Dear Eric: My husband of almost 60 years has Alzheimer’s. At this point, he does not know who I am other than “some nice lady” who comes to see him. I initiate and have sex with him. Our initial dating and marriage were very sexual but went on to deteriorate due to his multiple flings and affairs. By the time he was diagnosed, we had not had sex in more than 20 years.
Not that it matters, I never had any kind of affairs. He was not a very good husband; he made major decisions on his own and came and went as he pleased. He was also a bit of a bully and critical. I stayed because I didn’t think I could make it on my own. Now, with the disease, he is very sweet. My question is, am I raping him? Is this senior abuse? Much as I’m enjoying it, and he seems to also, it somehow seems wrong.
— Unknown Wife
Dear Wife: There’s a lot here so I want to be precise. While some may think that older adults with Alzheimer’s or dementia can’t consent to sex, experts in the field of gerontology disagree. In a 2023 study called “The Sexual Consent Potential Model,” researchers Nathalie Huitema, Ph.D., and Maggie Syme, Ph.D., wrote, “To thrive, we need relationships, we need touch, and we need connection. Individuals who live in nursing home settings and who may have cognitive concerns are no different.” To address this, they came up with a multi-part process for determining a person’s “various possibilities of meeting sexual and/or intimacy needs at any level of cognition.”
So, it is possible your husband is able to consent, even without the cognitive ability to recognize you. However, and this is a huge however, you’re putting yourself and him at risk if the facility where he’s being cared for doesn’t have a sexual expression policy and hasn’t evaluated his cognitive ability with respect to consent.
In 2014, an Iowa man was charged with sexual abuse of his wife because the staff at her nursing home didn’t think she had the ability to consent due to her Alzheimer’s. The law varies by state and each facility has different training and policies. So, continuing to have sex with your husband requires a lot more communication on your part.
I also fear that some of your resentment from the mistreatment you endured is playing a role in all of this. I’m sorry for the way he treated you. I don’t think this is the safe path to healing, though.
(Send questions to R. Eric Thomas at eric@askingeric.com or P.O. Box 22474, Philadelphia, PA 19110. Follow him on Instagram and sign up for his weekly newsletter at rericthomas.com.)
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