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Borges SQ, Camargos EF. Prevalence of and Factors Associated with Hypersexuality in Patients with Dementia: A Retrospective Cross-Sectional Study. J Geriatr Psychiatry Neurol 2024; 37:263-271. [PMID: 38156788 DOI: 10.1177/08919887231225481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The psychological and behavioral symptoms of dementia are frequently observed in clinical practice, and those related to sexuality are particularly challenging. However, few studies have evaluated the prevalence or factors associated with hypersexuality in patients with dementia. OBJECTIVES This study aims to determine the prevalence of hypersexuality in patients with dementia, describe associated factors, and qualitatively report the most common presentations and treatments. METHODS This retrospective cross-sectional study collected data from semi-structured charts of dementia patients who were followed up at a secondary care reference center between 2015 and 2019. Results: Of 552 total patients, 52 (9.3%) were hypersexual, which was associated with male sex (P < .000; OR 2.95, 95% CI 1.73-5.01), frontotemporal dementia (P < .007), alcohol use (P < .015; OR 2.35, 95% CI 1.16-4.73) and tobacco use (P < .000; OR 2.88, 95% CI 1.61-5.13). CONCLUSIONS Although our findings were similar to the literature, their significant variability reflects the limited and low quality of the available evidence and a lack of standardization regarding terminology, definitions, and diagnostic criteria for hypersexuality.
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Affiliation(s)
- Saulo Queiroz Borges
- Medical Sciences Graduate Program, University of Brasília, Brasília, Brazil
- Center for Older Adult Medicine, Brasilia University Hospital, University of Brasília, Brasília, Brazil
| | - Einstein Francisco Camargos
- Medical Sciences Graduate Program, University of Brasília, Brasília, Brazil
- Center for Older Adult Medicine, Brasilia University Hospital, University of Brasília, Brasília, Brazil
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Prent N, Jonker FA, Schouws SNTM, Jonker C. The risk of criminal behavior in the elderly and patients with neurodegenerative disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 197:181-196. [PMID: 37633709 DOI: 10.1016/b978-0-12-821375-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Behavioral changes are commonly observed in patients with dementia and can lead to criminal offenses, even without a history of criminal or antisocial behavior. Due to the growth of the aging population, this poses a rising problem to deal with for the criminal justice system and in general for society. Criminal behavior may include minor crimes such as theft or traffic violations, but also serious crimes such as physical abuse, sexual offense, or murder. In the assessment of criminal behavior among elderly (first-time) offenders, it is important to be aware of possible neurodegenerative diseases at the time of the crime. This book chapter provides an overview on criminal behavior in the elderly and specifically discusses existing literature on patients suffering from a neurodegenerative disease, including Alzheimer disease, vascular dementia, frontotemporal dementia, Parkinson disease, and Huntington disease. Each section is introduced by a true case to illustrate how the presence of a neurodegenerative disease may affect the criminal judgment. The chapter ends with a summary, multifactorial model of crime risk, future perspectives, and concluding remarks.
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Affiliation(s)
- Naomi Prent
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Neuropsychiatry, Altrecht Mental Health Institute, Woerden, The Netherlands.
| | - Frank A Jonker
- Department of Clinical, Neuro-, and Developmental Psychology, Section Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Neuropsychiatry, Altrecht Mental Health Institute, Woerden, The Netherlands
| | | | - Cees Jonker
- Department Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
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Band-Winterstein T, Goldblatt H, Lev S, Harel D. Forms of sexual assault against older women in the context of acquaintance relationships: An intersectional perspective. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2330-e2339. [PMID: 34850479 DOI: 10.1111/hsc.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 11/14/2021] [Accepted: 11/22/2021] [Indexed: 06/13/2023]
Abstract
This study addresses forms of sexual assault against women in late life (SAWLL) from an intersectional perspective, focusing on acquaintance relationships. Qualitative research was conducted, using in-depth interviews with 18 welfare and healthcare professionals who treated sexual assault survivors. Five forms (themes) emerged, relevant to the identification of SAWLL: (1) Coercive sexual assault in the context of changes brought on by old age, (2) contempt and sexual humiliation based on ageist and sexist social constructions, (3) violation of the older women's dignity in the multigenerational context, (4) life-long incestuous relationships and sexual assault against older women and (5) erotic touching and exhibitionism in caregiving relationships. The revealed forms emphasise the vulnerability of older women who are sexually assaulted in domestic relationships by perpetrators whom they know. These forms can contribute to filling the existing gap in knowledge on SAWLL and promote the visibility of sexually assaulted older women in the justice system. In addition, they can aid law enforcement, health and welfare professionals and policymakers to advance the general understanding of SAWLL as well as improve the response to this phenomenon.
