SEXUAL RISK BEHAVIOR
atrophic conditions in women. Since the advent of sildenafil (Viagra) in 1998—as well as other phosphodiesterase inhibitors, penile injections, vacuum devices, and prostheses— research has shown an increase in the number of men continuing intercourse into their 80s.3 Topical vaginal estrogens and testosterone for vulvovaginal atrophy have led to fewer sexual pain and lubrication issues for many postmenopausal women.3 Since postmenopausal women do not have to worry about unintended pregnancy, they may choose to engage in unprotected intercourse, putting themselves at higher risk for STDs.9 A 2003 study determined that the perception of risk for STDs among older adults is minimal compared with that of adolescents and young adults.7 Older adults were less likely than younger adults to know how HIV is transmitted and were less knowledgeable about HIV disease progression. A 2008 study assessed for knowledge of STD risk in 165 educated men and women older than age 50 years: A total of 92% of study participants agreed that condoms prevented STDs and AIDS, indicating some level of knowledge of the connection between prevention of STDs and AIDS, but only 13.3% always wore condoms with intercourse.9 Despite the fact that data are limited regarding late-in-life sexuality (especially in assisted-living and nursing homes), a 2011 study of older people in care homes found that these adults do not lose interest in sex but feel limited by staff attitudes and other physical or environmental constraints.10 This increases the likelihood that any sexual activity among these individuals will be unprotected. Societal changes
Overall, society’s view of sexuality in older adults has evolved, primarily in terms of the attitude and perception regarding the importance of sexual health in this population. Sexuality contributes to such health benefits in older adults as improved mental health, decreased stress levels, and decreased feelings of loneliness.8 One only has to turn on the television to observe the shift in society’s perception and acceptance of sexuality in older adults. The media portray older adults as vibrant and sexual beings in the advertising of various products. Such common phrases as, “50 is the new 30” show that the general public is embracing older age and sexuality. Approximately 20% of online daters are from the Baby Boom generation.5 However, even though sexual activity in older adults is more widely accepted, it should be remembered that risky sexual encounters involving unprotected sex (i.e., without a condom) may result in STDs.
POLL POSITION
Do you screen patients older than age 50 years for sexually transmitted diseases? n=240
32%
Yes No
68%
For more polls, visit CliniAd.com/10TDwDb.
TABLE 2.The PLISSIT model Obtaining Permission from the client to initiate sexual discussion Providing the client with Limited Information needed to function sexually Giving Specific Suggestions for the individual to proceed with sexual relations Providing Intensive Therapy surrounding the issues of sexuality for that client
The need for education
Sexuality has positive effects on general well-being and mental health, and pleasure is necessary to maintain this state of well-being, even in the aging population.8 Sexual activity in older adults improves quality of life, but some individuals are hindered by disabilities and/or illness.11 Even so, older adults continue to engage in unprotected intercourse or other risky sexual activity and perceive the risk of acquiring an STD as minimal. Regardless of the knowledge of increased sexual activity, clinicians provide older patients little education regarding safe-sex practices.7 Efforts to increase awareness of the risks of unprotected intercourse should focus on the development and implementation of educational materials geared toward older adults in clinics, assisted-living facilities, and nursing homes. A similar educational effort must be made to educate health-care providers regarding safe-sex practices and the risk of STD transmission in older adults.8,9 Developed in 1976, the PLISSIT model (Table 2) is a sexual-assessment tool that can be used in a variety of clinical settings and may be particularly useful when addressing older adults.12 The simplicity of this model allows a wide variety of questions to be individualized to the patient and his or her particular situation.
34 THE CLINICAL ADVISOR • APRIL 2013 • www.ClinicalAdvisor.com
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