Sex and the Older Adult

Why are nursing-home administrators so queasy about sexual expression? They're afraid of getting sued. An estimated 50 percent of elderly residents suffer from some degree of Alzheimer's disease or dementia, which, depending on its severity, can make them confused, forgetful, or unaware of their own behavior. Even in the best cases, many of these patients may not be able to provide clear consent to a sexual advance.

So what happens when one of these patients with dementia starts sleeping around? According to federal law, nursing-home residents are guaranteed some small degree of privacy, as well as the right to "psychosocial well-being"—which can be taken to include free sexual expression. The administrator must balance these rights with the possibility that the patient isn't able to consent to sex at all, and that his every encounter amounts to an elder version of gray rape.

How can doctors make it easier for their patients to have safe, fulfilling sex in their twilight years? To begin with, they might allow sex between two seemingly willing residents with dementia, in the same way that "age gap" laws allow for consensual sex between age-matched teenagers. Nursing homes might also consider formal exceptions to the consent rules for spouses or long-term partners. Perhaps the safest solution would be to encourage residents to designate a "sexual guardian" in advance of their cognitive decline. That person—whether a spouse, a friend, or a close relative—could serve as the elder-sex cop, or elder-sex partner, for their loved one.

- From Naughty Nursing Homes: Is it time to let the elderly have more sex? by By Daniel Engber

Harriet, Second from the Right

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