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Although inappropriate sexual behavior in older adults with dementia is not widespread, it can be problematic for health care providers, patients, and caregivers. Treating these behaviors is a challenge, especially in long term Sexual inappropriateness and dementia settings. Following are details of a case of sexually inappropriate behavior in an elderly patient with dementia. Case Report An year-old white male was seen in clinic with his daughter who reported that he frequently removed his clothes and touched his genital area.
He had been sexually inactive prior to the death of his wife of 50 years two months ago, and lived at home with a caregiver. Since his previous visit, his behaviors had worsened with increased frequency, and he verbalized inappropriate sexual comments directed toward his female caregiver. This was initially treated with citalopram, a selective serotonin reuptake inhibitor SSRI. However, one month later, as symptoms worsened, citalopram was discontinued and paroxetine, another SSRI, was started with interval increases in the dose when symptoms did not abate.
Due to the persistence of the symptoms, valproate was added but was later changed to carbamazepine as the patient developed increased confusion and diarrhea. On intermediate follow-up at six months after his initial symptoms, and with the continuation of nonpharmacologic approaches included redirecting, caregiver support group therapy, modifying clothing to prevent easy removal, and the trial of a same-sex caregiver, his family noted the persistence of "Sexual inappropriateness and dementia" inappropriate talk; however, he made no physical attempts to engage in sexual behavior.
Conclusion Despite nonpharmacologic and limited pharmacologic interventions, inappropriate sexual behavior in older adults with dementia is challenging to manage. J, an year-old male with a past medical history of PAD, hypertension, benign prostatic hypertrophy, previous deep vein thrombosis, and dementia, presented to clinic with his daughter.
She reported that his caregiver had voiced concern because Mr. J had frequently been removing his clothes and touching his genital region throughout each day. A retired baker, Mr. J had previously lived with his wife of 50 years who had died two months prior. At a previous
Sexual inappropriateness and dementia he had reported that he and his wife were no longer sexually active.
Physical examination, including the genital area, was negative for any abnormalities. It was suggested that his family and caregivers try to redirect him from the sexual behaviors and then return for follow-up.
At the subsequent visit one month later, Mr. J's daughter reported significant caregiver stress, as Mr. J's sexual behavior had worsened with increased frequency of episodes, and he was now verbalizing about his female caregiver's body parts. At that time he was prescribed citalopram 20 mg daily.
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TEDxTalk: Sexuality and Dementia, "Having the Sex Talk with Dad"