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Affiliation(s)
- Tova Band-Winterstein
- Department of Gerontology, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Sagit Lev
- School of Social Work, Bar-Ilan University, Ramat-Gan, Israel
| | - Dovrat Harel
- The Drama Therapy Graduate Program, Tel Hai Academic College, Kiryat Shmona, Israel
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Burley CV, Burns K, Brodaty H. Pharmacological and nonpharmacological approaches to reduce disinhibited behaviors in dementia: a systematic review. Int Psychogeriatr 2022; 34:1-17. [PMID: 35331345 DOI: 10.1017/s1041610222000151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Disinhibited behaviors in dementia are associated with multiple negative outcomes. However, effective interventions are under-researched. This systematic review aims to provide an overview of intervention studies that report outcome measures of disinhibited behaviors in dementia. DESIGN Systematic searches of the databases MEDLINE, EMBASE, and PsychINFO, Social Work Abstracts and Cochrane Central Register of Controlled Trial databases were conducted for publications published between 2002 and March 2020. We included hand-searched reviews, original articles, case reports, cohort studies, and randomized controlled trials (RCTs). All studies were rated for research quality. Statistical and clinical significance were considered for individual studies. Effect sizes were included where provided or calculated where possible. Mean effect sizes were calculated for RCTs only. PARTICIPANTS The systematic review included studies involving people living with dementia. MEASUREMENTS The Neuropsychiatric Inventory disinhibition subscale was used most often. RESULTS Nine pharmacological and 21 nonpharmacological intervention studies utilized different theoretical/clinical approaches. These included pain management, antidepressants, models of care, education and/or training, music-based approaches, and physical activity. The quality of research in RCTs was strong with a greater effect size in nonpharmacological compared to pharmacological approaches (mean Cohen's d = 0.49 and 0.27, respectively). Disinhibition was a secondary outcome in all studies. CONCLUSION Pharmacological (including pain management and antidepressants) and, more so, nonpharmacological (models of care, education/training, physical activity, and music) approaches were effective in reducing disinhibition.
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Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Kim Burns
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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5
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Elrafei H, Jamali Q. Assessment and treatment of hypersexuality: a review. BJPSYCH ADVANCES 2021. [DOI: 10.1192/bja.2021.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Hypersexuality is defined under various terms in the DSM and ICD diagnostic classifications. However, it can be challenging to differentiate between hypersexuality as one of the symptoms of a mental disorder and hypersexual disorder as a primary diagnosis. In this article, we explore the physiology, assessment and treatment of hypersexual disorder, and consider its aetiology and epidemiology. In addition, we highlight the paucity of evidence in the literature about licensed or specific pharmacological recommendations for its treatment and the poor awareness of hypersexuality in clinical and research practice. Further research is recommended to identify more precise guidance for the pharmacological management of hypersexuality.
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Sarangi A, Jones H, Bangash F, Gude J. Treatment and Management of Sexual Disinhibition in Elderly Patients With Neurocognitive Disorders. Cureus 2021; 13:e18463. [PMID: 34745786 PMCID: PMC8563511 DOI: 10.7759/cureus.18463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/17/2022] Open
Abstract
Sexual disinhibition is uncommon but challenging symptom to address in elderly patients with neurocognitive disorders. Due to the lack of large-scale studies, there is no gold standard treatment for sexual disinhibition, and treatment is largely left up to the discretion of the provider based on the severity and onset of the patient's symptoms. A review was conducted to investigate the non-pharmacological and pharmacological interventions for treating this condition. Articles that discussed treatments were screened for the type of treatment and possible side effects of medication if applicable. Thorough patient history should be taken prior to starting any drug therapy to rule out possible behavioral changes due to an existing medication side effect, delirium, or past mental or sexual health history. Non-pharmacological treatment has been generally recommended as first-line therapy over pharmacological treatment. Distraction/diversion of the patient when inappropriate sexual behaviors occur was the most common non-pharmacological intervention. Antidepressants were generally recommended as the first line of pharmacological treatment after attempting all possible non-pharmacological interventions. Several other categories of interventions are discussed as well in addition to the ethical implications of treating a patient for this condition.
