Despite what many people think, people enjoy having sex into old age. And there’s no age limit on affection or intimacy. 

Being able to interact and express ourselves in sexual, affectionate and intimate ways is intrinsic to our wellbeing and a large part of what makes us human. We often use these three terms interchangeably, but they are distinct concepts. And when we are talking about interactions between people, our choice of words matters, including in a residential aged care setting.

Sexuality and dementia

Though the risk of developing dementia increases with age, a diagnosis doesn’t stop a person from wanting to engage in sexual activity or developing new, meaningful sexual relationships.

A 2021 study¹ – one of the few to include the views of people living with dementia – found that people considered love, intimacy and being together fundamentally important to the maintenance of connections, self-identity and self-worth.

Supporting sexual, intimate and affectionate interactions among people living with dementia can reduce loneliness and has even been shown to improve cognitive performance.

Barriers in residential aged care

Unfortunately, the research also tells us that these kinds of relationships are often discouraged or even prohibited in a residential aged care setting. Residents are often assumed to be ‘post-sexual’ or are seen as vulnerable to sexual exploitation because of a dementia diagnosis.

Providers struggle to find a balance between people’s sexual needs and rights on the one hand, and protection from potential abuse on the other. Other challenges include the capacity of a person with dementia to give sexual consent, and the ability or willingness of staff to get involved in what is seen as a taboo part of life.

Staff may struggle with how they feel about people living with dementia expressing themselves in sexual ways, or they may come from cultural, religious and ethnic backgrounds where sexuality is viewed and talked about quite differently.

Words matter

A survey² of 1,000 residential aged care facilities startlingly revealed that only 74 of them had written policies on sexuality and sexual health, highlighting a critical need for guidance in this area.

Without this, interpretations of what is sexually appropriate and the ways sexual interactions are documented and described can vary greatly. As well as creating unnecessary stigma, this can end up having a negative impact on the person’s care and wellbeing.

What do we mean when we talk about sexual or other interactions?

To provide truly compassionate, person-centred care, we need to develop our vocabulary to describe sexual, intimate and affectionate interactions as accurately as possible.

This will support people living with dementia to express their sexuality safely and to share affectionate interactions with others. Importantly, it will also help divert resources to cases where they are needed, like those involving unwanted sexual behaviour.

Sexuality

Sexuality and sexual behaviour or interactions are more than just sexual intercourse, as is often assumed. The World Health Organisation defines sexuality as a central aspect of being human – encompassing gender, identity, sexual orientation, roles and reproduction. Sexual interactions can range from prolonged kissing, conversation of a sexual nature, and touching of intimate body parts to masturbation and sexual intercourse.

Intimacy

Intimacy is about emotional or physical closeness, communication and support. As sexual interactions become difficult for some older people with dementia, intimacy can take on even greater importance. In physical terms, it can take the form of handholding, hugging, kissing and touching non-intimate parts of the body like shoulders, arms, hands or back.

Affection

Affection is a key component of intimacy. It can be a fundamental part of a romantic partnership, but it can also be a physical expression between friends or family members to show love and appreciation.

Intimacy and affection both play a role when people greet each other, reassure and comfort each other and congratulate or praise each other.

See the person behind the behaviour

An intrinsic part of person-centred care is knowing and understanding the person. When we are dealing with interactions between two people in care, we should look beyond the behaviour and ask ourselves what the intention behind it might be. Cuddling or handholding might not be sexual in nature, or what appears to be masturbating could be a sign of an infection or form of discomfort.

Let’s talk about sex

By choosing clear and accurate terms to describe interactions between people, we can enhance the wellbeing of people living with dementia so they can express their sexuality and affection more freely and safely.

Despite the complications that living with a diagnosis of dementia may present, allowing space for meaningful relationships and physical closeness is a crucial part of holistic, supportive dementia care.

This blog post is sourced from Sexual vs Intimate vs Affectionate: What is the Difference? By Ashley Roberts, Dementia Consultant at Dementia Support Australia, Published in Apr/May/Jun 2025 Vol 14 No 2 Australian Journal of Dementia Care.

1. Roelofs, T. S., Luijkx, K. G., & Embregts, P. J. (2015). Intimacy and sexuality of nursing home residents with dementia: A systematic review. International Psychogeriatrics, 27(3), 367–384. https://doi.org/10.1017/S1041610214002373
2. McAuliffe, L., Fetherstonhaugh, D., & Bauer, M. (2020). Sexuality and sexual health: Policy in Australian residential aged care. Australasian journal on ageing, 39 Suppl 1, 59–64. https://doi.org/10.1111/ajag.12602

Watch Ashley Roberts expanding on this topic at the International Dementia Conference 2024 here:

Upskill your teams via our specialist dementia workshops. Topics include Sexuality and intimacy, Understanding changed behaviours, Creating connection for meaningful engagement, and much more.