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OLDER PEOPLE
the head, hugging the person without permission and displaying
other such behaviour. Although affectionate and well meaning,
behaviour of this type may demean the person. This
infantiUzation of the person may make it difficult for staff to
contemplate these 'children' as sexual beings (Archibald, 1998),
Indeed, for people who have a cognitive impairment and are
already having problems interpreting the world, this type of
behaviour may lead to mixed messages and a blurring of
boundaries. However, if behaviour goes outside the limits of what
Aizheimer's disease
Plaque
Neurofibrillary tangle
(twisted nerve cell fibres)
Frontal lobe
Temporal lobe
Frontal lobe
Judgement and behaviour
Figure 1. Diagram
showing the main
causes of dementia
and sites of
neurological damage
with respect to the
frontal and temporal
lobes of the brain.
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OLDER PEOPLE
dealing with sensitive issues, it needs to be used in a
therapeutic manner to open up conversation and not merely
to conceal staff discomfort.
While staff and family members can usually respond to sexual
approaches in a direct manner, people with dementia may have
lost the verbal ability and skill to refuse unwanted affection or
sexual advances (Mayers and McBride, 1998). Archibald (2002),
in a case study of one residential home, found that staff were
often unaware of the extent of sexual harassment occurring
between clients, and depended on clients to inform them or
Affection
Touch
Erotic and non-erotic intimacy
Attitudes of caregivers
Sexuaily inappropriate behaviour
Recisons for behaviour, inciuding cognitive and emotionai
factors
The importance of a team approach to care
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Conclusion
Addressing issues of sexuality is challenging, irrespective of care
environment or patient group. However, no issue carries such
emotional weight and conflicting vie\vs as hypersexuality, thus
it needs to be responded to in a way that protects the right,
dignity and feelings of all concerned.
Caring for people who challenge us
with sexual behaviour that is
KEY POINTS
considered 'inappropriate' always
I Although rare, hypersexual behaviour
demands reflection and assessment as
is a distressing outcome of dementia.
each person and situation is unique.
I Hypersexuai behaviour presents
The lack of training, the
the nurse with difficuit clinical, ethical
existence
of a culture that fails to
and practicai chaiienges.
allow
an
open and informed
I Nurses responding to hypersexuai
discussion,
and
the continued belief
behaviour need to pian care in a way
that
it
is
the
responsibility
of the
that respects the rights and dignity
staff
not
to
place
themselves
at risk
of aii patients, famiiy and heaithcare
in
relation
to
sexual
advances,
may
workers.
mean that inappropriate sexual
I There is an urgent need to include
expression to staff or other patients
issues of sexuality and older people
is not addressed in a sensitive and
in education programmes and create
constructive manner. Thus, there is
a cuiture within organizations where
a need for education to develop a
issues of sexuaiity can be spoken about
culture where staff feel comfortable
in an open and constructive manner.
to express their concerns, acknowledge their emotions without fear
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