Many older adults have a "don't ask, don't tell" relationship with healthcare providers about sensitive subjects, such as driving, urinary incontinence, or sexuality. As a caregiver, you may also feel awkward addressing these concerns. 

At a stage in life when we might expect sexually transmitted infections (STIs) to be decreasing, aging baby boomers are busting stereotypes and changing the conversation about growing old. Today, STIs are increasing among older adults, with the Centers for Disease Control and Prevention (CDC) reporting that both syphilis and Chlamydia cases in adults between 45 and 65 nearly tripled in the decade from 2000-2010.

What does this mean to you and your patients, residents, or clients? We asked CHA's Chief of Infectious Disease, Dr. Lou Ann Bruno-Murtha, to provide expert advice about STIs in older adults. 

Lou Ann Bruno-Murtha, DO 

CHA Chief of Infectious Disease

Assistant Professor of Medicine, Harvard Medical School

Older adults are living longer and enjoying more active lifestyles than ever before. With this reality and pursuit of healthy aging, there is a greater appreciation for the importance of sexuality in older people. Surveys of older US adults show that the majority of men and women who consider their health very good or excellent are sexually active. In fact, nearly 75% of participants 57-64 years old, 50% of people 65-74 years old, and about 25% of those 75-85 years old reported having sexual contact with another person (as reported in the New England Journal of Medicine in 2007).

Why now?

In addition to longer, healthier lives - the pharmaceutical industry has also helped older adults remain sexually active. Since the "little blue pill" (Viagra) first hit the market in 1998, diagnoses of erectile dysfunction have increased -meaning more elderly men are getting treated for this problem. Other medications such as hormone replacement also contribute to increased sexual activity. Estrogen creams help make sex more comfortable for women, while testosterone-replacement drugs boost libido in men and women.

Are older people at greater risk?

As people age, their immune systems tend to weaken, and other health problems make them more prone to infection. There are also physiologic reasons which increase the risk for STI acquisition among older women. With increased sexual activity, older adults are more at risk for acquiring gonorrhea,chlamydia, genital herpes, genital warts, syphilis, HIV, and other sexually-transmitted infections.

According to the CDC, STIs in older adults are higher in states with a higher density of retirees. New relationships after divorce, separation, or widowhood and new sexual encounters in aging adults, pose increased risk.

Compounding this is the fact that older adults have inconsistent condom use. Unwanted pregnancy is not an issue, and many fail to appreciate their vulnerability to infections, including HIV. In 2009, an AARP survey reported that half of older men who were single and dating rarely or never used condoms; only 12% reported consistent condom use. 

How to talk to older adults about sexual health

We know that sexual health conversations are often not initiated by patients or healthcare providers. So we need to change that. But we should also recognize that these conversations may be difficult, that people often guard their sex lives, and that there might be feelings of shame or embarrassment.

As caregivers, we must overcome stereotypical notions about aging and sexuality in order to facilitate honest discussions about sexual health, including risks for HIV and STIs, as part of routine health maintenance.

Here are some tips on how to start:

• Try talking about safe sex practices to minimize risk of STI acquisition. Sometimes talking about safe sex or condom use is easier than talking about sex itself. So maybe we can use this as a conversation starter.

• If a patient or client is reluctant to engage, remind them that this is a health issue. Sexual activity may affect other health conditions like heart disease or circulatory issues. Also, if they can talk about their indigestion or bowel habits, they should be able to talk about sex!

• Keep an understanding and accepting attitude. This can help promote a more comfortable discussion of sexuality.

Other great resources and conversation starters can be found at http://safersex4seniors.org/ a website created by an independent collective of professional sexuality educators, researchers, authors, trainers and counselors specifically for this topic.