Unwanted AdvancesUnwanted Advances

Sexuality CaseSexuality Case

Presentation Presentation

75-year old ambulatory male75-year old ambulatory maleRoutinely touches female staff Routinely touches female staff

members when they are bathing, members when they are bathing, toileting or dressing himtoileting or dressing him

No particular staff members as targetsNo particular staff members as targetsSays “I’m sorry” when CNAs ask him Says “I’m sorry” when CNAs ask him

to stop, then does it againto stop, then does it againNow seen touching a female resident Now seen touching a female resident

in her roomin her room

Ongoing Medical ConditionsOngoing Medical Conditions

DementiaDementia Heart diseaseHeart disease High blood pressureHigh blood pressure HypothyroidismHypothyroidism Enlarged prostate/ incontinenceEnlarged prostate/ incontinence Skin cancerSkin cancer ConstipationConstipation ArthritisArthritis Restless Leg SyndromeRestless Leg Syndrome

Recent Medical IssuesRecent Medical Issues

None None

Medications Medications

Aricept and NamendaAricept and NamendaLasixLasixMetoprololMetoprololSynthroidSynthroidFlomaxFlomaxSenna/MOM/Fleets/ColaceSenna/MOM/Fleets/ColaceUltram/APAP/VicodinUltram/APAP/VicodinMirapexMirapex

Medical AssessmentMedical Assessment

Possible causesPossible causesMedical conditionsMedical conditions

Medication-induced hyperthyroidismMedication-induced hyperthyroidismDementia Dementia Elevated testosterone levelElevated testosterone levelMania Mania Delirium Delirium

Medications Medications Mirapex Mirapex

Medical AssessmentMedical Assessment

Laboratory testsLaboratory testsCBC and BMP are normalCBC and BMP are normalUA is normalUA is normalThyroid tests are normalThyroid tests are normalTestosterone level is lowTestosterone level is low

Medical ManagementMedical Management

Assumed to be secondary to dementiaAssumed to be secondary to dementia 5-10% of dementia patients display 5-10% of dementia patients display

hypersexualityhypersexuality Mirapex discontinuedMirapex discontinued

Clonazepam added for RLSClonazepam added for RLS No other medication changes madeNo other medication changes made

Possible use of other medicationsPossible use of other medications No FDA indicationNo FDA indication

Certain antidepressantsCertain antidepressantsHormone treatmentHormone treatment

Nursing ManagementNursing Management

The resident is noted to target younger CNAs The resident is noted to target younger CNAs and nursesand nurses More mature caregiversMore mature caregivers Male caregivers employed when possibleMale caregivers employed when possible

Use a white jacket, other props Use a white jacket, other props To more fully identify the female caregiver as a To more fully identify the female caregiver as a

nursenurse Scheduled caregivingScheduled caregiving

Rapid, safe completion of taskRapid, safe completion of task Care plan protocol for this issues posted in Care plan protocol for this issues posted in

medical chart, on MARmedical chart, on MAR

Nursing ManagementNursing Management

Patient monitored in public areasPatient monitored in public areas Behavior documented on an hourly basisBehavior documented on an hourly basis

Encouraged to sit with male residents or less Encouraged to sit with male residents or less vulnerable femalesvulnerable females Male staff help as much as possible with activities, meals Male staff help as much as possible with activities, meals

No mixed messages sentNo mixed messages sent More physically demonstrative female staff encouraged More physically demonstrative female staff encouraged

to refrain from supportive hugs, hand holding, using to refrain from supportive hugs, hand holding, using terms of endearment (“Honey”) with the residentterms of endearment (“Honey”) with the resident

Firm, clear and calm redirection Firm, clear and calm redirection ““Please stop” rather than “That’s inappropriate”Please stop” rather than “That’s inappropriate”

Nursing ManagementNursing Management

Make sure is not misidentificationMake sure is not misidentificationBelieves person(s) are spouse or girlfriendBelieves person(s) are spouse or girlfriend

Make sure nursing assistant concerns Make sure nursing assistant concerns are addressedare addressedEmbarrassmentEmbarrassmentDisgust Disgust Education about this as part of the illness Education about this as part of the illness

is a mustis a mustUncomfortable for residents, staff and familiesUncomfortable for residents, staff and families

OutcomeOutcome

Elimination of Mirapex Elimination of Mirapex May have been helpfulMay have been helpfulNo need to move onto other agentsNo need to move onto other agents

Nursing interventionsNursing interventionsCut down on frequency of eventsCut down on frequency of events

No further incidents with other residentsNo further incidents with other residentsNew staff orientation discussed these New staff orientation discussed these

issuesissuesCare plan placed on chart, on MAR, for nursing Care plan placed on chart, on MAR, for nursing

staff less familiar with resident was effectivestaff less familiar with resident was effective