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Affiliation(s)
| | - Hannah Jones
- Psychiatry, Texas Tech University Health Sciences Center, Lubbock, USA
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Harel D, Band-Winterstein T, Goldblatt H. Between sexual assault and compassion: The experience of living with a spouse's dementia-related hypersexuality-A narrative case-study. DEMENTIA 2021; 21:181-195. [PMID: 34269088 DOI: 10.1177/14713012211032068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypersexuality is one of the behavioral and psychological symptoms of dementia. This symptom can lead to poor quality of life for the person who lives with dementia, as well as for his or her caregiver, who might be exposed to sexual assault. AIM This study aimed to highlight the experience of an older woman living and coping with a spouse who exhibits dementia-related hypersexuality. METHOD A narrative case-study of a single case was designed, composed of four semi-structured interviews conducted over a 10-month period. The data were analyzed through thematic, structural, and performance analysis. FINDINGS Four phases were revealed, depicting the experience of being a partner and caregiver of a spouse with dementia-related hypersexuality: a) "I need help": A distress call; b) "It depends how long I agree to go on with it": Living with the ambiguous reality of dementia-related hypersexual behavior within an ongoing intimate relationship; c) "It's as if I'm hugging someone who's no longer alive": The transition from the previous couplehood identity to a new couplehood identity; and d) "I am just taking care of him as if he is a child": A compassionate couplehood identity construction. CONCLUSIONS Living with a partner with dementia-related hypersexuality is a distressing experience for the caregiver-spouse. Yet, positive memories from a long intimate relationship can lead to the creation of a compassionate identity, which supports the caregiving process, and creates a sense of acceptance and meaning making. This, in turn, enables a positive aging experience. These finding have some practical implications for supporting and intervening in such cases.
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Affiliation(s)
- Dovrat Harel
- The Graduate Program in Drama Therapy, 26748Tel Hai College, Upper Galilee, Israel
| | - Tova Band-Winterstein
- Department of Gerontology, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
| | - Hadass Goldblatt
- Department of Nursing, Faculty of Social Welfare & Health Sciences, 26748University of Haifa, Haifa, Israel
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Saidlitz P, Cransac C. [Sexuality and inpatient care in cognitive-behavioural units]. SOINS. GERONTOLOGIE 2020; 25:17-22. [PMID: 32792236 DOI: 10.1016/j.sger.2020.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Talking about sexuality of the elderly remains a taboo in our society. However, care given in a Cognitive and Behavioural Unit to people with major neurocognitive disorders can led health professionals to being confronted with sexuality of patients. We discuss about elements that distinguish sexual behavioural disorders, including ability to consent to sexuality, as well as elements useful in care of innapropriate sexual behaviours.
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Affiliation(s)
- Pascal Saidlitz
- Centre Alzheimer, Gérontopôle, site Purpan, centre hospitalier universitaire de Toulouse, cité de la santé, place Lange, TSA 60033, 31059 Toulouse cedex 9, France.
| | - Camille Cransac
- Centre Alzheimer, Gérontopôle, site Purpan, centre hospitalier universitaire de Toulouse, cité de la santé, place Lange, TSA 60033, 31059 Toulouse cedex 9, France
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Lakstygal AM, Kolesnikova TO, Khatsko SL, Zabegalov KN, Volgin AD, Demin KA, Shevyrin VA, Wappler-Guzzetta EA, Kalueff AV. DARK Classics in Chemical Neuroscience: Atropine, Scopolamine, and Other Anticholinergic Deliriant Hallucinogens. ACS Chem Neurosci 2019; 10:2144-2159. [PMID: 30566832 DOI: 10.1021/acschemneuro.8b00615] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Anticholinergic drugs based on tropane alkaloids, including atropine, scopolamine, and hyoscyamine, have been used for various medicinal and toxic purposes for millennia. These drugs are competitive antagonists of acetylcholine muscarinic (M-) receptors that potently modulate the central nervous system (CNS). Currently used clinically to treat vomiting, nausea, and bradycardia, as well as alongside other anesthetics to avoid vagal inhibition, these drugs also evoke potent psychotropic effects, including characteristic delirium-like states with hallucinations, altered mood, and cognitive deficits. Given the growing clinical importance of anti-M deliriant hallucinogens, here we discuss their use and abuse, clinical importance, and the growing value in preclinical (experimental) animal models relevant to modeling CNS functions and dysfunctions.
