Managing sexual misconduct in aged care: part two

Most sexual harassment of older Australians occurs in nursing homes. And most often, such misconduct is perpetrated by other elderly residents.

In the second of our three-part series, we outline the options available to nursing home operators for dealing with inappropriate sexual behaviour by residents with cognitive impairment.

When perpetrated by an elderly dementia patient with impaired inhibitions and diminished judgment, Australian authorities consider acts of inappropriate sexual behaviour to be medical and psychosocial problems rather than matters for the criminal justice system. The Aged Care Act 1997 requires that nursing home operators adopt a strategy for the management of a resident’s inappropriate sexual behaviour within 24 hours of becoming aware of sexual misconduct.

The range of available strategies include managerial, therapeutic, and pharmacological options — often pursued in combination. Where possible, care providers are encouraged to develop strategies in close consultation with patients’ families.

Medication is often the first approach taken to address problematic behaviour. Pharmacological treatments are generally considered to be both effective and easily administered. Commonly, doctors prescribe antidepressants, antipsychotics, hormonal agents, or beta blockers.

It should be noted, however, that none are specifically licensed for the treatment of inappropriate sexual behaviour. Also, as elderly patients are often on a variety of drugs, doses should initially be low, and staff and family members should be alert to signs of adverse effects.

Many experts have concerns with medicinal responses to inappropriate sexual behaviour in the elderly, however. Pointing to the potential dangers of overmedicating, they argue that prescriptions ought to be limited to those sustaining life, mitigating pain, and combating infection.

Alternative non-pharmacological interventions, they argue, should be explored instead. For aged care providers, however, such strategies are often less appealing as they can be administratively burdensome or prove controversial with patient’s families.

One immediate response commonly adopted by nursing homes involves altering staff rosters to ensure that only male nursing staff are assigned to the care of elderly male patients identified as exhibiting inappropriate sexual behaviour towards female staff and residents.

This managerial change reflects the understanding that inappropriate sexual behaviour in dementia patients is an unthinking response to stimulation. Studies have demonstrated the value of minimising triggering stimulation such as certain television programs, and various types of music and visual literature. Of course, identifying what stimulates each patient can be a challenging task which requires significant observation by trained staff.

Inappropriate sexual behaviour in dementia patients is not always a response to overstimulation, however. Often, it is caused by the exact opposite: boredom. Behavioural therapies that distract and occupy patients can often prove a simple means of controlling sexual conduct.

Social activity, such as accompanied outings, can reduce a patient’s inclination to impose themselves on others, while routine involvement in arts and crafts activities can aid patients inclined to sexually touch themselves inappropriately.

Embarrassed by the uncharacteristic behaviour of their elderly relatives, many families gravitate to responses that suppress sexual drive. Many clinicians, however, consider this unethical, preferring approaches that provide patients with an appropriate outlet for sexual needs that, while misguided by the effect of dementia, are natural.

One increasingly common, although controversial, response is the periodic engagement of sex workers. As the strategy requires the consent of the patient’s family, it is often met with resistance. Many simply find the idea taboo.

Evidence cited in several overseas studies, however, shows that approaches that allow for normal sexual expression are highly effective in preventing inappropriate sexual behaviour and enhance the quality of life of those with dementia. These studies encourage aged care institutions to actively provide families and staff with literature about sexuality and aging.

Despite the range of responses and their efficacy, the issue of inappropriate sexual behaviour makes the prospect of entering institutional aged care alarming for many, particularly women, sexual-orientation minorities, and victims of childhood sexual abuse.

Next, in the final part of this series, we will explore how fear is driving these groups to push for change in the aged care sector.

< Go back and read part one.

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