Dr Nathalie Huitema's plenary talk on sexuality and intimacy in residential aged care, and the panel discussion that followed, were among the highlights of our recent flagship event, the International Dementia Conference, held on 5-6 September 2024 at the Hilton Sydney.

The way cognitive impairment affects a person's understanding of and right to consent to sexual behaviours was central to the mainstage discussion.

In our follow-up interview, Nathalie outlined the ethical framework she prefers in relation to determining consent capacity for those living with dementia, saying it is crucial that it is "individual and not one-size-fits-all."

"It's an individual decision to make," she said, adding, "That makes it complicated and takes some more effort."

In response to a question from the floor, medical and legal ethics expert, Olga Pandos, summed up how consent is determined for people living with dementia in Australia.

She highlighted that fluctuating cognitive ability, lack of technical understanding, inability to retain information for long periods, and adverse outcomes don't disqualify a person from being considered to have capacity.

"We have every right to make mistakes, and we have every right to make decisions that other people don't agree with," said Olga. "The diagnosis of a cognitive impairment does not mean someone lacks capacity."

The panel also touched on the human need for affection, something that is too often sexualised, according to The Dementia Centre consultant, Ashley Roberts.

"I just don't think we use the word affection enough in aged care."

"I just don't think we use the word affection enough in aged care," he said.

"We use words like sexual or intimacy.

"If we find a better way to describe a situation, maybe we can manage it better."

In the past, the topic has led to responses from awkwardness to disapproval, or - at the very least - inaction within the sector.

While almost every other aspect of human behaviour can be incorporated into a resident's or patient's care plan, the need for physical intimacy is usually overlooked.

That's because, according to Nathalie, sexuality among older adults has been seen as aberrant.

"When it comes to sexuality people tend to freak out and don't know what to do," said Nathalie, a sexologist and psychologist based in the US.

"If you were to translate sexual behaviour to any other behaviour, people would respond totally differently. But sex in older adults is not normalised."

She adds that it's not only ignored, but actively discouraged.

"People say, 'It's inappropriate behaviour,' whereas sex is very appropriate - it's normal behaviour," she said.

"It might not be in the right place, so maybe an inappropriate place, but in essence it's very normal."

In her talk, Nathalie shared a 'Sexual Consent Potential Model' she has developed, urging providers to take pro-active steps to address the issue.

Also on the panel was Gwenda Darling, who lives with dementia. She passionately advocated for older people to be allowed to express their sexuality in whichever way they liked (as long as it didn't override a partner's consent).

Speaking to the Sydney Morning Herald following IDC2024, Gwenda said, "It’s really important providers respect the rights of residents who wish to engage in sexual activities."

(Pictured above: MC and panel facilitator Leigh Sales, Ashley Roberts, Dr Nathalie Huitema, and Olga Pandos at IDC2024.)