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Affiliation(s)
- Anton M. Lakstygal
- Graduate School of Biology, St. Petersburg State University, St. Petersburg 199034, Russia
| | | | | | | | - Andrey D. Volgin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg 197341, Russia
| | - Konstantin A. Demin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, Ministry of Healthcare of Russian Federation, St. Petersburg 197341, Russia
- Institute of Translational Biomedicine (ITBM), St. Petersburg State University, St. Petersburg 199034, Russia
| | | | | | - Allan V. Kalueff
- School of Pharmacy, Southwest University, Chongqing 400700, China
- Anatomy and Physiology Laboratory, Ural Federal University, Ekaterinburg 620002, Russia
- Laboratory of Biological Psychiatry, ITBM, St Petersburg State University, St. Petersburg 199034, Russia
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
- Granov Russian Scientific Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, St. Petersburg 197758, Russia
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Cambier Z, Boissonnault JS, Hetzel SJ, Plack MM. Physical Therapist, Physical Therapist Assistant, and Student Response to Inappropriate Patient Sexual Behavior: Results of a National Survey. Phys Ther 2018; 98:804-814. [PMID: 29893928 DOI: 10.1093/ptj/pzy067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/04/2018] [Indexed: 11/14/2022]
Abstract
BACKGROUND A recent survey found that 84% of physical therapist, physical therapist assistant, and student respondents experienced inappropriate patient sexual behavior (IPSB) over their careers and 47% over the prior 12 months. Prevalence data justify consideration of how to address IPSB. OBJECTIVE The objective was to determine how physical therapist clinicians (used here to mean physical therapists, physical therapist assistants, and students) address IPSB and examine strategy impact. DESIGN The design was observational and cross-sectional. METHODS Several sections of the American Physical Therapy Association and selected education programs fielded the electronic survey. Respondents reported on the frequency and effect of IPSB response strategy. Response-strategy impact was tested for statistical significance. Open-ended comments were analyzed using qualitative methods. RESULTS Of 1027 respondents, 396 had experienced IPSB over the prior 12 months; 391 provided data on the frequency and effect of response strategies used. Common informal responses included distraction, ignoring IPSB, and altering treatment to avoid physical contact or being alone. Common formal responses included reporting the behavior within the facility and documenting the behavior. Successful strategies included distraction, avoidance, direct confrontation, behavioral contracts, transfer of care, and chaperone use. Experienced clinicians were more likely to be direct, whereas novice clinicians were more likely to engage in unsuccessful actions of ignoring and joking. LIMITATIONS Limitations included self-report, clinician memory, and convenience sampling. CONCLUSIONS The first findings in 20 years on physical therapist, physical therapist assistant, and student response to IPSB provide direction for the profession. Results indicate a need for clear workplace policies coupled with training for managers and supervisors to support clinicians in resolving IPSB. Policies on using behavioral contracts, chaperones, and transfer of care could empower staff to consider these successful options. Professional education and training for all physical therapy professionals on assertive communication and redirection strategies with IPSB appears warranted.
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Affiliation(s)
- Ziádee Cambier
- Swedish Medical Center, 500 17th Ave, Suite 100, Seattle, WA 98122 (USA)
| | - Jill S Boissonnault
- Division of Physical Therapy, School of Health Professions, Shenandoah University, Leesburg, Virginia; and Physical Therapy Program, Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin. Dr Boissonnault is a certified women's health specialist
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison
| | - Margaret M Plack
- Department of Health, Human Function, and Rehabilitation Sciences, Doctor of Physical Therapy Program, George Washington University, Washington, DC
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Abstract
UNLABELLED ABSTRACTBackground:Our objective was to examine and describe the common socio-demographic and clinical characteristics of first time older sex offenders. METHODS Research papers published in MEDLINE, PsycINFO, and EMBASE were searched systematically. Following removal of duplicates and irrelevant papers, a total of 423 papers were reviewed to determine whether the selection criteria were met. A total of seven publications were included and evaluated by two researchers. RESULTS Of the seven publications, there were two retrospective research studies and five case reports. There was a higher proportion of neurocognitive disorder in this offender group and the victims were usually vulnerable individuals. Yet, cognitive assessments were rarely done or reported. Two subtypes of older sex offenders were identified: (i) offenders who had offended in the past but were not previously detected; (ii) first-time offenders with a high proportion of neurocognitive disorder. CONCLUSION There is a paucity of research in first time sex offending by older people. This review has highlighted a need for better designed studies to explore the characteristics of older sex offenders. Better collaboration between forensic and old-age psychiatric services is required for improved assessment and management of older sex offenders.
