The Rise in Sexually Transmitted Diseases in Seniors

Today’s Baby Boomers grew up in the 1960s and early 1970s watching the old westerns featuring famous cowboys like Marshal Matt Dillon, Lucas ‘The Rifleman' McCain and Wyatt Earp who kept the streets of the wild west under control. Carrying a six-shooter or rifle, they instilled fear into those who sought to wreak havoc upon the citizens of a growing territory. These were the cowboys of our youth, the heroes we admired and tuned in to every week to watch a new adventure as they sent villains running out of town.

Today, we have a different type of cowboy riding into town and in some cases, still wreaking havoc. Instead of sitting high in the saddle, they are now sitting low in a four wheeled mustang convertible with the top down. We may not find a pouch of chewing tobacco in their pocket but there may be a pack of mints and a medicare card. They may not be wearing huge stetson hats or handkerchiefs around their necks (although some may sport gold chains) but they are on the hunt. And instead of guns, what they are carrying can be just as deadly as the weapons of the old west and can potentially affect many more people.

They’re called “Condo Cowboys” by those who work with them and what they are bringing are sexually transmitted diseases (STDs), which, according to the Centers for Disease Control (CDC), are at an all time high among older adults.

Fran, a senior advocate and social worker from nearby Boston spoke to us about the issues of the “Condo Cowboys” and sexually transmitted diseases.

“I’ve been in social work for 40 years and working specifically with seniors for the last couple of decades and it used to be that when you reached the age of fifty, you were considered to be dead from the neck down. It was wrong then and boy, is it ever wrong now. Any discussion of sex with this age group in the past was off the table which is why we have the problems we have now”, she said.

Fran continued, “Today, we are forced to discuss senior sexuality because we not only have sexually transmitted diseases like syphilis, gonorrhea and chlamydia among this group, but we also have hepatitis B and HIV. It’s no joke. And when it comes to being active, if an older male has a driver’s license, a car and can drive at night, he has his pick of the women. These are the 'Condo Cowboys' we talk about."

Why talk about this now? Because within the last couple of weeks, the CDC issued a disturbing report about the proliferation of STDs in the United States, including the fact that the numbers continue to increase. Rates of syphilis, gonorrhea and chlamydia have climbed for the fourth consecutive year and among seniors, there are indications that infection rates may be even higher.

Recently, the CDC reported 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.

Sure, we 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 the reality of this age group. With the new-found sexual revolution in seniors comes the downside of sexually transmitted diseases. But as Fran stated earlier, these discussions are still difficult to have and we have experienced just how some view senior sexuality.

A few months ago, we did a blog similar to this one about the high rates of STDs among seniors and the need to address the situation. As soon as we published it, several well-meaning friends of our blog contacted our office fearing the site had been hijacked by someone peddling pornography. We were certainly thankful that they had our well being at heart, but what it also pointed out was the fact that we as a society are still not comfortable seeing the word “sex” connected to any discussion about seniors.

Then comes the question, why would a law firm have an interest in this? According to award winning elder law attorney RJ Connelly III, those who work with seniors in any capacity need to be concerned about all aspects of their health.

"We are willing to discuss issues like mental health, addiction, medication compliance and even death and often do so without batting an eye, and yet we shy away from discussions of sexual health with this age group. And based upon the rates of STDs in the senior community, this is something we must discuss openly and honestly," stated Connelly.

"Consider this," said Connelly, "for older adults, the sexual disaster of their time was an unwanted pregnancy, and since that concern is off the table, they no longer think about protection when in fact they are just as, or in some ways, even more susceptible to STDs as any other group."

But why this group of seniors? Why is it the Baby Boomers? Well, there are some answers.

Healthier living options, improved medical care, people living longer and higher standards of living all work in tandem to provide seniors with a much more active lifestyle than that of just a few decades ago – and this goes hand in hand with the relaxed attitude of this generation.

