Love, sex and Alzheimer’s

Henry Rayhons, a 78-year-old retired farmer and former Iowa state senator, was accused of having a nonconsensual sex with his wife, an Alzheimer’s patient, at a nursing home last year. On Wednesday, a jury in Hancock County, Iowa, acquitted him.

During the trial, prosecutors argued that Henry Rayhons engaged in sexual acts with his ailing wife, Donna Rayhons after he was told that she could not properly consent to sex because of her dementia. The jury was tasked with determining whether the alleged sexual contact did in fact occur and whether Donna Rayhons was capable of consenting to sex. Defense lawyers argued that Henry Rayhons was being unfairly prosecuted, arguing that no sexual contact occurred on or around the date of the alleged incident.

The case has attracted national attention. At issue is when and if patients with dementia can properly consent to sexual activity. Beyond the question of Henry Rayhons’ guilt or innocence, the case underscores how the American ideals of individualism and self-sufficiency ignore the needs of an increasingly older population. It also highlights how the obsession with youth and sex, which has led to the sexualization of old age, promotes a denial of its physical realities.

The constant marketing of drugs for erectile dysfunction, such as Cialis and Viagra (whose combined sales are forecast to total $3.9 billion by 2019), and others for women, like Osphena, has enabled an expectation of sexual activity until death. Aesthetic disadvantages can be assuaged with a few shots of Botox, butt and breast lifts or hair transplants. For those with other limitations, surgical technology such as hip and knee replacements promises to boost sexual agility.

“When my hip pain had progressed to the place I couldn’t comfortably open my legs for a partner to penetrate me,” Dorothy Dodson wrote in a recent book, “Naked at Our Age: Talking Out Loud About Senior Sex,” “I opted for bilateral hip replacement surgery at the age of 67. A year later I was a born again hedonist.”

The prevalence of sexual activity among seniors is increasing. According to a 2013 study by the University of Minnesota, 67 percent of men and 39.5 percent of women report having sex up to age 74, and a sizable 38.5 percent of men and 16 percent of women report having had sexual activity even up to 95 years of age.

For those who don’t have spouses or partners, online dating sites such as OurTime.com can help. These sites’ marketing campaigns feature the happily coupled elderly gushing over the rediscovery of high school giddiness. For the older and less connected, nursing homes have become sites of hookups. A 2012 study in The Student British Medical Journal found that the rates of STDs among U.S. seniors ages 50 to 90 doubled from 2000 to 2010.

For baby boomers eager to buy into the dream of old age as a wild and willful second youth, the longevity of their sexual activity offers an escape from the ebbing of life and the approach of death. The Rayhons case illustrates how the sexualization of old age has its limits.

Donna Rayhons died in August 2014, and charges were filed against Henry Rayhons a week later. It may never be known what exactly happened or whether there was some solitary moment of lucidity when she consented. What is obvious, however, are the limitations of an Alzheimer’s patient who deteriorates suddenly and significantly and is unable to meet the expectations of a partner who is healthy and frustrated by the loss. Protecting such a patient may mean protection from the very person who purports to love him or her.

While cases involving abuse allegations by a patient’s spouse are rare, sexual assault and abuse of dementia patients is not. In October 2014, an assisted care facility in Florida reported a sexual assault on 76-year-old female dementia patient by a family member. In Oregon a $4 million lawsuit was filed last summer by the family of an 82-year-old woman with dementia who was sexually abused by another elderly resident over the course of a year. The suit alleged that the care facility where the two lived knew about the abuse but did nothing to keep them apart.

In Minnesota an investigation by the state’s department of health alleged neglect at the White Pine Senior Living Center after a woman with dementia was found sitting in the lap of an elderly man who was also a resident. Both were naked from the waist down, and the woman said she had been assaulted. The man was previously caught trying to take the woman to his room by putting her in his wheelchair. 

Determinations of when relationships are consensual and when they are not are often too difficult to make, according to Maria Ibrahim, a Maryland geriatrician who works with nursing home patients. As a result, nursing homes usually try to discourage them altogether. But this ignores the needs of consenting patients.

American society has long lacked the cultural and sociological resources necessary for proper care of the elderly. The ethic of self-fulfillment dictates that children tend to their own lives and careers instead of interrupting them to care for elderly parents. In this regard, the sexualization of old age has provided a cover: Even in our senectitude, we supposedly have not only the right but the expectation that we can live the same sort of life we had in our youth, including love and sex.

The Rayhons case exposes this norm as a sham. It presents questions not simply of culpability and protections owed to the elderly and incapacitated but also about the need for honest conversations about life, death and aging in American society. The baby boomer pretense that old age is a second youth enabled by money and medicine has allowed generational neglect toward building the resources required for an ever-older America to age with compassion and dignity.