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"Behind Closed Doors with open minds?": A qualitative study exploring nursing home staff's narratives towards their roles and duties within the context of sexuality in dementia. Int J Nurs Stud 2017; 74:112-119. [PMID: 28688334 DOI: 10.1016/j.ijnurstu.2017.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/03/2017] [Accepted: 06/09/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite sexual expression being recognised as a fundamental human need, sexuality in old age is often ignored and frequently misunderstood, with residents with dementia in a nursing home often viewed as asexual or incapable of being sexually active. OBJECTIVES The current study aims to understand the views held by nursing care home staff towards dementia and sexuality and explore the roles they may adopt whilst responding and managing sexual needs and expression for residents with dementia. METHODS Face to face, in-depth, semi structured interviews were conducted with eight staff members working in two nursing homes in Greater London, United Kingdom. Data were analysed using Interpretative Phenomenological Analysis. RESULTS The findings suggest that representations of sexuality in dementia held by nursing home staff ranged from the perception that sexual expression in old age was part of human nature and a basic human right to others that proposed that with the loss of memory, people with dementia may also experience loss of interest in sexuality and intimacy. Based on the representation of sexuality held (personhood versus biomedical model), nursing home staff adopted a role or a combination of roles (a facilitator, an informant, a distractor, an empathiser, a safeguarder) that legitimised past and anticipated responses in managing sexual expression in the nursing home setting. Nursing home staff's responses varied depending on the severity of the condition, level of involvement of the resident's family and their own personal views on their duty of care, old age, sexuality and dementia. CONCLUSION The simplified binary labelling and classification of sexual behaviour in dementia as appropriate or inappropriate often applied in institutional settings, fails to account for complex factors that may influence staff's decisions on the ethical dilemmas raised by dementia. A role based continuum approach could help staff move away from rigid binary judgments and train them to adopt formal carer roles that promote a more contextualised rights based approach in the provision of dementia care.
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Abstract
Inappropriate sexual behavior (ISB) is a relatively common and potentially disruptive form of behavior in people with dementia. It can cause considerable distress and put placements and people at risk. Yet it is poorly researched and understood. In addition to non-pharmacological approaches to management, a wide range of classes of medication has been used in ISB, and the results have been reported as single cases or short series, though none has been the subject of a randomized clinical trial, in part because of the lack of a well-defined method of observing and measuring ISB, as well as the significant ethical considerations. Pharmacological treatments for which there is low-level evidence of efficacy in the literature include antidepressants, antipsychotics, anticonvulsants, cholinesterase inhibitors, hormonal agents, and beta-blockers. None of the drugs discussed here is licensed for use in ISB, and elderly people, particularly those with dementia, are at high risk of adverse effects. Caution is advised before using medication in this group of people. It is important to consider alternative non-pharmacological treatments, as well as discussing issues of ethics and consent with those involved, before initiating treatment. It is helpful to identify and monitor target symptoms. Pharmacological treatments should be started at low dose and titrated up slowly and carefully. Nevertheless, in some situations, medication may provide a useful part of a management plan for ISB.
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Affiliation(s)
- Riccardo De Giorgi
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, UK. .,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Hugh Series
- Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, OX3 7JX, UK
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14
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Abstract
To describe inappropriate sexual behaviour (ISB) observed in patients with dementia, we conducted searches using the Cochrane Library, PubMed, and Web of Science to find relevant articles, chapters, and books published from 1950 to 2014. Search terms used included 'hypersexuality', 'inappropriate sexual behaviors', and 'dementia'. Publications found through this indexed search were reviewed for further relevant references. Sexuality is a human's need to express intimacy, but persons with dementia may not know how to appropriately meet their needs for closeness and intimacy due to their decline in cognition. Generally, the interaction among brain, physical, psychological, and environmental factors can create what we call ISB. The most likely change in the sexual behaviour of a person with dementia is indifference. However, ISB in dementia appear to be of two types--intimacy-seeking and disinhibited--that differ in their association with dementia type, dementia severity and, possibly, other concurrent behavioural disorder. Tensions develop from uncertainties regarding which, or when, behaviours are to be considered 'inappropriate' (i.e. improper) or abnormal. While most ISB occur in the moderate to severe stages of Alzheimer's dementia, they may also be seen in early stages of frontotemporal dementia because of the lack of insight and disinhibition. ISB are often better managed by non-pharmacological means, as patients may be less responsive to psychoactive therapies, but non-pharmacological interventions do not always stop the behaviour.
