What is the meaning of intimacy? When young, intimacy may be construed simply as a sexual experience. But in long-lasting relationships intimacy takes on greater meanings. The daily routines, the shared experiences and family history, the mutual understanding of each other are all aspects of intimacy. Sex, at any age, is certainly about intimacy but may be a difficult topic to explore and approach openly, especially with older adults.
In the context of caregiving for a person in the midst of dementia changes, intimacy takes on a whole new texture. Daily routines have been disrupted, verbal communication has shifted, mutuality and remembered past experiences and history are eroding. Maintaining intimacy becomes the responsibility of the caregiver and it takes a patient and skilled caregiver to manage the shifts and changes.
In a recent edition of Aging & Society the journal article “I don’t know if you want to know this: carers’ understandings of intimacy in long-term relationships when one partner has dementia,” was the subject of the last Round Table. Our discussion began as we considered intimacy as “every day-ness,” a descriptive term used in the article, and then proceeded to consider how sex and the expression of one’s sexuality – so rarely explored or spoken about with older adults – inhabits the caregiving experience. Everything about this article was counter intuitive to the caregiving literature that commonly speaks to the burden of caregiving, the need for respite and opportunities for self-care apart from one’s partner. This article instead flips the idea of caregiving on its head and asks how to maintain intimacy and redefine caregiving as a means of staying close. The ability to be in the demented person’s reality – to live in the moment – extends the intimacy of a long-term relationship even into a sexual experience as a part of caregiving.
From this group of seasoned professionals, it was commented more than once, that concepts in this article would be especially helpful to several of our clients who have been frustrated with the lack of communication and sharing with their partner. These caregivers might benefit from remembering how they expressed their unique intimate relationship, encompassing the small interactions of everyday-ness to the more physical relationship of sexual contact, as a means of finding connection. As described by the authors:
Sexual intimacy remains a feature of intimate older adult relationships, and is important too in relationships affected by dementia where romance, touching, feeling attractive and loved, and being sexual are still important components of close partnerships. Sexuality is for many couples an important way for a partner with a diagnosis of dementia to feel that they still bring something to the relationship despite the gradual and inevitable erosion of other interpersonal skills…We would argue that intimate behavior does function as another way of expressing care, but is also embedded as an extension of previous intimacies in the relationship, and that it is important to understand these complexities.
The ability or the appropriateness of having a conversation about sex and sexuality with our clients seems to be a matter for debate. Easier said than done! Sex isn’t even something we talk about with our close friends, much less professionals who are near to strangers. As titled in the journal article: “I don’t know if you want to know this” refers to the fact that it is unexpected that an older person might still want to talk about having sex, much less still wants to have sex with their long-time partner. As clinicians we need to consider our own comfort level in opening up these conversations and know our limits. But always mindful that our clinical responsibility it to leave space for those conversations, difficult though they may be.
In addition to reading and learning from the voices of the caregivers interviewed in this journal article I encourage you to watch this short video The Age of Love, https://vimeo.com. You will smile!
The Round Table Discussion Group meets monthly for an interdisciplinary conversation with experienced professionals in the field of aging. Each conversation uses one or two journal articles as reference points. The article read for this discussion was:
I Don’t Know If You Want To Know This: Carers’ Understanding of Intimacy in Long-term Relationships When One Partner Has Dementia, Jane Youell, Jane E. M. Callaghan and Kevin Buchanan, Aging & Society 36, 2016, 946-967.