This chapter explores the findings of theoretical and empirical studies for the complicated construct of capacity to consent to sexual relations in elders. This is alongside an attempt to clarify through small-scale research, the knowledge and attitudes towards consent capacity as reported by elders themselves. Results indicate that Greek respondents are not fully informed about consent capacity and approach this topic as a taboo. Moreover, they believe that the Greek society and state do not provide adequate prevention programs. Future directions on how to make elders and their family members aware of consent capacity problems are discussed.
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Although in recent years a great emphasis has been given to the psychological assessment of civil capacities in older adults, namely, medical consent capacity, sexual consent capacity, financial capacity, testamentary capacity, capacity to drive, and capacity to live independently (American Psychological Association, 2005; 2006; Demakis, 2011), still little progress has been made in the assessment of the above capacities worldwide (Diaz-Ponce et al., 2016; Giannouli, 2014; Giannouli & Tsolaki, 2013; Knight et al., 2008). The main problem for this lack of progress is that different researchers adopt diverse theoretical psychological and legal constructs, and in addition to that, the lengthy procedure of standardization of relevant tests across different cultural settings is making the adoption of specific instruments for assessing these capacities hard not only in Greece, but worldwide (Giannouli, 2015; Giannouli & Tsolaki, 2013; 2015).
Complex sexual behavioral changes, inappropriate/improper sexual behaviors and related disinhibition in older persons with cognitive impairments and especially in Alzheimer’s disease patients are present and generally accepted as troubling to their caregivers and family members (Bardell, Lau & Fedoroff, 2011; Bartelet, Waterink, & van Hooren, 2014; Black, Muralee, & Tampi, 2005; Canavelli et al., 2011, 2017; Cipriani et al., 2016; DeMedeiros et al., 2008; Derouesné, 2009; Giami & Ori, 2012; Gomes-Pinto, 2014; Lombardo & Rossi, 2016; Rosen, Lachs, & Pillemer, 2010; Thom, Grudzinskas, & Saleh, 2017; Vloeberghs et al., 2007; Wallace & Safer, 2009; Ward & Manchip, 2013). Especially healthy spouses report inappropriateness and even aversion for this change (Davies et al., 2012; Harris et al., 2011; Simonelli et al., 2010; Ward et al., 2005). Although several pharmacological and nonpharmacological treatment proposals exist (Canevelli et al., 2013; Chen, 2010; Joller et al., 2013; Light & Holroyd, 2006; Ozkan et al., 2008; Tune & Rosenberg, 2008; Tosto et al., 2008; Tucker, 2010), the impact of dementia on sexuality has not been thoroughly examined and controlled (Kamel & Hajjar, 2004; Mahiu & Gastmans, 2012), nurses and other care staff need to gain a better understanding of and insight into late life sexuality (Archibald, 2003; Mayers & McBride, 1998), and as a result the older individuals are more prone to abuse either as perpetrators or as victims (Elias & Ryran, 2011; Johnson, Knight, & Alderman, 2006; Tarzia, Fetherstonhaugh, & Bauer, 2012).