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Affiliation(s)
| | - Martina Ulivi
- Neurology Unit, Versilia Hospital, Lido di Camaiore, Italy
| | - Sabrina Danti
- Neurology Unit, Versilia Hospital, Lido di Camaiore, Italy
| | | | - Angelo Nuti
- Neurology Unit, Versilia Hospital, Lido di Camaiore, Italy
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Cipriani G, Lucetti C, Danti S, Carlesi C, Nuti A. Violent and criminal manifestations in dementia patients. Geriatr Gerontol Int 2015; 16:541-9. [DOI: 10.1111/ggi.12608] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Claudio Lucetti
- Neurology Unit; Versilia Hospital; Lido di Camaiore Lucca Italy
| | - Sabrina Danti
- Neurology Unit; Versilia Hospital; Lido di Camaiore Lucca Italy
| | - Cecilia Carlesi
- Neurology Unit; Versilia Hospital; Lido di Camaiore Lucca Italy
| | - Angelo Nuti
- Neurology Unit; Versilia Hospital; Lido di Camaiore Lucca Italy
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Bronner G, Aharon-Peretz J, Hassin-Baer S. Sexuality in patients with Parkinson's disease, Alzheimer's disease, and other dementias. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:297-323. [PMID: 26003251 DOI: 10.1016/b978-0-444-63247-0.00017-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sexual dysfunction (SD) is common among patients with Parkinson's disease (PD), Alzheimer's disease (AD), and other dementias. Sexual functioning and well-being of patients with PD and their partners are affected by many factors, including motor disabilities, non-motor symptoms (e.g., autonomic dysfunction, sleep disturbances, mood disorders, cognitive abnormalities, pain, and sensory disorders), medication effects, and relationship issues. The common sexual problems are decreased desire, erectile dysfunction, difficulties in reaching orgasm, and sexual dissatisfaction. Hypersexuality is one of a broad range of impulse control disorders reported in PD, attributed to antiparkinsonian therapy, mainly dopamine agonists. Involvement of a multidisciplinary team may enable a significant management of hypersexuality. Data on SD in demented patients are scarce, mainly reporting reduced frequency of sex and erectile dysfunction. Treatment of SD is advised at an early stage. Behavioral problems, including inappropriate sexual behavior (ISB), are distressing for patients and their caregivers and may reflect the prevailing behavior accompanying dementia (disinhibition or apathy associated with hyposexuality). The neurobiologic basis of ISB is still only vaguely understood but assessment and intervention are recommended as soon as ISB is suspected. Management of ISB in dementia demands a thorough evaluation and understanding of the behavior, and can be treated by non-pharmacologic and pharmacologic interventions.
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Affiliation(s)
- Gila Bronner
- Sexual Medicine Center, Department of Urology, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | - Sharon Hassin-Baer
- Parkinson's Disease and Movement Disorders Clinic, Sagol Neuroscience Center, Department of Neurology, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Makimoto K, Kang HS, Yamakawa M, Konno R. An integrated literature review on sexuality of elderly nursing home residents with dementia. Int J Nurs Pract 2014; 21 Suppl 2:80-90. [DOI: 10.1111/ijn.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kiyoko Makimoto
- Division of Health Sciences; Osaka University Graduate School of Medicine; Suita Japan
| | - Hee Sun Kang
- Department of Nursing; Red Cross College of Nursing; Chung-Ang University; Seoul Korea
| | - Miyae Yamakawa
- Division of Health Sciences; Osaka University Graduate School of Medicine; Suita Japan
| | - Rie Konno
- Division of Health Sciences; Osaka University Graduate School of Medicine; Suita Japan
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Momtaz YA, Hamid TA, Ibrahim R. The impact of mild cognitive impairment on sexual activity. Am J Alzheimers Dis Other Demen 2013; 28:759-62. [PMID: 24085247 PMCID: PMC10852860 DOI: 10.1177/1533317513504612] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVE The aim of this study was to identify the unique impact of mild cognitive impairment (MCI) on sexual activity among older adults. METHODS Data for the study were drawn from a national survey entitled the "Determinants of Wellness among Older Malaysians: A Health Promotion Perspective" conducted in 2010. RESULTS According to the Mini-Mental State Examination education-adjusted cutoff points, 15.6% of the 1046 respondents were identified as having MCI. Older adults with MCI had a significantly lower level of sexual activity than the healthy cognitive group (chi-square = 50.20, P < .001, 32.5% vs 62.3%). The results of 3-step hierarchical logistic regression model revealed that MCI is significantly associated with decreased sexual activity in community-dwelling older adults, over and beyond demographic factors, and age-related medical conditions affecting sexual activity (odds ratio 0.33, P < .001, 95% confidence interval 0.23-0.49). CONCLUSION Findings from the present study support the significant role of cognitive functioning to perform sexual activity in later life.
