Plenty is lost when an elderly person moves into a nursing facility — the comforts of home, a sense of privacy, the pleasures of independence. But on top of that, they’re often deprived of one of the greatest joys of all: sex.
I know: Old people, sex — what?! When the subject comes up, it’s typically used as a joke and, regardless, tends to induce a cataclysmic cringe. But the evidence shows that many people do get it on well into their 80s. (And also? Grow up.)
A new article published in the Journal of Medical Ethics takes nursing homes to task because elderly patients’ “sexual expression” is often “overlooked, ignored or even discouraged.” The authors of the Australian paper argue, “The formation of relationships, physical intimacy and the expression of sexuality are a basic human right and a normal and healthy part of aging,” and caregivers should respects patients’ “decisions about their sexuality, intimacy and physical relationships.”
The problem — beyond the privacy-destroying lack of single rooms or locking doors – is that many nursing home patients struggle with diseases like Alzheimer’s and dementia, which come with cognitive issues that can complicate consent. (These conditions can also ramp up sexual behavior.) As Daniel Engber put it several years ago in a piece about nursing home nookie, “Break it up, and they may be depriving a dying man or woman of physical pleasure and companionship. Leave them be, and the nursing home may be exposed to negligence claims from dismayed relatives or a forgotten spouse.”
These things don’t happen in a social vacuum, either. As Carol Bradley Bursack, author of “Minding Our Elders,” put it to me, “I think it’s a shame that in our society there’s that ‘ew’ factor about [elderly sex].” It’s easy to discount this issue as insignificant, but its not. “Human touch is so important to mental health for everyone,” says Bursack.
The problem is finding a way to balance elderly patients’ right to “sexual expression,” as the paper puts it, with the consent problems raised by cognitive impairment. Bursack says, “Until there is a real cognitive impairment where people don’t seem to be able to make any decisions on their own, if there is no abuse, and both people seem to want to have this kind if connection, why shouldn’t they be allowed to have this in a private area?” Similarly, the report argues against treating patients with various stages of Alzheimer’s and dementia the same: “Clearly there is a significant difference between the capabilities of a person with mild dementia and one with advanced or final-stage dementia and, therefore, a single approach to sexuality and ‘people with dementia’ is inappropriate.”
Engber suggests that “the safest solution would be to encourage residents to designate a ‘sexual guardian’ in advance of their cognitive decline.” In other words, a person who could “serve as the elder-sex cop, or elder-sex partner.” Of course, given how uncomfortable people can be talking about sex, perhaps especially with our elder relatives, this approach brings its own challenges.
At least one nursing home in the U.S. has found a way to humanely address the issue. The Hebrew Home at Riverdale — which, believe it or not, follows Orthodox Jewish law — has nurses and social workers determine whether a patient is capable of giving consent and even went so far as to develop a policy stating that “residents have the right to seek out and engage in sexual expression,” as well as the right to “materials with sexually explicit content.” Hoorah, porn for grandma!