Objectives: The aims of the study were to examine: i) whether sex offending in elderly people is a serious problem, ii) whether mental disorder or alcohol abuse occur in association with such behaviour, iii) how such behaviour is managed by the psychiatric service and iv) the outcome of such management.

Method: Referrals of people with sexually offensive behaviour to the North Dublin Psychiatry of Old Age Service from its inception in 1989 to date (1997) were examined. Information collected included: i) mode and reason for referral, ii) demographic, social and medical information, iii) psychiatric diagnosis, iv) management and v) outcome.

Results: Thirteen cases were identified in the eight year period. The sexually offensive behaviours included indecent assault, masturbation in public and lewd remarks. Diagnoses included vascular dementia, frontal lobe dysfunction, Alzheimer's disease, chronic schizophrenia, depression with alcohol abuse and ‘no psychiatric diagnosis’. Two patients had positive syphilis serology detected on dementia screening. Alcohol abuse featured in almost half of the cases. Regarding treatment, five were treated with oral cyproterone acetate and one with benperidol, and all of these had a good response. Three were treated with neuroleptics and also settled. Specific treatment was not indicated in three cases and forensic services were involved in a further three cases.

Conclusions: It is noted that most subjects had an underlying psychiatric diagnosis particularly organic brain damage. Management alleviated the problem in all cases with psychiatric disorder. Cyproterone acetate is clearly useful in management. This review highlights the importance of thorough assessment, diagnosis and management of sexually offensive behaviour in old age.