From Gatekeeper to Facilitator: Balancing Between Sexual Rights and Protection From Harm in Dementia Adults

• Published in: The American journal of geriatric psychiatry 2024-10
• Main Authors: Cheng, Han-Yun, Liu, Li-Yuan
• Format: Article
• Language: English
• Subjects: cognitive impairment; Dementia; later-life sexual activity; sexual consent capacity; sexual right; sexuality
• ISSN: 1064-7481; 1545-7214; 1545-7214
• DOI: 10.1016/j.jagp.2024.09.014

•What is the primary question addressed by this study? How do we uphold the sexual autonomy of dementia adults while mitigating the risks of them being involved as either perpetrators or victims?•What is the main finding of this study? There are some practical limitations and ethical concerns with current sexual consent capacity models, including unattainability in the real world, setting high standards, overemphasizing risks and protection, and neglecting the importance of privacy and autonomy. Thus, it is essential to adopt a balanced approach and develop policies and education that facilitate nonharmful sexual activities.•What is the meaning of the finding? Instead of assuming a gatekeeping role that monitors the ability and risks of dementia elderly to engage in what types of sexual relationships, we should put more attention on how to keep the risk within a reasonable level and support the benefits of intimacy. The assessment of sexual consent capacity has been a challenge due to its dynamic nature, influenced by factors such as time, environment, individuals involved, and the nature of activities. Particularly in people living with dementia, the complexity is intensified with the interplay of the disease's impact, residential care setting, and legal constraints. This amplifies the dilemma faced by practitioners—whether to prioritize protection or encourage and support sexual expression. This article aims to provide a sensible approach to uphold the sexual autonomy of people living with dementia while mitigating the potential risks of them being involved as either perpetrators or victims. In this narrative review, a literature search spanning from 1990 to 2023 was carried out on PubMed. Relevant articles on people living with dementia and topics related to sexuality were scrutinized. 41 relevant articles identified themes related to the impact of cognitive impairment on sexuality, challenges in residential care facilities, sexual consent capacity assessment models, and ethical frameworks regarding sexual rights and law. Discussions highlight the often neglected influence of prolonged suppression of sexual expression and the benefits of actualization of sexual autonomy, especially in people living with dementia, whose sense of identity is fading. It scrutinizes the limitations of existing sexual consent capacity evaluation models, emphasizing ethical concerns, practical challenges, and the need for a more balanced approach. Proposed strategies advocate