‘Inappropriate’ sexual behaviours in dementia

Sexual harassment from older residents at long-term care facilities: is it really part of the job?

OBJECTIVES

To explore the extent to which staff members in long-term care facilities (LTCF) have experienced situations of sexual harassment, how they commonly and ideally manage the situation, and how their work position influences their responses.

DESIGN

Cross-sectional quantitative study, using the vignette technique.

METHOD

A total of 2,196 staff-members who were currently working in Spanish LTCF participated in the study. Data were collected using a self-administered questionnaire. Questions regarding sexual harassment were analysed by a vignette that described a case of sexual harassment. Participants had to choose common and best practices for dealing with the case, and report the frequency with which they had experienced similar situations.

RESULTS

The results indicate that 29.9% of participants had experienced an episode of sexual harassment in a LTCF similar to the one presented in the vignette. Responses to the situation were diverse and there were significant differences between common and perceived best practices. Differences were also found depending on the work position of the participant (manager, technical staff or nursing assistant).

CONCLUSIONS

There is a need for a fuller recognition of the sexual needs of older people. However, the presence of inappropriate sexual behavior must also be acknowledged. The right of staff to work in an environment free of harassment must be respected. The need for explicit institutional guidelines and training opportunities is discussed.

Staff responses to residents exposing their genitals in public in long-term care settings: The gap between common and perceived best practices

AIMS AND OBJECTIVES

To explore staff reactions to residents' behaviour consisting in exposing their genitals in public, and to differentiate between what is perceived as common practice (what most staff do) and best practice (the best possible approach).

BACKGROUND

The presence of inappropriate sexual behaviours (ISBs) in long-term care facilities poses practical and ethical dilemmas since they may impinge on the rights of others (staff and residents) and thus need to be adequately monitored and managed. However, no studies have focused on how staff handle ISBs, and particularly exposing oneself in public.

METHODS

A total of 2,175 people working in 152 Spanish LTC facilities participated in the study. They were presented with a vignette describing a resident exposing his/her genitals in public, and they were asked what they think most of their workmates would do and what they think should be done in that situation. The STROBE checklist was used to enhance the quality and transparency of the research.

RESULTS

Approximately one-third of participants (32.4%) reported having experienced behaviours such as the one described in the vignette. Staff reactions underline the predominance of restrictive practices. However, if prompted to think in terms of best practice, supportive reactions increased in frequency. Finally, factors such as work position have an influence on perceived common and best practices, with care assistants generally holding more restrictive views than directors or technical staff.

CONCLUSIONS

Around one-third of staff members, and particularly those in managerial or technical positions, had witnessed residents exposing their genitals in public. However, there is no common ground among staff regarding the best way to handle the situation.

RELEVANCE TO CLINICAL PRACTICE

Our findings stress the importance of organisational policies and workplace training in the management of challenging behaviours such as exposing oneself.

Disinhibited Exposing Behavior, Hypersexuality, and Erectile Dysfunction as a Consequence of Posttraumatic Stress in a 42-Year-Old Male Patient

Research into sexual dysfunction and its explanations within a cognitive behavioral framework in patients with posttraumatic stress is sparse. In this report, we present the case of a 42-year-old male with severe posttraumatic stress symptoms who displayed apparent exhibitionistic behavior, hypersexual behavior in the form of excessive masturbation, and erectile dysfunction. Differential diagnostics showed that the presented exhibitionistic behavior could be more accurately classified as non-paraphilic disinhibited exposing behavior. Functional behavioral analysis of his sexual behavior suggested that disinhibited exposing and hypersexual behavior served as dysfunctional coping strategies for trauma-associated negative emotions. Erectile dysfunction seemed to be the result of trauma-associated hyperarousal and excessive masturbation. Within the context of operant learning processes, we propose that his sexual behaviors became highly automated and were used as the main strategies to regulate trauma-associated negative emotions. Implications for the diagnoses and suggestions for the conceptualization and incorporation into a cognitive behavioral therapy treatment of posttraumatic stress disorder are made.