhibited or socially inappropriate.
4-Misidentification-which generally occurs later in the disease when the person’s long-term memory has begun to fail and memory for the spouse is gone. In this case, the individual may make sexual advances to strangers or other family members http://www.alzheimer.ca/english/care/ethics-intimacy.htm
The general approach to management of these issues can be briefly summarized into four main points.
1-Look for the cause or something in the environment that triggered the behavior. In some cases, a couple may have to sleep in separate rooms.
2-Try to adopt a matter of fact and calm approach. Over-reacting or getting angry with the person can make the situation worse and damage the affected person’s already fragile self-esteem.
3-Distract the person. This is probably one of the most effective approaches to managing a person’s sexual overtures.
4-Don’t argue! 
 Over time a couple’s intimacy will undergo a certain amount of change. It is important to remember that everyone retains a need for physical closeness especially if they are used to it. This has nothing to do with sex. The importance of physical touch is a basic human need that communicates caring and personalizes caregiving. People with dementia are at great risk for loss of tactile stimulation at a time in their lives when they probably need it most. As a caregiver, you need to be aware of the power you hold in your fingertips. The power of touch can enhance the well-being of your loved one and give them a sense of security and love when they need it more than ever before. There can be numerous ways to appropriately provide the human need for touch. Gently rubbing lotion on your loved ones hand, a simple hug, a massage, holding hands-all communicate care and affection and can enhance the well being and quality of life of your loved one.
Even with the onset of dementia, there are still aspects of your relationship that you can nurture. This can be fostered through reminiscing about enjoyed experiences, rituals and traditions, talking about the past, reviewing photo albums, assisting with personal care such as shaving or manicures, singing and music. Remember, people with dementia are experiencing short-term memory loss, the past is very near and dear to them. Frequent discussions about the past should be encouraged and could also be used as a great tool for distraction when the need arises. Although sex is a difficult and sometimes embarrassing subject to address, please remember, you are not alone and other couples are grappling with the same issues and concerns. .
 

Comments

  • Charlene Collins - Atlanta Family Health Examiner 4 years ago

    Very well written... very informative. There is a lot here that I wasn't aware of.

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