Johnson and Colleagues Publish Article in Geriatric Nursing

Ragan Johnson, assistant professor, recently published an article entitled "Sexual Health and the Older Adult" in Geriatric Nursing. Co-authors include Trimika Bowdre and Ricketta Clark, both of the University of Tennessee Health Science Center College of Nursing. 

Background

Sexual health is an integral component of holistic health across the lifespan. Despite this, nurse practitioners (NP) often omit sexual health histories from their examination of older adults.1 While the aging adult may be seen as nonsexual, one study found that 73% of participants aged 57–64 were sexually active. Additionally, 53% of the 64–75 age group and 26% of the 75–85 age group were having sex.1, 2 Increased divorce rates, widowed status, erectile dysfunction medication use, and Internet dating place older adults at risk of sexually transmitted infections (STIs) and HIV.1, 3 The Centers for Disease Control and Prevention (CDC)4 reported that from 2012–2016 there was a significant increase in the incidence of chlamydia (6084–11,093), gonorrhea (3874–9737), and syphilis (737–1697) among the 55 and older age group. While human papillomavirus (HPV) is the most common STI in the United States (US), it is not a nationally notifiable condition.4 Overall prevalence of HPV was 42.5% among US adults aged 18–59, with subtypes 16 and 18 accounting for 66% of cervical cancers and approximately 25–50% of low and high-grade dysplasias, respectively.4 The CDC2 also reports people aged 50 and older account for 17% of new HIV diagnoses. Similar to the infection rates among younger people, the subgroup of older adults with the highest infection rates is gay and bisexual men (49%). However, the heterosexual population is also at increased risk (44%) with heterosexual women accounting for 24%.2

HIV risk factors for older adults are the same as in the general population, yet society has the misconception that older adults do not engage in high-risk behaviors, are not at risk for infection, or are no longer sexually active due to their age. Research has found that older adults remain sexually active well into their 80′s; yet, they may lack knowledge about HIV transmission.5 This gap in knowledge highlights the need for providers to seize the opportunity to include education regarding sexual health, sexual hygiene, and information about STI and HIV transmission during primary care visits and focused visits related to gynecological and genitourinary complaints. Individuals who have been in long-term monogamous relationships who are recently divorced or widowed may not consider using condoms due to misinformation or lack of information about STI transmission rates among older adults. Likewise, women who have gone through menopause do not have the risk of pregnancy; therefore, they may be less likely to use a condom.5 Despite visiting their providers more frequently, older people are less likely to initiate a discussion related to their sexual behaviors, and NPs are less inclined to ask their older patients about sexual health because they may not view them as participating in risky behaviors.6, 7, 8 However, given the high rates of HIV and STI transmission among this population, patients could benefit from the inclusion of sexual health as a routine part of these visits.

HIV symptoms often mimic other common biological changes or age-related symptoms that occur during the normal aging process9; therefore, older adults could be less likely to seek care early in the disease process and more likely to have late-stage infection at the time of diagnosis.2 This leads to delayed initiation of treatment and could result in higher morbidity and more progressive immune system damage. While studies have suggested that providers cite lack of knowledge, discomfort with the issue, and time as barriers to discussing sexual health with patients,1, 7, 10 NPs should play an active role in assisting older adults in maintaining a healthy overall quality of life, which includes their sexual health. NPs should take the initiative to initiate those difficult conversations, conveying HIV prevention information, and properly screen their older patients for HIV.