An observational study of sexual behavior in demented male patients

Background. Concerns have been expressed that patients with dementia will display disinhibited, inappropriate sexual behavior. Retrospective research suggests that this is rare, but no observational research has been reported. The purpose of this study was to conduct such an observational study. Methods. Subjects were 40 patients with a dementia diagnosis who were living in institutional settings; subjects ranged in age from 60 to 98. Coders observed subjects on nine separate occasions, three in the morning, three in the afternoon, and three in the evening. Subjects were observed in multiple situations; coding included appropriate, ambiguous, and inappropriate sexual behaviors. Reliability coding was obtained for 42% of the patients on 11% of coded episodes. Results. Behaviors could be coded with high reliability (94% to 100% across categories of behavior). On average, patients displayed .43 appropriate sexual behaviors, 1.48 ambiguous behaviors, and .83 inappropriate behaviors across the nine observation periods. This was not evenly distributed across patients, however, only 18% of patients ever displayed a sexually inappropriate behavior, and these were usually brief and minor. Inappropriate sexual behavior was observed in only 1.6% of the observed one-minute time segments. Conclusions. Observational research documents what had been previously suggested by retrospective reports: inappropriate sexual behavior is uncommon in dementia patients and brief and minor even when it occurs. Ambiguous behaviors, such as appearing in public incompletely dressed, which could suggest exhibitionism but more likely reflects self-care deficits, were more common. Misinterpretation of these events may be the source for some of the persistent lore regarding sexually disinhibited behavior in dementia patients.