19: Early Stages: Intimacy & Sexuality

This program will:

• Present an overview of the various stages and changes related to Alzheimer’s disease
• Discuss intimacy and sexual issues as relationships change during the early stages

• There are no easy answers when it comes to the care of another
• Our hope is to offer you useful information and guidelines for caring for someone with dementia
• These guidelines will need to be adjusted to suit your own individual needs

• Progressive dementia
• Later years of life
• Changes in brain
• Chemistry
• Structure
• Processing
• Loss of brain cells and pathways
• Hippocampus damage affects new information processing and storage
• Results are changes in behavior and functioning

• Suspiciousness
• Paranoia and negativity
• Restlessness/wandering
• Rummaging
• Depression
• Aggression
• Catastrophic reactions
• Agitation
• Verbal abuse
• Combativeness
• Apathy and depression
• Caregiver stress
• Anxiety
• Depression
• Sleep disruption
• Care recipient abuse

DELUSIONS

• Strongly held ideas or beliefs that have no basis in reality

ILLUSIONS

• Misperceptions or misinterpretations of real objects

HALLUCINATIONS

• Perceptions of things that are not there

• Forgetting things
• Neglecting hygiene
• Dressing and grooming poorly
• Communication difficulties

AMNESIA

• Loss of memory

APHASIA

• Inability to speak or understand language

AGNOSIA

• Inability to recognition people, objects and places

APRAXIA

• Inability to perform routine, over-learned activities

• Changes occur in stages over many years
• Early, middle, late and end-stage

Early stages

• Forgetful
• Suspicious, obsessed
• Restless, apathetic
• Sleep changes may begin
• Aware, concern

Middle stages

• Difficulty functioning at home and at work
• Personality changes and difficult behaviors
• Sleep pattern changes more common

Late stages

• Greater difficulty with activities of daily living
• Reduced mobility
• More difficult behaviors
• Worsening of sleep pattern disturbances

End-stage

• Unable to walk
• Unable to recognize familiar people
• Weight loss
• Incontinence
• Needs complete care
• May have moments of lucidity

• Change with aging
• Important for self-esteem and gender identity

What are some of the possible factors at play in this situation?

• A. Robert has a medical condition that affects his sexual desires .
• B. Robert is losing his inhibitions about sex .
• C. Mary is too stressed and tired from caregiving .
• D. Age-related changes are affecting Mary’s sexual response .
• E. All of the above.

Choice A: Robert has a medical condition that affects his sexual desires, is a possibility.

Choice B: Robert is losing his inhibitions about sex, is also a possibility.

• Alzheimer’s disease results in lowered inhibitions, which can lead to inappropriate sexual behavior.

Choice C: Mary is too stressed and tired from caregiving, is another possibility.

• Caregiver stress and fatigue can reduce sexual interest.

Choice D: Age-related changes are affecting Mary’s sexual response, is also a possibility. CHANGES OF AGING CAN CAUSE

• Painful intercourse
• Decreased vaginal lubrication
• Erectile dysfunction
• Choice E: All of the above, is the best answer.

• Reduction in female hormonal levels
• Vagina
• Wall thins
• Lubrication decreases
• Space shortens and narrows
• Cervix can descend
• Body becomes less sensitive to arousal

• Reduction in testosterone levels
• Degree of erection lessens
• Orgasmic contractions fewer and weaker
• Refractory period lengthens

• Physical and mental health can affect sex life
• Societal views about older people and sex

• Strategies
• Create romantic atmosphere
• Plan for more time
• External aids

• Cardiovascular disease
• Hypo and hyper thyroid
• Chronic obstructive pulmonary disease
• Arthritis

• Medications can contribute to sexual dysfunction
• Medical interventions can change self-image

• Needs continue throughout the illness
• Caregiving demands increase
• Partner may be uncomfortable with sex
• Fear of inappropriate sexual behavior
• Changes in the relationship

• Memory issues may affect quality of sex
• Caregiver issues
• Multiple requests for sex
• Not aroused by someone who forgets their name
• Consent

• Lowered inhibitions
• Public sexual behavior (groping, masturbating)
• Increased frequency of sex
• Suggestive talk
• The frontal lobe of the brain, which controls our “executive functions,” such as impulses,judgement,reasoning, and decision-making abilities,gets damaged

• Understanding
• Unique solutions

Click here to learn more about Sexuality and Alzheimer’s

What could Mary do to resolve the situation?

• A. Gently take his hand and leave the church
• B. Hand him a hymnal to hold
• C. Take his hand, squeeze it, and hold it

Choice A: Gently take his hand and leave the church, is a possible solution.

Choice B: Hand him a hymnal to hold, is another possible solution.

Choice C: Take his hand, squeeze it, and hold it, is a good choice.

• Use discrete distraction
• Refrain from scolding or showing disapproval
• Normalize the behavior

• Sexual problems are rare
• Understand that the disease is the cause
• Respond in a matter-of-fact way

• Remind when behavior is inappropriate
• Orient the person who is confused
• Find out the reason for the behavior
• Remove the person from the situation
• Reassure and honor dignity
• Be cautious when showing affection

• Redirect, distract

• Alternative ways to be intimate
• Redirecting to self-stimulation

• There is no right or wrong
• Should not feel guilty

• Changes in sexuality due to Alzheimer’s disease
• Changes associated with aging
• Effects of medical illnesses and medications
• Strategies include:
• Remind the person about appropriate behavior
• Reorient the person to the situation
• Use distraction or redirection
• Provide privacy for sexual expression
• Respect dignity and autonomy
• Consider caregiver needs

Written by:
Catherine M. Harris, PhD, RNCS.
Mindy J. Kim-Miller, MD, PhD

Edited by:
Sasha Asdourian

www.LightBridgeHealthcare.com

Click here to open Certificate of Completion

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