(P09) Determining Decisional Capacity for Sexual Consent in Patients with Dementia

Introduction: For older adults who have dementia and are living in care facilities, the topic of physical intimacy posits a clinical and ethical dilemma. Long-term care workers must respect their patients’ autonomy, but also protect them from harm. A principal component of this topic is the assessment of the capacity to consent. In this case, a clinical interview tool was applied in a novel way to assess the decisional capacity to consent to physical intimacy between two patients with dementia living in a long-term care facility (LTC).

Case Description: A male and female, both with a history of dementia, were showing signs of an intimate bond. One afternoon, they were found alone in the male patient’s room with their pants off, initiating a physical relationship. Neither of the patients could recall the preceding events or state their intentions. The staff proceeded to help them get dressed. The facility did not have a policy related to patient sexual activity. The medical director identified that assessing the patients’ capacity to consent to sex through the U-CARE clinical interview tool was necessary. Each patient was interviewed separately. Understanding (U) of the interaction was assessed by asking what their intentions were and if they were aware of the mechanics of physical intimacy. Consistency (C) in responses was assessed throughout the interview. Appreciation (A) for potential consequences was assessed by asking whether they understood their medical diagnoses and associated limitations. Reasoning (R) was assessed by asking the patients to develop a plan for a scenario where they needed help. Expression (E) of the desire to engage in a physical relationship was assessed. The male met the U-CARE criteria for decisional capacity to consent to sex, but the female did not.

Discussion: This case showed a prompt and effective response toward two patients with dementia expressing the desire for a physical relationship. It is critical to assess how healthcare structures support a high quality of life in advanced age, which still includes sexual expression. Since dementia does not equate to global incapacity, assessment of domain-specific competence is necessary. The U-CARE model provides a framework to determine the capacity to consent to sexual activity; allowing those with dementia to have their autonomy and well-being promoted while still being protected from harm.