Aging And Intimacy: Love, Friendship And Sex At An Assisted Living Community
A lot of people don’t want to talk about sex. But the urge to have sex or be intimate with someone doesn’t go away with age, or even if that person develops dementia. It’s an issue many families face when confronted with such a diagnosis, but at one assisted living community in Phoenix, sex is just sex.
"I talk to nursing about that. I said, 'You know, it is a twin bed. I am concerned about them rolling out of the bed,' but they have mats," said Denise Gutierrez.
Her mother, Laurie Thomas, lives in one of the cottages at Huger Mercy Living Center, an assisted living facility in northwest Phoenix.
Thomas has frontotemporal degeneration, a lesser known type of dementia. Before Thomas came to Huger Mercy in 2015, she lived with a male companion, but when she moved into the facility, her companion went to live with his family.
Gutierrez said it was a sad time for her mother, but then, she met someone.
"One day, I came in and her door was shut. She leaves it closed often and I knocked on the door and they were sitting on bed holding hands," Gutierrez said. "And my mother is elated and said 'look who came back.'"
Gutierrez said the gentleman her mother was holding hands with looked just like her former companion. He had the same build, even used the same walker.
His family knows about his relationship with Thomas, and they’re OK with it. So does the staff at Huger Mercy.
"People think intimacy immediately jump right to sexual intercourse," said Lisa O’Toole, manager at Huger Mercy. "And that could be included, but we have to think of intimacy, we think of relationships."
O'Toole explained, "Part of the disease process is that unlearning. So we’re not thinking as we would usually as an adult, so we unlearn to the point that we’re childlike. That this is my best friend and I connect with you. Honestly we encourage it."
Karen Shannon’s husband, Matthew, has Alzheimer’s disease. He also came to Huger Mercy in 2015. For Shannon, placing her husband was painful. She felt guilty.
Then, she said something happened.
"One day I came to visit with Matthew and Tom was there and the two of them were chatting and I was chatting with them for a while and suddenly they got up and left and they went on their little walk," Shannon said. "So I’m sitting there by myself I can’t tell you the expression is, for me my heart was full of joy."
Marianne McCarthy, a geriatric and psychiatric nurse practitioner at Huger, said intimacy is something we all need, from the moment we’re born to the moment we die, and that doesn’t change even with a dementia diagnosis.
"People tend not to touch people as they get older, and I find that older adults and especially those in different facilities are starving — starving for intimacy," McCarthy said.
Which could explain how someone’s behavior could be misconstrued as being “sexually inappropriate.”
"That term, sexually inappropriate, makes me a little bit crazy because we’re defining things as inappropriate based on whatever," McCarthy said. "Whether they’re our puritanical values. Women become neutered when we become older, men if they’re sexual beings, they’re thought of as dirty old men."To illustrate her point, McCarthy talked about the one time she was called to another facility to evaluate an 87-year-old man who had dementia and was in a wheelchair with an amputated leg.
"And I remember going back out to staff, I said, 'Really? What did you want me to do with this gentleman, what do you think should happen with this gentleman? And what was it that he was doing?' And all he was doing was flirting."
That said, some cases do require interventions like psychotropic drugs or even relocation to another facility.
But going back to McCarthy’s example, it does speak to the need for more, well, sex ed.
Michele Grigaitis-Reyes is a family nurse practitioner at Banner Alzheimer’s Institute in Phoenix. In her experience, she said, most facilities nationwide aren’t doing that.
"For example disrobing. Disrobing can be caused by so many triggers that have nothing whatsoever to do with sexual activity or intent," Grigaitis-Reyes said.
In fact, said Grigaitis-Reyes, inappropriate sexual behavior occurs in about 15 percent of people with dementia and often in residential settings. That leaves a significant percentage of people who are simply in need of human connection.