Another complexity in evaluating sexual relationships between residents is the issue of their understanding of the involvement. A demented resident may be unaware of the situation altogether. “Sometimes they don't know the name of the person they're having the relationship with, which is fascinating,” Dr. Rosenzweig said. “Yet it's just as meaningful and emotionally rewarding to them.”
Nonpharmacologic interventions for dealing with sexually inappropriate behaviors include a nursing facility's medical director advising staff to maintain professional boundaries with residents, a concept that can be hard for some nurses to buy in to, Rosenzweig said. The certified nurse assistants see themselves as the resident's friend and confidant as opposed to having that professional boundary,” he said.
Other strategies include coworkers consulting with one another to establish a consistent approach to dealing with the behavior; fostering social stimulation and recreational activities, modifying the clothing of a resident acting inappropriately, such as dressing a man in a one- piece jump suit with back snaps and clasps, or discouraging revealing clothing for staff members, avoiding explicit television shows, encouraging appropriate behavior through rewards and attention, and isolating an offending resident from potential targets of inappropriate behavior.
Pharmacologic interventions for sexually inappropriate behaviors are poorly studied and ethically controversial, Dr. Rosenzweig said. Medications that have been studied but are without clear indications in this area include hormonal agents, serotonergic agents, antipsychotics, and mood stabilizers. Despite several recent successes with oral estrogen, any drug should generally be “an intervention of last resort,” he said.
“You have to be thoughtful and you have to use common sense and trial and error approaches,” he concluded.
Dr. Rosenzweig disclosed that he is a member of the speakers' bureaus for Abbott Laboratories, Eli Lilly and Company, Bristol-Myers Squibb, Novartis Pharmaceuticals, and Astra-Zeneca.
'Do you let the family make a decision or interfere in the love life … of an elderly couple in your facility?' DR. ROSENZWEIG