50 Shades of “Gray”: Study Calls for More Sex in Senior Care Residences

Older adults—even those with memory impairments—living in senior care facilities still have a right to have sex, says a paper published in the Journal of Medical Ethics in June, but many are prevented from doing so by prohibitive policies or environments. 

“Sexual self-determination is considered a fundamental human right by most of us living in Western societies. While we must abide by laws regarding consent and coercion, in general we expect to be able to engage in sexual behaviour whenever, and with whomever, we choose,” write the paper’s authors. 

But for seniors with dementia, it’s not so simple.


It can be hard for staff to balance a resident’s rights with their care and the safety and care of others living in the facility. Pair that with generally negative (or avoided) views on sexuality in older adults, and, the authors say, this can lead to  “residents’ sexual expression being overlooked, ignored, or even discouraged.” 

The big issue is consent, and whether residents with memory or other cognitive impairments are able to safely agree to sexual activity or physically intimate relationships.

“While every effort should be made to ensure that no resident comes to harm, [senior care facilities] must respect the rights of residents with dementia to make decisions about their sexuality, intimacy, and physical relationships,” the paper says. 


Some care facilities have restrictive policies toward sexual activity among residents, and even where policies may be absent, environments may not be conducive to pursuing intimate relationships. Whether it’s because of a lack of privacy or and absence of physical accommodations, that should change, the authors say.

“Since it has been well established that sexuality and intimacy continue to be important in later life and are central to an individual’s health and wellbeing, the lack of attention paid by aged care facilities to residents’ sexual needs is concerning,” the authors write. 

When older residents with memory impairments pursue sexual relationships, it’s very important for care providers to make sure it’s consensual and understood, Frieda Pulkowski, owner of Cherry Tree Senior Care Consulting, has emphasized in a previous SHN article on senior sex.

Honoring and accommodating residents should be a priority—but so is keeping them safe, she says.

“It helps to identify what level of dementia the resident has—obviously residents with milder stages are more likely to meet the above criteria [of knowing the risks and benefits of their actions and having the ability to make informed decisions],” Pulkowski has previously said. “It also helps to identify whether or not the behavior in which the resident is now engaging is consistent with his or her historically held belief system.”

As more adults age, and the numbers of those with memory impairments increase, the topic of sexual activity among residents will become more relevant. For now, they conclude, most senior care facilities will likely ignore these issues and, instead, err on the side of caution. 

Access the full paper.

Written by Alyssa Gerace