Caregivers and nurses: Knowing when to get involved in issues of elder intimacy

As caretakers of elderly people we focus on their health, comfort and emotions. We monitor their eating, bathroom routines, and even their socialization. But what about intimacy and romance? At what point, if ever, does a romance in an elder person’s life warrant some sort of interference from caregivers or nurses? This is a tricky issue which requires sensitivity.

Human touch is important and a need that all people are entitled to have that need fulfilled in a safe way. For all people, young and old alike, it is most important to ensure that everyone is safe and consents to everything that occurs in a relationship, romantic or otherwise.

However, issues of consent can be tricky in elders when determining if two individuals are fully cognizant and competent. When dealing with residents with dementia, drawing this line can be even trickier. However, many residents with dementia still maintain the capacity to have safe and fulfilling romantic relationships.

When assessing intimacy between two fully competent residents, I believe that it is no one’s business but their own unless there is evidence of something wrong occurring. Such evidence would indicate that the arrangement is detrimental for the resident due to isolation, undue influence, abuse or neglect. If any of these frightening signs are apparent to a caregiver, nurse or family member, it is best to contact an elder law attorney.

For example, if an elderly resident – such as one’s father – wants to be with a younger gal (e.g. an “Anna Nicole Smith” situation), he should be fully free to do so. It is his business alone. However, if you doubt that the resident is capable of understanding the risks of his relationship, or if his new girlfriend is using undue influence, then an evaluation with a neuropsychologist and an elder law attorney is imperative. An elder law attorney can make sure that an individual’s assets are not taken from them unfairly. If financially protecting the elder causes the relationship to falter or fail, this indicates that the partner may have been trying to take advantage of the elder financially.

Romance and sex are on the spectrum of affection and in our culture, elders engaging in these activities can have a “Harold and Maude” feel to it. You may be thinking, “they are too old for that!” Often the children of the resident may raise objections. But sex and intimacy is often lovely and life-sustaining for competent elders to be in a relationship.

Following are questions for caregivers to ask:

  • Are both parties consenting?
  • Does the relationship cause happiness or stress and agitation?
  • Is there potential physical danger?
  • Do both people have the capacity to understand the risks of undue influence?
  • Is there a risk for financial abuse?

After answering these questions, nurses and other healthcare professionals need to look out for the following:

  • Claims of inappropriate behaviors from the residents
  • Socially concerning behaviors between residents
  • Inappropriate behavior between other caregivers and residents (bathing, changing etc.)
  • Evidence of manipulation that may be related to taking financial advantage of a resident

Here is what to avoid:

  • Using drugs like Advan or Xanax for treatment of dementia-related behaviors
  • Telling the residents “no touching”
  • Do not cause a scene if two residents go off together, assuming there is no alarm of inappropriate behavior or undue influence. Tell a supervisor and stay alert.

Overall, it is important to remember that elders need human touch just as much as everyone else, and can engage in safe, romantic, consensual relationships as long as all parties give consent. Keeping this in mind, watch for any warning signs to ensure that no one in the situation is using undue influence or being taken advantage of. If not, live and let live.

Elizabeth Landsverk, M.D., is founder of ElderConsult Geriatric Medicine, a house-calls practice in the San Francisco Bay Area that addresses the challenging medical and behavioral issues often facing older patients and their families. Landsverk is board-certified in internal medicine, geriatric medicine and palliative care and is an adjunct clinical professor at Stanford University Medical School. 

Guest Columns, Elizabeth Landsverk, M.D., January 18, 2017