Despite the general reduction in sexual needs with aging, human beings have sexual needs which are life long. This study looks at the overall lack of privacy, as well as at the biological, psychological and social changes that occur among the institutionalized elderly with dementia, and addresses the appropriateness of sexual expression. Conflicts involving social values, a lack of policies regarding sexual issues, and a lack of in-service training in institutions result in caregivers experiencing difficulty with the sexual issues faced by patients. It is essential to develop strategies which are consistent with culture and institutional philosophy. Through the understanding of sexual expression and its influencing factors among residents with dementia, caregivers can develop a care plan that allows residents to express appropriate sexual behavior.