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Can Dementia Cause Inappropriate Behaviour

How To Handle A Dementia Patients Thrifty Behavior

Caregiver Training: Sexually Inappropriate Behaviors | UCLA Alzheimer’s and Dementia Care Program

Regardless of whether they have dementia, many elders were strongly influenced by the Great Depression and pride themselves on their frugality and resourcefulness. Furthermore, most seniors are living on a limited income and worry about having enough money to see them through retirement. Dementia can exacerbate these concerns and even cause them to project their anxieties other people.

Food tends to be a particular point of contention for many older adults. Some experienced hardship and famine themselves or heard about it from their parents and grandparents and were therefore raised with the mantra, waste not, want not. The memories that dementia patients retain are often from decades back, so they might panic if they see that food is being wasted. For example, a senior with dementia might become overcritical of someone who doesnt clean their plate or save leftovers. They might say something like, That woman is throwing away food! Thats a sin! Look at her dumping her dinner in the garbage!

The Thoughtful Pause Between Stimulus And Response May Deteriorate In Dementia

In the last post, we discussed how and why frustration, depression, anxiety, and not participating in activities are common in dementia. In this article well tackle the thorny issues of apathy, irritability, agitation, aggression, combativeness, inappropriate behavior, willfulness, and sundowning.

Apathy is common in dementia. When dementia damages the front of the brain or some of its connections, apathy can result. The normal drive to plan for the future is lost. Sometimes this loss can manifest by letting house repairs go, neglecting to pay bills, or not going to the grocery store until every scrap of food in the house is gone. When more severe, the desire to do anything at all may be gone, and the individual with dementia can sit passively for hours staring at a blank wall or a television that is not turned on.

Disinhibited behavior can lead to safety issues. When your loved one has behavior problems it can be distressing, physically exhausting, and heart-breaking. Behavior problems can also lead to safety issues. Dementia may lead individuals to act precipitously without thinking of the consequences. If they are feeling angry, they could strike out with their fists or any available item, including knives, guns, and baseball bats. If they feel like getting out of the car they may do sodespite the fact that the car is moving! In later posts, well discuss ways of managing these safety issues.

Key Questions

Handling Sexual Behavior And Dementia

Most family caregivers have made peace with dementia symptoms like memory loss and repeated questions. However, there is a shocking behavioral symptom that often catches families off-guard: hypersexuality. Seniors may say and do sexually inappropriate things as their condition progresses. Lewd comments and gestures can all increase due to neurodegenerative diseases such as Alzheimers, frontotemporal dementia and even Parkinsons.

These behavioral changes can be very difficult for family caregivers to witness, let alone manage, but it is important to monitor them carefully to ensure both the patients dignity and that of the people who interact with them. First, we must acknowledge that an individuals natural sexual desire doesnt just disappear with age and infirmity. When dementia is part of the equation, though, this basic desire may remain intact while ones sexual and social inhibitions decline due to worsening neurological damage in the brain. Unfortunately, some individuals have always been inappropriate or pushed these delicate boundaries, but dementia patients are unique in that they do not fully understand or have control over their actions.

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Responding To Sexual Behaviors In The Moment

Encountering a sexual behavior from someone with dementia can evoke uncomfortable feelings of stress, embarrassment or even fear in many family members or caregivers. Its easy to be overcome with shock or disbelief, especially if its the first time it has happened.

Keep in mind these simple steps:

  • Remain calm
  • Ensure the safety of all involved
  • Step back, or out of the room, if needed
  • If possible, determine the cause behind the behavior

Depending on the situation, it may help in the moment to

  • calmly and firmly tell them not to touch you
  • respectfully remind them why its inappropriate
  • look them in the eye and ask them to stop because its making you uncomfortable
  • ignore comments or behaviors that arent harming anyone
  • step out of the room
  • redirect with humor
  • provide privacy

Box 2why Does Sexual Behaviour Increase In Dementia

Inappropriate behaviour in dementia  how do you deal with it ...

