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Published online by Cambridge University Press: 03 January 2025
Introduction
The global population of people aged 60 years and older will more than double, from 900 million in 2015 to about 2 billion in 2050 (World Health Organization, 2022) and the expectation is that this will be accompanied by an increase in the number of people living with dementia (PLWD), given the increased prevalence of dementia associated with ageing. Currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year. Dementia is a syndrome characterised by deterioration in cognitive (intellectual) functions such as memory, orientation, language and judgement, causing functional impairment. Dementia has a range of physical, psychosocial and economic impacts, not only for the PLWD but also for their carers, families and society at large. Yet, there is often a lack of awareness and understanding of dementia and its impacts, resulting in stigmatisation and barriers to diagnosis and care (World Health Organization, 2023b). One of these impacts is on sexuality.
Older people, including PLWD, can continue to enjoy active sex lives. Regardless of dementia, the desire for intimacy may represent the expression of basic human instincts and needs, ranging from sexual needs to the need for companionship, physical contact and the relief of loneliness. In England and Wales and in Australia, as well as in many other jurisdictions arounds the world, the legal position is for individuals engaging in sexual activity (ranging from kissing, cuddling to sexual intercourse), to give ‘here and now’ consent to such activities. Herein lies the problem for PLWD who may have lost, or be wrongly presumed to have lost, mental capacity and on this basis may be precluded from engaging in sexual relations either in the interest of their safety or that of others. This is regardless of whether the intimacy desire is a basic human instinct or driven by changed behaviours arising as a result of dementia. As such, in the name of ‘protection’, clinical and legal practice in this area has become highly risk averse, usually to the detriment of PLWD.
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