Each day, 10,000 baby boomers turn 65. This is a generation that redefined tradition and prided itself on the anthem “sex, drugs and rock ’n’ roll.”
Yet, the ignorance, prejudice and silence about sex and sexuality we fought so hard to upend are still alive and kicking as we age. As soon as you add Alzheimer’s into the equation, sexual freedom between a husband and wife is in question, leaving to a third party to decide what constitutes consent.
When should decision-making power on these intimate matters be taken away from an older person? And who gets to decide whether a person with dementia is capable of making a particular choice, especially such a personal one?
For Donna Rayhons, the answer to that last question is 12 strangers in Northern Iowa. Those 12 people, the members of the jury in the criminal trial of her husband, Henry Rayhons, determined that he had not committed sexual abuse in the third degree while visiting her one day last May at the Concord Care nursing home facility. The prosecution failed to prove that Henry Rayhons actually had sex with his wife on the date in question, or that, if he had, that she was incapable of consenting.
Deep stigmas exist around older adults’ sexuality. Widely seen as the purview of young people, sex, both as a loving and joyful act and as a potential crime, is rarely discussed, even by professionals who deal with issues of aging. This seems to have been the case for Donna Rayhons. The discussion at the Concord Care facility, during which staff allegedly told Henry Rayhons that his wife could no longer consent to sex, lasted less than one minute, and the word “sex” was never spoken. Donna Rayhons herself was never included in a conversation about sex with her husband. The determination made by the facility that she lacked capacity to consent was based on a standardized assessment.
It doesn’t have to be this way. At the Hebrew Home at Riverdale, for example, we have a sexual expression policy, an organizational commitment to assisting residents in initiating and maintaining sexual relationships if they so choose, helping them to manage physical impairments that might make intimate relationships difficult, and creating uniform standards for how staff must respond. If an individual has some form of dementia, that diagnosis is the beginning, and not the end, of a conversation about sexuality. Cognitive capacity exists along a continuum, with decision-making ability varying widely. Each choice and decision a person makes in old age do not require the same level of cognition. Someone who cannot make a complex decision can still choose an intimate partner and engage in physical intimacy.
Nonverbal cues and changes in affect can be assessed to determine an individual’s state of mind about a particular relationship. Individuals with dementia often have periods or times of the day when they are more lucid, and those patterns should be assessed when engaging an older adult in a conversation about sex. Family members can be educated about older adult sexuality in a frank and open way, making it clear that healthy sexuality is an integral part of healthy aging. Geriatricians must ask their patients about sex.
The Rayhons’s case is a powerful and vexing lesson that squeamishness and stereotypes cannot be permitted to carry the day when it comes to our rights to sexual expression throughout the lifespan. While it is critical to protect those who are vulnerable, protection cannot come at the cost of infantilizing the elderly, stripping them of their agency or sexuality. Numerous studies demonstrate the physical and emotional benefits of maintaining an active sex life throughout one’s life. While frequency of sexual activity decreases as people age, the satisfaction associated with that activity rises as people get older.
Simply put, sex means more to people as they get older, and may even keep them physically healthier. Touch is one of the last pleasures we lose in old age. As a society, we must protect that human right.
In the Jewish tradition, it is considered a mitzvah for a husband and wife to enjoy each other physically and sexually. In fact, according to Jewish law, one of the responsibilities that a husband owes his wife is an ongoing sexual relationship in which her needs are satisfied. This obligation is irrespective of his wife’s ability to conceive and bear children; it continues beyond her fertile years throughout their lives.
The Torah ideal of kosher sex takes place in the context of a committed and sanctified relationship — in other words, a marriage in which the partners see each other not as objects of self-gratification but as reflections of the image of God.
Regardless of how we feel about the verdict for Henry Rayhons, none of us wants a panel of 12 strangers making choices about our adult sex lives for us. Perhaps if Donna Rayhons had been given the opportunity to be heard, these 12 strangers would not have needed to make that choice for her. And hopefully, as we work toward breaking down stigmas and silence, they won’t make that choice for us, either.
Daniel Reingold is the president and CEO of RiverSpring Health, which runs the Hebrew Home at Riverdale.