Disease-related factors

  • Sexual disinhibition is a recognised feature of frontal lobe lesions and forms part of KluverBucy syndrome, originally described following bilateral temporal lobectomy in monkeys

  • Disinhibition due to organic brain disease

  • Normal etiquette may be forgotten

  • Delusions, hallucinations, misidentifications

  • Publications of particular interest.

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    Understanding Challenging Behaviors In Dementia

    Alzheimers and other dementias often are accompanied by challenging behaviors that were not always prepared to handle. Sometimes, dementia seems to bring out the individual’s basic personality all the more. Other times, personalities seem to be completely different as dementia progresses.

    For example, a loved one may be punctuating every sentence with & **%***#%* words they’ve never uttered throughout their whole life. A husband who has been faithful to his wife for their entire marriage may now be attempting to touch someone inappropriately or begin to have a girlfriend at a facility where he lives. Yet another person may have always been hospitable and welcoming, and now refuses to open the door to visitors and can be heard screaming for them to leave.

    Communicating Effectively With The Person Who Has Dementia

    As a persons condition progresses, his or her ability to communicate diminishes. Understanding the effects of the disease will help you communicate as effectively as possible for as long as possible

    Your loved one may:

    • Lose ability to reason and understand
    • Use language that is more direct or accusatory
    • May become withdrawn and speak very little

    Medications and other health problems also may affect communication. If you notice significant or abrupt changes in your loved ones ability to communicate, talk to his or her physician.

    Tips for better communication Although you may find these changes frustrating and even alarming, you can counter them. Consider using these tips to improve communication with your loved one:

    Even when your loved one no longer responds in the way he or she once did, your efforts to communicate will help to keep him or her engaged in life for as long as possible.

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    Uncontrolled Sexual Behaviour In Dementia

    It not clear whether uncontrolled sexual behaviour is more prevalent in men than women or in patient with more severe dementia. Most studies only included men and dementia severity was often not investigated with regard to uncontrolled sexual behaviour. In studies that focused on uncontrolled sexual behaviour and included severity of dementia, the results were inconclusive. Burns et al. found a positive association with severity of dementia, while De Medeiros et al. (2008] concluded that half of the subjects with uncontrolled sexual behaviour had mild dementia, whereas most subjects with non-sexual behaviours had severe dementia. However, this difference did not reached significance. In both studies the frequency of sexual behaviour was equal for men and women, while two other studies have shown that sexual behaviour was more prevalent in men .

    In sum, based on these cross-sectional studies, prevalence rates of uncontrolled sexual behaviour in dementia vary between 1,8%-28%, which depends on type of dementia.

    Articles On Behavior Problems With Dementia And Alzheimer’s

    What Causes ISBs â Dementia-Related Inappropriate Sexual Behavior?

    Many times, people with Alzheimerâs still have their sex drive. But changes in their brains can make them act in ways that are new or different for them.

    For example, they may show more interest in sex than before. They may touch, hug, or try to kiss others, even strangers. They might touch their private areas, masturbate around others, or try to touch other peopleâs private areas.

    They may use vulgar language or make sexual advances. They may take their clothes off around others or come out naked or in their underwear.

    This behavior may surprise you, but remember that it isnât their fault. Itâs caused by the effects of the disease on their brain. It may help you not feel hurt or embarrassed to remind yourself and others of this.

    It isnât usually an emergency. You can often manage it at home.

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    If You’re Looking After Someone With Dementia

    Your needs as a carer are as important as the person you’re caring for.

