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An 80 year old widowed nursing home (NH) resident with early dementia severe bilateral knee arthritis is observed by nursing staff to be masturbating when they abruptly entered his room. He is embarrassed by both events, but the nursing staff was upset and reported this to their supervisors. The patient refuses to discuss this with the nursing staff when confronted by the nurse supervisor. This constitutes inappropriate sexual behavior (ISB) based on:
A. He is too old to be engaging in this behavior.
B. Sexual activity in the setting of dementia is most likely evidence of frontal lobe disinhibition.
C. Nursing homes are non-private facilities, and behaviors of this type are not permissible in public.
D. This does not constitute ISB.
He is too old to be engaging in this behavior.
Sexual activity in the setting of dementia is most likely evidence of frontal lobe disinhibition.
Nursing homes are non-private facilities, and behaviors of this type are not permissible in public.
This does not constitute ISB.
This patient has the right to assume that the NH is his home, and therefore has a reasonable expectation of privacy. Dementia does not preclude sexual behaviors, nor does age. While demented patients are more likely to exhibit disinhibited behaviors, this individual did not do so in an inappropriate area, nor has he engaged in other behaviors that would establish a trend.
An 80 year old nursing home resident with mild to moderate dementia is reported to the medical director and his primary provider as having made multiple inappropriate sexual comments to several female and male caregivers, and on separate occasions to have grasped the breast of one female caregiver and the crotch of a male caregiver. Behavioral redirection has not seemed to improve his behaviors. At this time, appropriate management is to:
A. Start a cholinesterase inhibitor medication.
B. Apply physical restraints to the resident during direct cares.
C. Transfer the resident to a state facility for registered sexual offenders.
D. Discuss the option of chemical or physical castration to manage the resident's behaviors.
Start a cholinesterase inhibitor medication.
Apply physical restraints to the resident during direct cares.
Transfer the resident to a state facility for registered sexual offenders.
Discuss the option of chemical or physical castration to manage the resident's behaviors.
Frontal lobe dysfunction, executive function impairment, and disinhibited behaviors are common in dementing disorders. If the patient is still at the early to moderate stages of disease, a trial of cholinesterase inhibitors or NMDA blocking agents would be appropriate as a first step to both improve behaviors and improve neurocognitive reserve. Physical restraints are federally prohibited in nursing homes, and chemical and/or physical castration may have no effect on a demented patient. Finally, the patient is exhibiting behavioral disturbances associated with a dementing disorder, and not what would be considered felony sexual assault.