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Affiliation(s)
| | - Tengku Aizan Hamid
- Institute of Gerontology, Social Gerontology Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rahimah Ibrahim
- Institute of Gerontology, Social Gerontology Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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20
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Cross BS, DeYoung GR, Furmaga KM. High-Dose Oral Medroxyprogesterone for Inappropriate Hypersexuality in Elderly Men with Dementia: A Case Series. Ann Pharmacother 2013; 47:e1. [DOI: 10.1345/aph.1r533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To retrospectively examine the utility of high-dose oral medroxyprogesterone (MPA) for the treatment of inappropriate hypersexuality (IH) in elderly men with dementia. CASE SUMMARY Ten men aged 65 years or older (median 79.5 years, range 65–93 years) were identified from all admissions at a 170-bed tertiary referral psychiatric hospital between December 2005 and January 2011. Admission records were used to identify subjects who received at least 100 mg daily of oral MPA. The primary outcome of successful treatment was chart documentation of a substantial decline in IH, such that subjects could return to preadmission residence. Data were collected to assess trends in dose, adverse effects, use of other symptom-modifying medications prior to MPA initiation, and successful return to preadmission placement. A trial serotoneric agent was used in 70% of subjects prior to MPA initiation. Sixty percent of subjects failed a trial of an antipsychotic, while 40% did not have response to the use of both a serotonergic agent and an antipsychotic before MPA was initiated. The average daily dose of MPA was 300 mg (range 100–400 mg/day). No adverse effects were documented from physician, nursing, or behavioral health rounding notes; however, adverse effects may not have been systematically assessed at the time of MPA administration. Seventy percent of subjects experienced favorable changes in target behaviors from MPA. DISCUSSION Few data exist on effective therapy options for treatment of IH. The minimum concentration of MPA needed to suppress IH in the male body is unknown. MPA was titrated upward, with the efficacy measure being a decrease in inappropriate behaviors. Use of MPA likely contributed to decreased IH; however, other factors involved in hospitalization could have contributed to improved behavior. CONCLUSIONS While requiring further study, high-dose (100–400 mg/day) oral MPA may represent an effective and well-tolerated treatment option for subjects displaying IH.
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Affiliation(s)
- Bethany S Cross
- Bethany S Cross PharmD, at time of writing, PGY-1 Pharmacy Practice Resident, Saint Mary's Health Care, Grand Rapids, MI; now, PGY-2 Psychiatric Pharmacy Resident, Central Texas Veterans Health Care System, Temple, TX
| | - G Robert DeYoung
- G Robert DeYoung PharmD BCPS, Clinical Pharmacist and Program Director, Pharmacy Residency (PGY-1), Advantage Health Physician Network and Saint Mary's Health Care, Grand Rapids, MI
| | - Kevin M Furmaga
- Kevin M Furmaga PharmD BCPP, Clinical Psychopharmacology Specialist, Department of Pharmacy, Pine Rest Christian Mental Health Services/Saint Mary's Health Care Grand Rapids; Adjunct Associate Professor, College of Human Medicine, Michigan State University, Grand Rapids; and Adjunct Assistant Professor, College of Pharmacy, University of Michigan, Ann Arbor
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Abstract
SummaryHuman sexuality is a complex interaction of biological, social and emotional factors. When any or all of these factors are disrupted by a progressive dementia it is unsurprising that sexual ‘problems’ are identified. Most sexual behaviour ‘problems’ relate to expressions of normal sexuality complicated by changes in relationships, care needs and cognitive function, and complex ethical and legal considerations emerge. Rarely, new and severe hypersexual or paraphilic behaviours arise de novo, usually due to damage to certain brain areas, and sometimes due to medication side-effects, psychiatric disorder or delirium. Evidence and approaches to assess and to manage sexual behaviour problems in dementia are discussed.
