Sex and intimacy should be a normal part of life in an aged-care facility, say four leading aged-care experts. Every nursing home should have clear policies on sexual expression, the academics write in the latest Australian Journal of Dementia Care.
The policies should cover privacy, give guidance to staff on how to assess non-verbal assent, and discuss opportunities for residents to express their sexuality in a safe, private place. ''Expression of sexuality must be considered an acceptable and normal part of living in an aged-care facility,'' they say.
Only 20 per cent of nursing homes have a policy relating to sexual health or sexuality, and only 10 per cent had specific information, according to surveys of all aged-care facilities in Victoria.
''Sexual expression by people with dementia in residential aged-care can be a source of humour, disgust, fear and conflict, which often results in the separation or relocation of residents,'' the academics say.
''Staff may laugh and ridicule the residents, families may fear their mother [usually] is being molested, and conflict can result.''
The authors are Michael Bauer, Deirdre Fetherstonhaugh, Rhonda Nay and Laura Tarzia from the Australian Centre for Evidence Based Aged Care at La Trobe University. They say nursing-home staff could be ''curtailing residents' rights to sexual expression'' by hiding behind their duty of care and refusing to accept non-verbal cues.
When health professionals and students were asked what they thought of older people having sex, the response was almost always ''yuk'' or ''it does not happen''.
When asked about sexual activity among people with dementia, there were puzzled responses in nearly every case.
Dr Bauer said the main sticking point was the staff's ability to determine whether residents could give consent.
Yet he said many residents were capable of expressing consent non-verbally. They made decisions every day using non-verbal cues about what they ate, wore and with whom they sat at lunch. ''Just because someone loses the ability to communicate verbally, it doesn't mean that they can no longer let you know what they would like and whether they are enjoying something.
''Being able to interpret body language and facial expressions becomes really important.''
Dr Bauer said traditional ways of deciding whether someone could give consent became problematic when dementia was involved.
''Although a person with dementia may not be able to understand the risks involved in having a big operation, they may still be able to decide on what flavour of ice-cream they'd like.''
Most people with dementia were more interested in intimacy than sex, Dr Bauer said.