Intimacy, Marriage and Alzheimer's Disease
Talking about intimacy and sexuality is never easy, from the time we are youngsters until we are very old and wise. For some, sex is enjoyable, for others it is embarrassing and for others still it is frightening. Nevertheless, sex is part of our lives, and when combined with Alzheimer’s Disease, it can problematic. It is important to distinguish the differences between intimacy and sexuality to better address the challenges created by dementia. Intimacy is a "warm friendship," while sexuality is the use of words, gestures, movements or activities that attempt to display physical affection. Sexual activity in healthy relationships helps people to stay in good physical condition and helps to reduce physical and psychological stress.
Dementia’s Impact on Sexual Relationships
Even the most confused individual affected by dementia is still a sexual being. Dementia does not mean just memory loss as the common perception. It is a form of brain damage that can affect many different aspects of consciousness, motor skills and executive function, in addition to memory. With respect to sexual behavior, your loving partner may no longer remember how to arouse and satisfy you; may develop impotence from blood pressure medications; may become hypersexual or unable to understand the consequences of his/her actions in public; may lose social skills and charisma; may lose self-esteem; or may engage in impulsive, thoughtless or indifferent behavior.
Your loved one may engage in sexual behavior such as public **********, undressing or inappropriate sexual advances. You should not feel responsible for these behaviors, they are the result of your loved one’s brain disease and are not a reflection on you. Accusations of infidelity or hypersexuality may make you feel misunderstood and angry. Take time to reassess the situation. Is your loved one seeking reassurance or a boost in self-esteem? Is it simply a breakdown in judgement? Understanding the behaviors in these terms depersonalizes the impact.
Caregivers to loved ones with dementia, especially spouses, express many concerns.
Guilt: for refusing a spouse’s sexual advances, for wanting a satisfying intimate relationship, for simply wanting a personal life, for wanting the burden to end.
Frustration: with problems that arise during sex, with demented spouse’s inability to satisfy or appear interested in your sexual needs, with the inability to relate to your loved one due to his/her diminished mental capacity.
Resentment: for having to suppress one’s own needs, over your loved ones accusations of infidelity, of your marriage vow to care "in sickness and in health."
Embarrassment or Confusion: over changes in spouse’s behavior, by sexual advances by your spouse who no longer recall’s your name, by repeated advances even after sexual episodes early in the day, over emotional intimacy that has been lost.
Fear: of acting selfishly, of attending to one’s own needs, of wounding pride if you refuse sexual advances, of raping your spouse because they really can’t give informed consent.
Effectively coping with these changes in your relationship are essential. Start by doing things that reduce stress and enhance your self-esteem. Keeping a journal can help you to release your pent up feelings. Most importantly, develop a support system of peers who you can comfortably share your feeling and experiences. This may seem awkward at first – however once you recognize that this is an issue, you can begin to grow from it. Many Alzheimer’s support groups have a mix of children caring for aging parents and spouses caring for their partner. Seek out individuals who are "most like you" to share a cup of coffee, ask the facilitator to raise the issue cautiously, suggest a guest speaker, or consult with a religious advisor or therapist.
Remember, that as a caregiver, you are not required to devote every ounce of energy to your loved one. It is essential to maintain your balance and minimize your stress level. It is OK to get angry sometimes (but not to get violent). Your emotions are natural, but the challenge is to address the in a healthy manner and grow from the experience.
Rediscovering Loving Relationships
A couple’s role and intimacy will undergo change (all relationships do over time). Even with the onset of dementia, there are still facets of your relationship that you can nurture. However strained and limited, you can still focus on these positive aspects of a relationship:
singing and music
reviewing photo albums
talking about the past
taking walks or rides
visiting with animals or children
engaging in simple projects such as gardening or painting
assisting with personal care such as shaving, manicures or hair-setting
exercising and dancing
However you cope with the changes in your loving relationship, you may be able to find additional emotional support and relationships in friends and family, children, pets, and coworkers/volunteers.
**Remember they are not GONE they too need the Human Factors In Their Lives As Well**