The expression of relationships, sexuality and intimacy by people ...

This article contains content of a sexual nature that some readers may find offensive.

People living with dementia in a care home environment are likely to have reduced access to intimacy with another individual. The personal beliefs, morals and ethics of care staff can lead to a judgemental approach to this element of care. Compounding this are concerns over safeguarding issues and confusion with mental capacity assessments. Ultimately, this may lead to individual needs in this area being ignored or, worse still, completely denied.

?I will focus on three key areas of this population: the need for relationships, sexual behaviour and intimacy, and support for care home staff?

So, three key questions are raised here; questions that require practical and useful solutions. Firstly, why is this area of care such a taboo subject in the care home environment? Secondly, what can be done to encourage those supporting people to live with dementia to feel more comfortable around this issue? Finally, what methods can be employed in order that this normal part of everyday living patterns is afforded the same importance as every other activity, and instrumental activity, of daily living?

Professor Alistair Burns, the National Clinical Director for Dementia in England and Professor of Old Age Psychiatry at the University of Manchester, states that ?the expression of sexuality and intimacy is fundamental as an individual? (The last taboo, a guide to dementia, sexuality and sexual behaviour in a care home, International Longevity Centre UK, 2011).
Taking this statement as the nucleus of this article, I will focus on three key areas of this population: the need for relationships, sexual behaviour and intimacy, and support for care home staff.

The need for relationships

As a human race, we are social animals and as such crave the company of, and contact with, other human beings. Back in the early 1970s, Mother Theresa famously said: ?The biggest disease today is not leprosy or tuberculosis, but rather the feeling of being unwanted.? This is equally important in today?s society, and even more so when a person is living with dementia. Bit by bit, the individual is robbed of their character and personality. The world becomes an unpredictable place to be. Self-confidence and self-esteem take a huge hit. It can be a world of total isolation; a world of loneliness. One of the most common behavioural symptoms found in people living with dementia is anxiety, often fuelled by underlying feelings of fear rising from inner feelings of the unknown. It therefore makes sense that having this disability and living in an unfamiliar community a person will require the empathy, genuine kindness and physical comfort of others. One could argue that care home staff provide such empathy and kindness, but is this a falsehood? Is this an artificial relationship simply because that carer is being paid to care? However, a fellow peer living in the care facility who is experiencing similar losses and detachments from a previous life does have true empathy. Therefore, if we consider it from that angle, this is clearly a time when new relationships will be forged, often platonic, sometimes same sex and occasionally intimate and sexual.

The familiarity of the family constellation and network of friends becomes diminished on moving into a care facility. Many of the lifestyle changes that come with this experience, and the presenting cognitive challenges, are contributing factors to feelings of vulnerability. This emotional rollercoaster makes it clear that the formation of new relationships becomes even more of a need.

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Dr D J Nightingale is Dementia Consultant with Retirement Villages Ltd and Borough Care; Founder and CEO of Dementia Doctor (UK) and Co-Founder and CEO of Dementia Therapy Specialists (US).
drdan@dementiadoctor.co.uk

Source: http://qualityandcompliancemagazine.co.uk/the-expression-of-relationships-sexuality-and-intimacy-by-people-living-with-dementia/

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