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Carabellese F, Candelli C, Vinci F, Tamma M, Catanesi R. Elderly sexual offenders: two unusual cases. J Forensic Sci 2012; 57:1381-3. [PMID: 22509748 DOI: 10.1111/j.1556-4029.2012.02129.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this case report is to describe two cases of sexual abuse by elderly subjects for which the Judge commissioned an expert psychiatric-forensic opinion. The elderly are generally believed to commit nonviolent crimes, whereas the two cases we observed feature forcible rape committed by elderly offenders, who showed no form of mental disease and had rationally planned their offense. They had never previously committed similar acts and had no history of homosexuality; both had been married for many years before the death of their wives and had adult children. Finally, no previous episodes of rape emerged in their personal histories during interrogations. The sociocultural context in which the crimes were committed was identical and arouses interest as regards both the method employed and how the crimes were discovered. The legal authorities then commissioned accurate investigations including medicolegal and psychiatric-forensic evaluations of the offenders and their victims.
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Affiliation(s)
- Felice Carabellese
- Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy.
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Stubbs B. Displays of inappropriate sexual behaviour by patients with progressive cognitive impairment: the forgotten form of challenging behaviour? J Psychiatr Ment Health Nurs 2011; 18:602-7. [PMID: 21848594 DOI: 10.1111/j.1365-2850.2011.01709.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Persons with progressive cognitive impairment such as dementia or Alzheimer's disease may display an array of challenging behaviours. For instance, levels of agitation and aggression have been reported as high as 33% in home-dwelling individuals and 80% in those residing in institutions. One form of challenging behaviour that may be displayed by this group is inappropriate sexual behaviour (ISB), but it is often overshadowed by other behaviours such as aggression. Inappropriate sexual behaviour involves any verbal of physical action of a sexual nature which is displayed in an inappropriate social context. Examples of ISB include: exposure of genitals in public/ward environments, 'groping' of nurses and masturbation in public areas. It has been estimated that the prevalence of ISB ranges from 2% to 17% of individuals with progressive cognitive impairment. Although it is less frequent than other challenging behaviours, it still may have significant deleterious effects on the victim's health. This paper is a review of the available literature on the nature, effects and management of ISB in persons with progressive cognitive impairment. Possible avenues for future research are also explored.
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Affiliation(s)
- B Stubbs
- Mental Health Research Network Midlands Branch, Northampton, UK.
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Vitale C, Santangelo G, Trojano L, Verde F, Rocco M, Grossi D, Barone P. Comparative neuropsychological profile of pathological gambling, hypersexuality, and compulsive eating in Parkinson's disease. Mov Disord 2011; 26:830-6. [DOI: 10.1002/mds.23567] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 11/02/2010] [Accepted: 11/08/2010] [Indexed: 11/11/2022] Open
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The Complex Nature of Inappropriate Sexual Behaviors in Patients with Dementia: Can We Put it into a Frame? SEXUALITY AND DISABILITY 2010. [DOI: 10.1007/s11195-010-9187-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rosen T, Lachs MS, Pillemer K. Sexual aggression between residents in nursing homes: literature synthesis of an underrecognized problem. J Am Geriatr Soc 2010; 58:1970-9. [PMID: 20840462 DOI: 10.1111/j.1532-5415.2010.03064.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Evidence exists suggesting that most sexual aggression against older adults occurs in long-term care facilities. Fellow residents are the most common perpetrators, often demonstrating inappropriate hypersexual behavior caused by dementing illness. This resident-to-resident sexual aggression (RRSA) is defined as sexual interactions between long-term care residents that, in a community setting, at least one of the recipients would be likely to construe as unwelcome and that have high potential to cause physical or psychological distress in one or both of the involved residents. Although RRSA may be common, and physical and psychological consequences for victims may be significant, this phenomenon has received little direct attention from researchers. This is a review of the existing literature and relevant related research examining elder sexual abuse and hypersexual behavior that describes the epidemiological features of this phenomenon, including risk factors for perpetrators and victims. The legitimate and recognized need for nursing home residents, even those with advanced dementing illness, to express themselves sexually makes preventing and managing sexual aggression in nursing homes more challenging. This review discusses the ethical dilemma this situation creates and the need to evaluate the capacity to consent to sexual activity of residents with dementing illness and to re-evaluate capacity as the diseases progress. Suggestions are offered for managing incidents of RRSA and for future research, including the importance of designing effective interventions.
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Affiliation(s)
- Tony Rosen
- Emergency Medicine Residency Program, New York Presbyterian Hospital, New York, New York, USA
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Abstract
BACKGROUND This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia. METHODS A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed. RESULTS No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior. CONCLUSIONS Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.
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Wallace M, Safer M. Hypersexuality among Cognitively Impaired Older Adults. Geriatr Nurs 2009; 30:230-7. [DOI: 10.1016/j.gerinurse.2008.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 08/27/2008] [Accepted: 09/02/2008] [Indexed: 10/20/2022]
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