    To help care for yourself:

    • join a local carers’ support group or a specialist dementia organisation â for more details, call the Carers Direct helpline on 0300 123 1053 lines are open 8am to 9pm Monday to Friday, and 11am to 4pm at weekends
    • call Dementia UK’s Admiral Nurse Dementia Helpline free on 0800 888 6678 to talk to a registered specialist dementia nurse lines are open 9am to 9pm Monday to Friday, 9am to 5pm at weekends

    Managing Inappropriate Sexual Behavior In Alzheimers Disease

    Inappropriate sexual behavior is a common yet rarely discussed symptom in individuals with dementia. Author Elizabeth Marcus writes about her personal experience with her fathers behavioral changes in her new book, Dont Say a Word!: A Daughters Two Cents. Elizabeth shares what she learned caring for her father, as well as advice for caregivers responding to the symptoms. Neurologist Dr. Martin Samuels offers background on changes in the brain that can cause inappropriate sexual behavior and other personality shifts that are common in people with dementia. Guest: Elizabeth Marcus, author Martin Allen Samuels, MD, Brigham and Women’s Hospital

    Episode Topics:

    Visit Elizabeth Marcus author website to learn about her new book, Dont Say a Word! A Daughters Two Cents.

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    Choose From The Options Below To Find Out More About These Behaviours And What Support Is Available

    Some people with dementia will respond as they always have during sex. However, some partners say that a person with dementia can appear cold and detached. Others say that their partner forgets that they have had sex immediately afterwards, or no longer appears to recognise them as their partner.

    These situations can be upsetting and confusing both for the person with dementia and their partner.

    Find out more about coping with these changes on our page, ‘How can dementia affect a person’s sexual behaviour‘.

    Behavioral Variant Frontotemporal Dementia

    Coping With Dementia Behavior Changes

    People with behavioral variant frontotemporal dementia often have trouble controlling their behavior. They may say inappropriate things or ignore other peoples feelings. bvFTD may affect how a person deals with everyday situations. bvFTD can also affect language or thinking skills. Unfortunately, people with bvFTD rarely notice these changes.

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    What Are Disinhibited Behaviours

    Disinhibited behaviours are actions which seem tactless, rude or even offensive. They occur when people dont follow the usual social rules about what or where to say or do something.

    Disinhibited behaviours can place enormous strain on families and carers. They can be particularly upsetting when someone, who has previously been private and sensitive, behaves in a disinhibited way.

    Disinhibited behaviours may include any of the following:

    • Tactless or rude remarks – A person with dementia may comment tactlessly about another persons appearance for instance. They appear to have lost their social manners, and it can look as if they are trying to deliberately embarrass or harass the other person.
    • Bold behaviour – A person with dementia may inappropriately flirt with someone or make sexual comments.
    • Exposure – A person with dementia may take some, or all of their clothes off at inappropriate times or in inappropriate settings.
    • Fondling – Forgetting social rules, a person with dementia may publicly fondle themselves or masturbate in front of others.

    Medical Causes Of Sleeping Problems In Dementia

    Sleeping problems may be caused by physiological or medical causes including:

    • brain damage that affects the biological clock in the brain that directs our sleep patterns
    • illness such as angina, congestive heart failure, diabetes or ulcers
    • pain caused by conditions such as arthritis
    • urinary tract infections that cause a frequent need to urinate
    • leg crampsor restless legs, which can indicate a metabolic problem
    • depressionthat causes early morning wakening and an inability to get back to sleep
    • side effects of medication, such as antidepressants and diuretics
    • snoring and sleep apnoea
    • ageing that causes sleep patterns to change so that some people need more sleep and some need less.

    Things you can try include:

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    How To Manage Embarrassing Or Challenging Situations

    If the person behaves in a way which could be seen as sexual in public, you may feel embarrassed or upset.

    You might feel that you want to protect them from other peoples responses to the behaviour for example, if people are laughing or are shocked. It can help to quietly explain to others why the person with dementia is behaving in that way, for example, you could show a helpcard which explains the persons diagnosis.

    It can help to realise that behaviour that appears sexual doesnt always indicate sexual desire. Instead, the person might be feeling or trying to indicate something different. If you can understand why someone is behaving in a certain way, it might be easy to understand their behaviour. For example:

    • Someone who begins taking their clothes off in public may be too hot and trying to cool down. Or they might be uncomfortable for example, if their clothes are itchy or tight and be trying to undress, while not realising that this isnt appropriate in a public place.
    • Someone might also touch their genitals because they need to use the toilet.
    • They may be agitated or bored.

