What to Do? Elderly Patients Sexually Harass Healthcare Staff

Greg A. Hood, MD

Disclosures

January 31, 2018

In This Article

What Causes This Sexually Aggressive Behavior?

There is a wide differential of potential diagnostic causes for such behavior. Some is due to willful misbehavior. Patients who want to be sexually aggressive can even be emboldened by their circumstances and infirmities. Some may feel, or have learned by experience, that they are able to get away with it specifically because of their circumstances.

However, not all such behavior is willful.

Some patients may simply misread social cues, sometimes even owing to generational changes in social conventions, speech, and behavior. Dementia may rob the patient of the ability to retain newer understandings, or instructions of how to behave in today's world. It is perhaps a reflection of this point that Tarana Burke, who created the #MeToo movement, has said that for a true culture shift, it's especially important to teach children about the importance of respect and boundaries.[5]

As we get older and revert through our Shakespearian "second childhoods," some people will lose higher thinking capacities and revert to the prevailing attitudes that they held in times long past.

Inability to Constrain One's Behavior

Some cases of inappropriateness or aggressive hypersexuality probably stem from the loss of the ability to constrain one's actions and behavior, as a direct consequence of the conditions responsible for their health decline.

Neurologic pathology, from tumors to brain damage incurred by stroke, trauma, dementia, and other causes, can promote disinhibition, impulsivity, and hypersexuality when certain centers of the brain are affected. Potential causes may include the spectrum of causes of Klüver-Bucy syndrome. This is a syndrome resulting from bilateral lesions of the medial temporal lobe (including amygdaloid nucleus).[6] It may be caused by temporal lobectomy, trauma, brain tumors, herpes simplex encephalitis, or stroke.

Symptoms of Klüver-Bucy syndrome include compulsive eating, hypersexuality, insertion of inappropriate objects in the mouth (hyperorality), visual agnosia, and docility. There are several other pathologies that also may be related.[7]

The rampant prescribing of testosterone and related medications also may contribute to hypersexuality. I have seen this prescribing continue even into advanced age and at skilled nursing facility admissions.

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