Those of the boomer generation grew up with the Beatles, Rolling Stones and Woodstock. Sex, drugs and rock and roll was the mantra with them as they protested everything from the Vietnam War to the Washington establishment. They thumbed their noses at the societal norms of the time and explored their new-found freedom in everything from drug use to sexual activity.

In fact, this group engaged in more drug use and sexual activity than any other group in the nation’s history. Studies indicate that their sexual activity and drug use outrank the generations before and after them and as a result, they have a much more lenient and less judgmental attitude towards sexuality and drug use. And it appears they are carrying these attitudes with them into senior communities along with the consequences of increased and unprotected sexual activity. This is a problem that once only concerned those much younger.

Along with these attitudes, researchers say, there are some other issues that may also account for the increase in the STD rates among seniors. These include:

  1. 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 and attitudes have changed over the decades so out of marriage sex is much more acceptable today.

  2. 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. A recent 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.

  3. Society still expects seniors to be non-sexual – As we discussed earlier, 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 family, medical and other health professionals, don’t spend the time explaining the dangers of unprotected sex to them. A New England Journal of Medicine study found that both doctors and their patients felt uncomfortable discussing sexual behaviors.

  4. 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. And get ready for this -- Viagra (sildenafil) is now available as a generic meaning that prices are lower and within the budget of those who could not afford it in the past.

  5. 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 under-served group. But with this togetherness also comes relationships and sexual activity. In a brief but unscientific study we did, not a whole lot of these programs offer routine sex education and even fewer make condoms available.

For some of the seniors we spoke with, they openly discussed the fact the sexual activity is a part of their lives, but when it came to discussing STDs, they pointed the finger elsewhere. Most believed that these high rates of disease are confined to urban areas, where older adults are using drugs or are alcoholics thereby lowering their inhibitions, or may not be able to get the appropriate preventative health care or just have "moral shortcomings". But, according to government statistics, this is not the case.

The CDC reports that the largest increases in STDs have been found in Pima and Maricopa counties in Arizona, which is home to a number of 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.

The acceptance that seniors are sexually active means 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 – also need to be trained in the knowledge of sexually transmitted infections and be able and comfortable in holding non-judgement discussions with those they care for and their families.

But, senior sexuality is not just about the act itself as it poses other problems for staff at senior facilities.

“What I have seen”, said Fran, “is the same type of behaviors we witnessed as teenagers. Many laugh at it and some may find it amusing, but it means more drama for staff. They now need to know who is with who and which person may be angry because of that. Then, when things go sour, we see arguing, fighting, gossip and bullying."

"And believe it or not, there are some who don’t mind getting a little too friendly in the community room in front of others prompting staff to address the problem which, in many cases, ends in a nasty exchange. This is usually followed by calls from the families of those who witness these amorous acts calling us to complain. It is a real problem for all concerned," stated Fran.

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 experiencing 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. Older adults are also more likely receive an STD diagnosis when it is too late and are not able to benefit from the medications available for treatment in the early stages. This occurs because many seniors are too embarrassed to ask to be tested for STDs -- and because some of these diseases do not have symptoms, many don't realize they are infected until serious and possibly permanent damage has occurred.

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;

  1. Education - 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.

  2. Discussions - teach seniors how to talk to their partners about sexual behaviors and protection.

  3. 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.

  4. 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.

  5. 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.

  6. Hepatitis C - Be aware of the increase in HCV infections in baby boomers.

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 or grandma spend the night out. A senior falling victim to an STD due to his or her partner’s lack of knowledge or refusal to use protection could prove deadly and is unacceptable when we consider the fact that it can be prevented or treated. We must not be afraid to talk about this.

Connelly Law Offices offers a free workshop for those who work with seniors where the problem of STDs in seniors is discussed openly, frankly and in a non-judgmental manner. Click on the link below to see the workshops we offer:

Connelly Law Offices, Ltd. Free Community Education Series

We also offer our free downloadable handout on Safer Sexual Behaviors Among Seniors.

Next week, we will discuss the increase in HIV/AIDS cases among seniors and how this infection impacts other age related illnesses.

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.

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