Sexually inappropriate behavior can be a manifistation of disinhibited behavior seen in older adults with major neurocognitive disorders. Sexual expression in older adults with major neurocognitive disorders is normal and should not be universally discouraged when in an appropriate setting and when the rights of others are not violated. The evaluation of sexually inappropriate behavior should include a detailed history that includes what the behavior is, who is involved, what is the context of the behavior, who is being impacted, and if the behavior is out of proportion with other disinhibited behaviors. Look for and potentially remove medications that could be contributing to sexually inappropriate behavior including dopamine agonists, anticholinergic agents, and benzodiazepines.

A significant percentage of older adults remain sexually active. Studies have shown that sexual activity in older adults is associated with better cognitive and mental health and better sleep. Major neurocognitive disorders are a common cause of sexually inappropriate behavior. Despite the few studies discussing sexual aspects in MNCD, existing reports indicate that up to 25% of patients suffering from Alzheimer’s disease have inappropriate sexual behavior, including increased sexual urge and hypersexuality. The ability of patients to consent to sexual relations may be underestimated by healthcare staff. Therefore, the issue of consent is an important point of discussion among staff members and each case should be assessed separately. Long-term care facilities should have policies in place that address the evaluation of a patient’s capacity to consent to sexual activity.