Today, healthier living options and improved medical care work in tandem to provide seniors with a much more active lifestyle than that of just a few decades ago. However, with this freedom and increased activity come the dangers that once only concerned those much younger.
People in the Baby Boom generation have all seen the jokes on television sitcoms about the “frisky” behaviors of seniors. Scenes of Grandma and Grandpa sneaking away from the family with a wink and a nod to escape into parts unknown to the delight and laughter of the audience was a mainstay of sitcoms that featured senior characters. These shows portray senior sexual activity as something “cute” or even “abnormal” which garner the laughs but do little to represent that reality facing this age group. With the new found sexual revolution in seniors comes a downside – the tremendous increase in sexually transmitted infections and diseases.
Now before I go any further, I have heard the terms sexually transmitted diseases and sexually transmitted infections used interchangeably and wondered if this was correct. Wanting clarification, I went to someone who worked in the social services field for an explanation.
He stated that sexually transmitted infections (STIs) are infections that have a high
probability of being spread from person to person through sexual contact. If the infection results in altering the person’s normal bodily functions, then it becomes a sexually transmitted disease (STD). Further, he stated that not all STIs cause symptoms and can be deceiving. Given that, he states using the term STI is technically more accurate because not all infections have symptoms so taking precautions and getting tested if a senior is sexually active, especially with multiple partners, is important. With that being said, let’s look at this issue in the senior community.
The Centers for Disease Control (CDC) reports a significant increase in sexually transmitted infections among seniors. According to their researchers, since 2010 those over the age of 65 have shown a 52% increase in chlamydia, a 65% increase in syphilis and an astonishing 95% increase in gonorrhea. What accounts for these numbers?
Researchers cite five main reasons for the spread of STI/STDs among seniors.
An increase in divorce rates among those over 55 – this increase means more people dating and engaging in sexual relationships. Adding to this is the fact that societal norms have changed over the decades meaning out of marriage sex is much more acceptable today.
Seniors don’t use protection – Older males come from a time when using condoms was not an expectation and older females don’t fear getting pregnant so the use of protection among this group is low. In fact, a survey done by the Sexual Information and Education Council of the United States found that those over the age of 65 have the lowest rate of condom use of all age groups studied.
Society still expects seniors to be non-sexual – Despite the fact that better treatments are available for sexual disorders, our society still has an expectation that senior citizens would rather play shuffleboard and bingo than engage in sexual activity. Because of this belief, those close to seniors, including medical and other health professionals, don’t spend the time explaining the dangers of unprotected sex to them. In fact, a New England Journal of Medicine study found that both doctors and their patients felt uncomfortable discussing sexual behaviors.
Better medical treatment – senior males are being treated with testosterone replacement therapy or have access to medications like Viagra which allow them to continue to be sexually active much longer today than in the past.
The number of senior communities being built – There is no doubt that senior living communities are a good thing and offer companionship and support to a once underserved group. But with this togetherness also comes relationships and sexual activity. In fact, in a brief but unscientific study I did, not a whole lot of these programs offer routine sex education and even fewer make condoms available.
Let me present a bit more proof about the need for sex education in senior living communities. The CDC reports that the largest increases in STI/STDs have been found in Pima and Maricopa counties in Arizona, which is home to many retirement communities. Between the years of 2005 and 2009, cases of syphilis and chlamydia rose 87% in those 55 and older. During that same time, Florida, also a haven for retirees, saw a 71% rise in the central part of the state and a 60% rise in the southern part. Today, most of these communities are making sex education a requirement for those moving in as part of their policies.
The acceptance that seniors are sexually active is important meaning that programs and facilities working with them must adopt policies about safer sexual behaviors for their patients and residents. Beyond that, all facility staff – from nurses to CNAs to volunteers to administrators – need to be trained in the knowledge of sexually transmitted infections and be able to hold non-judgement discussions with those they care for and their families.
All involved in senior care must be comfortable discussing sexual activity which will help in removing the stigma of senior sexual behaviors. Because seniors are less apt to discuss their sexual health because of embarrassment or lack of knowledge, they may be exhibiting symptoms of an infection but ignore them. Unfortunately, having an infection can make them more vulnerable to other viral diseases like genital herpes, genital warts, hepatitis B and HIV.
Age itself also presents problems for those who may contract a STI/STD. There are several reasons for this:
An older immune system is less able to fight off infections
Underlying health conditions make it much easier to contract sexually transmitted infections
Skin changes allow easier access for these viruses to enter the bloodstream through tears and cuts
So, you can see how important it is to demystify the sexual behaviors of our seniors. Now let’s discuss HIV/AIDS. Is it really a problem among our senior population?
It sure is.
First, let me explain the difference between HIV and AIDS. HIV is a virus that may cause an infection, but AIDS is a condition or a syndrome. Being infected with HIV can lead to the development of AIDS, which stands for acquired immunodeficiency syndrome. AIDS develops when HIV has caused serious damage to the immune system and allows opportunistic infections like pneumonia, tuberculosis and even some cancers to develop. A normally healthy immune system would be able to fight off such illnesses.
Thankfully, HIV today is no longer a death sentence for those who contract this
virus. With new medication cocktails and better understanding of this infection, those with HIV can now live relatively normal lives and lifespans. This is great news but it also presents a problem.
The CDC reports that the number of seniors living with HIV/AIDS is increasing. In fact, a study by Yale Medical School reports that more than 50% of those living with HIV are over the age of 50. Given that, a recent meeting by the White House AIDS and Aging group sounded the alarm that age is not a barrier that protects seniors from contracting this virus.
Even with this knowledge, medical professionals do not routinely test for HIV when a senior presents with symptoms that would raise suspicions in someone younger. It is reported that in this age group doctors often misdiagnose early symptoms of HIV such as fatigue, weakness and memory changes as normal signs of aging.
Another problem with HIV infection in a senior is that it can take years for symptoms to appear. A sexual encounter that may have occurred years before may have been forgotten by a senior and then goes unreported when symptoms appear.
If an undiagnosed case of HIV progresses to AIDS, the symptoms can mimic other age-related conditions. For example, the most common type of pneumonia in AIDS patients can be misdiagnosed by medical professionals as congestive heart failure, HIV related dementia can be attributed to Alzheimer’s or Parkinson’s and the fatigue and weight loss associated with AIDS could be chalked up to normal aging. Obviously, early diagnosis is the key so treatment can begin.
So how do those of us who work with seniors on a regular basis or have seniors in our family who are active and independent address this issue? Here are some suggestions;
Educate seniors, program staff and even family members on the risks of unprotected sex. Know the warning signs of an STI/STD and the long and short-term effects and be willing to discuss this topic.
Discussions - teach seniors how to talk to their partners about sexual behaviors and protection.
Know their history - When facilities or medical providers are doing a psychosocial assessment, explore the sexual history of the client. Also include questions about any history of IV drug use, which is becoming more common as baby boomers age.
Available protection - If you are a senior living community, senior center or any senior social venue, consider making condoms available as well as pamphlets on sexual behaviors and STI/STDs.
Testing options - Ask if the senior has ever had an STI/STD test. Medicare does provide free STI/STD screenings with low cost treatment should a positive result occur.
Hepatitis C - Be aware of the increase in HCV infections in baby boomers. To see my blog on HCV, click below:
The bottom line is this, given the cold realities of sex in the 21st century, we must have this discussion with our seniors. A wink and a nod or a wry smile is no longer enough when grandpa spends the night out. Falling victim to a STI/STD due to his or
his partner’s lack of knowledge could prove deadly.
Please see my downloadable handout on Safer Sexual Behaviors Among Seniors.
Attorney Connelly practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.