Inappropriate Sexual Behaviors: Dementia Edition

Dementia

Alzheimer’s Disease

the most common dementia diagnosis among older adults. It is caused by changes in the brain, including abnormal buildups of proteins, known as amyloid plaques and tau tangles.

Frontotemporal Dementia

a rare form of dementia that tends to occur in people younger than 60. It is associated with abnormal amounts or forms of the proteins tau and TDP-43.

Dementia is the loss of cognitive functioning such as thinking, remembering, and reasoning to an extent that it interferes with a person's daily life and activities. Individuals diagnosed with dementia have difficulty controlling their emotions, and their personalities may change.

What is Dementia

Mixed Dementia,

a combination of two or more types of dementia

Lewy Body Dementia

a form of dementia caused by abnormal deposits of the protein alpha-synuclein, called Lewy bodies.

Vascular Dementia

a form of dementia caused by conditions that damage blood vessels in the brain or interrupt the flow of blood and oxygen to the brain.

Inappropriate Sexual Behaviors are displayed by individuals with dementia, but it is often overshadowed by other behavior such as aggression and treatment addresses the aggression and not ISB

Persons with progressive cognitive impairment such as dementia may display an a variety of challenging behaviors.

ISB and Dementia

Studies suggest that the more severe the cognitive impairment, increases the likelihood of the person displaying ISB, and attempts to manage this behavior often involve medications or social isolation according to Fisher and Carstensen

ISB and Dementia

ISB can be defined as any instance of verbal or physical action of an explicit, or perceived, sexual nature, which is unacceptable within the social context in which that is carried out by an individual

ISB can cause significant physical and mental harm to the individual of such behavior. Specifically, ISB may elicit psychological feelings and unease in the victim, such as a nurse providing care for that person

Recording Chart

Pharmacological Interventions

• Researchers note that, "Side effects of neuroleptic treatment are frequent . . .", and that older adults are more prone to developing other health impairments from medication than are younger individuals.

Pharmacological

Due to easy administration and perceived efficiency, medication tend to be the preferred, first-line method of intervention in cases of inappropriate sexual expression in patients with Dementia.

There is currently little evidence to suggest medical management of inappropriate sexual behavior is effective .

• Researchers conclude that ISB in persons with progressive cognitive impairment is very difficult to treat and urges that more non-pharmacological treatments should be used to prevent unnecessary prescription of psychotropic medication.

Behavioral Interventions

Fisher and Carstensen suggests antecedent manipulation techniques as a means of behavioral remedy, and describe the reinforcement of sexual expression at an appropriate time and circumstance as a frequently effective technique.

• the use of restrictive clothing (e.g., pants on backwards, use of jump suits)
• blocking the patient from the stimulus
• Isolating the behavior/ immediate relocation to address masturbating and bed sharing without permission through hanging curtains or portable screens

Jeffery Buchanan suggests:

• Eliminating the behavior or punish it is not the most effective method, but to have the behavior occur in more appropriate places such as the resident's room would be suitable
• More ethical approach because it does not change the function and it allows the client to maintain access to reinforcement when access to other sources of reinforcement may be limited due to decreased mobility and progressive cognitive deficits.

Behavioral

Alderman, N., Knight, C., & Birkett-Swan, L. (2009). Inappropriate sexual behavior and

aggression observed within a neurobehavioral rehabilitation service: SASBA and OAS-

MNR outcomes over a three-month period. Journal of CyberTherapy and Rehabilitation,

2(3), 205+. https:// link.gale.com/apps/doc/A225590100/HRCA?

u=tel_oweb&sid=googleScholar&xid=aac37b90

Buchanan, J. A. (2006). A review of behavioral treatments for

persons with dementia. The Behavior Analyst Today, 7(4),

521-537. http://dx.doi.org/10.1037/h0100092

References

Harris, L., & Wier,, M. (1998). Inappropriate Sexual Behavior

in Dementia: A Review of the Treatment Literature. Sexuality

and Disability, 16(3), 241–241. https://doi.org/10.1023/

a:1023059428632

Summary

Sloane, P. D., Davidson, S., Buckwalter, K., Lindsey, B. A., Ayers, S., Lenker, V. & Burgio, L. D. (1997).

Management of the patient with disruptive vocalizations. The Gerontologist, 37, 675–682

Stubbs, B. (2011). Displays of inappropriate sexual behaviour by patients with

progressive cognitive impairment: The forgotten form of challenging behaviour?

Journal of Psychiatric and Mental Health Nursing, 18(7), 602–607. https://

doi.org/10.1111/ j.1365-2850.2011.01709.x