    Always respect the person and their dignity, and try not to cause them any distress.

    Dementia and challenging sexual behaviour

    Find out more about challenging sexual behaviours and what support is available.

    In What Stage Do Challenging Behaviors Occur In Alzheimers

    How Dementia Related Inappropriate Behavior Affects Loved Ones

    Different kinds of behaviors occur during the stages of Alzheimers. Typically, in the early stages of dementia, people will battle the memory loss by initiating behaviors that they feel help them to control the situation or prevent problems. For example, its not unusual to see someone develop a level of obsessive-compulsive behavior since routine and repetition are reassuring and can prevent mistakes.

    Other people in early dementia will begin hoarding things, either because they forgot they already had the item or because they are comforted by knowing they have multiple items in case of an emergency.

    As the disease progresses into the middle stages, individuals may develop more anger, aggression, and agitation. The middle stages tend to be the most difficult in terms of behaviors since the person’s ability to reason or use logic has declined. People in the middle stages also might experience some psychological behaviors such as hallucinations or paranoia, which can be very upsetting and distressing for the person and her loved ones.

    In the later stages of dementia, people tend to experience more apathy and withdrawal. It can become more difficult to elicit a response from your loved one. In late-stage Alzheimer’s, individuals usually require more physical assistance from you in their activities of daily care but display fewer challenging behaviors.

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    How To Handle Dementia And Racism

    While some of the inappropriate things that come out of dementia patients mouths tend to be off the wall or even comical, other comments are deeply hurtful to those around them. These remarks are the product of interacting with the world as usual but without any social filters. A senior with cognitive impairment may comment on a persons attractiveness, weight, clothing, accent or even race. The first few items on this list can come across as downright rude, but offensive remarks about ones race or ethnicity cross a very serious line and must be addressed swiftly and sensibly by caregivers.

    This is often an issue with elder care providers like in-home care agencies, adult day care centers and senior living communities where the comprehensive staff is comprised of people from diverse backgrounds and interacts with clients and residents on a regular basis. A dementia patient may comment on a persons race or ethnicity or even use racial slurs. While we dementia caregivers quickly learn to laugh off an odd statement or redirect repeated questions, these kind of remarks cannot be swept under the rug.

    Why Is The Person With Dementia Mistaking A Person For Someone Else

    Dementia can cause changes to a persons perception of situations, people and things. As a result, the person with dementia may mistake people for others, which can be distressing for everyone involved.

    If your partner mistakes someone else for you, and behaves sexually or affectionately towards them, it is natural that you will feel upset. Try to approach the situation in a way that maintains the dignity of the person with dementia as much as possible.

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    How To Cope With Common Changes In Behaviour

    Although changes in behaviour can be difficult to deal with, it can help to work out if there are any triggers.

    For example:

    • Do some behaviours happen at a certain time of day?
    • Is the person finding the home too noisy or cluttered?
    • Do these changes happen when a person is being asked to do something they may not want to do?

    Keeping a diary for 1 to 2 weeks can help identify these triggers.

    If the change in behaviour comes on suddenly, the cause may be a health problem. The person may be in pain or discomfort from constipation or an infection.

    Ask a GP for an assessment to rule out or treat any underlying cause.

    Keeping an active social life, regular exercise, and continuing activities the person enjoys, or finding new ones, can help to reduce behaviours that are out of character.

    Read more about activities for dementia.

    Other things that can help include:

    • providing reassurance
    • activities that give pleasure and confidence, like listening to music or dancing
    • therapies, such as animal-assisted therapy, music therapy, and massage

    Remember also that it’s not easy being the person supporting or caring for a person with behaviour changes. If you’re finding things difficult, ask for support from a GP.


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