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Let's Talk About Sex ... and Senior Citizens

As STD rates rise among the elderly, health-care providers and public health departments continue to shy away from discussing their sexual health. Is it time for a sexual revolution?

Sexual health campaigns and providers overlook the elderly even though many of them are still sexually active.
(AP/Nati Harnik)
People face many health issues as they age: loss of hearing and sight, sore joints, memory loss. Many of those are common (and commonly discussed), but medical providers often sweep health issues related to sex under the rug -- and it's hurting the growing population of seniors.

Sexually transmitted disease (STD) rates among people over the age of 65 are rising. Between 2007 and 2011, rates of chlamydia increased 31 percent, and syphilis cases rose 52 percent. Sexual health campaigns and providers, however, overlook the elderly even though 53 percent of people between 65 and 75 years old and more than 25 percent of people between 75 and 85 are still sexually active, according to a 2007 survey.

It's also easier for seniors to catch STDs because of their lowered immune systems and menopausal effects on women like the thinning of vaginal walls -- and harder for doctors to detect them because the symptoms, such as the worsening eyesight and arthritis caused by chlamydia and gonorrhea, can often be attributed to aging and go undiagnosed and untreated. 

But public health departments don't seem to be paying attention: A 2005 study of sexual health pamphlets in departments across all 50 states, for example, found only two that focused on aging adults. 

“It’s almost like an ignorance. We have plenty of research and knowledge, but providers just continually don’t discuss sexual health with older adults,” said Maggie Syme, assistant professor at Kansas State University’s Center on Aging. “Sexuality can be tough to talk about, and doubly so when dealing with the elderly. But there needs to be a movement to educate providers that it needs to be done.”

Medicare started covering annual STD screenings in 2011, but only 5 percent of seniors on Medicare are taking advantage of the free testing. And older adults in long-term care facilities might not be even aware of this.

“[Nursing] homes often aren’t equipped to provide condoms and STI tests -- it’s just not on their radar. I’ve heard directors of nursing homes just say they feel underprepared for sexual health,” Syme said.

Only 13 percent of long-term care facilities train their staff to handle sexual behavior among seniors, according to a 2013 AMDA survey. Nursing homes and assisted living facilities require health assessments upon intake, but it often only asks about HIV, according to Syme. In retirement communities, where admission is typically voluntary, health assessments aren’t required at all, so there’s often no way for aides and nurses to know about the sexual health or history of a person. 

Health-care providers may hesitate to talk about the elderly's sexual health, but the seniors themselves appear eager to discuss the issue. When Planned Parenthood of Southwest Oregon held a program this year called “The Heart Has No Wrinkles” for older adults to talk about their sexuality, the event attracted over 100 people -- that's more than a typical city council meeting.

"It just goes to show that older adults want to be acknowledged for being vibrant, healthy and enjoying all aspects of life," said Joanne Alba, the education projects coordinator for Planned Parenthood of Southwest Oregon. 

While Planned Parenthood doesn’t seem to be the obvious choice for providing sexual health education for seniors, the Southwest Oregon branch hopes to forge a new path.

“We may not be able to provide direct services for all of the issues older adults may have, but we want to be leaders in sexual education -- no matter what age or demographic,” Alba said.

Education, Syme said, is key to curbing STD rates and getting a healthy dialog started.

“The population in retirement communities now, they grow up in a time when sex education wasn’t always mandatory, but they need it just as much as anyone else. They don’t always have a perception of how risky their behaviors can be," she said.

Aging and sexuality are taboo topics in American culture, another reason health providers have failed to merge the two. But with the uptick in STDs and high-profile cases regarding consent with people who have dementia, it’s clear that "the boomer generation is here, they’re aging, and they’re still having sex,” said Alba.

Mattie covers all things health for Governing.

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