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Grey area: The fragile frontier of dementia, intimacy and sexual consent

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Grey area: The fragile frontier of dementia, intimacy and sexual consent was the Saturday July 14, 2018 front page headline in the Globe and Mail.

Seniors and sexuality finally makes the front page of a national newspaper. However It is much more than that and the focus of the article is on consent and how it is (not) defined for those whose capacity may be questionable and the challenges faced by both families and residential settings.

As a society we have our share of hangups- especially when it comes to sexuality. Our parent’s generation didn’t talk about sex and we don’t really want to ask them questions about it either. For many, intimacy is about closeness, love and connectedness with another; sexual activity may or may not be part of the equation. Not all of our equipment may work as well as it once did either.

The issue regarding sexuality and seniors comes to the fore for those who reside in facilities, particularly those who reside in publicly funded long term care/nursing homes. Privacy is almost non existent and there is no such as thing as ‘behind closed doors’ due to safety concerns. For those seniors with dementia ( and appreciate that this is 1 in 3 over age 85) the issue is about capacity and understanding and consenting to sexual activity.

The Criminal Code indicates that consent can be ‘spoken or unspoken, but it needs to be affirmative and happen in the moment; passivity cannot be construed as a “yes,” and nobody can consent (or dissent) on anyone else’s behalf, not even with the power of attorney.’ This definition applies to all of us.
What is defined as capacity to consent for sexual activity for those living with dementia is not clear. Does the individual understand what they are doing and any consequences that may follow and can they change their mind and say no? This is even more complicated when one party is still married to another individual.

While Long Term Care settings would like to be considered as the person’s home, they really are not. They facilities are regulated by the Provincial Ministry, front line staff are Personal Support Workers; safety is supposed to be paramount and staff are to treat all residents with respect and dignity. However staff hold their own values and there is no policy on how to respond to physical intimacy between residents. Policy makers, researchers, advocates and involved, invested and interested individuals are discussing this issue and hopefully very soon we will have some best practices as we boomers age gracefully into ‘seniorhood’.

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About Audrey Miller
About: Audrey Miller, Managing Director of Elder Caring Inc. has over 30 years social work and rehabilitation experience working with older individuals and their families. She advises the financial, insurance, legal and business communities regarding elder care issues. Audrey is a recognized expert in her field. Email:


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