Touchy Subject – Rise in STDs Among Seniors Prompts Calls for Education, Compassion

That’s certainly not an uncommon question to ask these days, given the dangers of sexually transmitted diseases (STDs) and the widespread awareness of these afflictions.

But when Suzanne McElroy asks the same question of her clients, “they look at me with this shocked expression and ask, ‘why would I need that? I’m too old to get pregnant.’”

And that’s a big part of the problem when it comes to a growing — and alarming — trend that has emerged in recent years: a surge in the number of reported STDs among what would be considered older populations, those age 50 and up. Indeed, most of these individuals are probably too old to get pregnant, but they’re definitely not too old to contract STDs and the various health issues that accompany them.

As a franchise owner of Home Instead Senior Care, based in Springfield, McElroy knows the reality of what is happening behind closed doors with her clients, who range in age from the mid-70s to over 90, and the many issues that the aging process brings. But she also knows the disturbing statistics regarding STDs in seniors.

One of the most notable published reports is the American Assoc. of Retired Persons’ “Sex, Romance, and Relationships,” released in 2010. It surveyed a nationally representative sample of middle-aged and older people about their sex lives. These are the major findings: 

• Three out of 10 respondents said they had sex at least once a week, including almost half of those who were single but dating or engaged, and 36{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of those who were married;

• 85{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of men and 61{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of women said sex was important to their quality of life; and

• Just 12{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of single men and 32{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of single women who were dating reported always using condoms during sex.

That last bullet point is the really disconcerting stat, said McElroy, and just one of the reasons the Centers for Disease Control and Prevention recommends that everyone be tested once for HIV, and those who engage in risky sexual behavior should add chlamydia, gonorrhea, and syphilis to their yearly screening tests.

Elaborating, McElroy said there are two myths concerning this subject. One is that seniors don’t have sex, which is untrue, and the other is that they can’t contract sexually transmitted diseases, which is equally false. “We started an initiative around seniors and STDs, and true, it was a little shocking, and some didn’t want to be associated with it because they saw it as ‘unseemly,’ but we have to dispel these myths.”

McElroy said older Americans account for a relatively small percentage of new STD diagnoses overall, and diseases in general are escalating in the Baby Boom generation (born between 1946 and 1964) because there are simply more of them. However, the rate of STD diagnosis in those ages 50 and over has doubled over the last decade, and that constituency includes a large portion of the Baby Boomers as well as what is left of the Silent (1925-1944) and GI (1905-1924) generations.

“Also, many seniors may have married at, say, 19, and never had any other partners, and the only thing they know is that condoms prevent pregnancy,” McElroy continued, adding that it’s the reason her company offers a conversation-starter booklet called The 40/70 Rule, designed to stimulate dialogue between seniors and their children on a host of issues, including sex (more on that later).

Leslie Kayan, Healthy Aging Program coordinator at the Franklin County Home Care Corp., is a strong supporter of any conversation that opens seniors up to talking about sexuality. As a community health educator, she’s taught sex education to teens, parents, teachers, church leaders, and healthcare providers.

A Baby Boomer like McElroy, Kayan grew up during the ‘free love’ generation, a culture with an openness and knowledge about sex and STDs, which she said will carry over to her senior years. “But anyone who is older than I am is extremely unlikely to ever have had any formal sexuality education,” she said. “Many of them have been married for years, and now they are widowed and out there, at risk for the first time. And safe sex isn’t even on their radar.”

“If you look at sexuality as part of the human condition from puberty till the day we die, it just doesn’t stop,” McElroy added. “It goes through cycles, but it doesn’t stop just because we reach a certain age.”

McElroy pointed to the proliferation of senior online-dating services like www.ourtime.com, www.seniorpeoplemeet.com, and www.findseniorsonly.com; the enormous revenues for erectile-dysfunction (ED) drugs like Pfizer’s Viagra ($2.5 billion in 2012) and Eli Lilly’s Cialis ($1.93 billion in 2012); and the growth in senior and assisted-living facilities that promote socialization. The messages are tantalizing, with little education to go with them, she said.

McElroy has 35 employees who are fully trained in all aspects of non-medical care of seniors. To keep that training up to date and relevant, she does extensive research into a variety of subjects, including sex and the older populations.

And in many national publications that have addressed that topic, she’s seen the words ‘seniors’ and ‘frisky’ together in the same sentence, and this juxtaposition does not amuse her.

“How demeaning that readers are totally picturing two white-haired people having ‘fun,’” she said in a voice tinged with a mix of anger and frustration. “How about two white-haired people who are lonely because they lost their spouse?”

Her staff knows that respect is to be shown to senior clients’ behaviors because many are living in retirement communities that facilitate socialization among eligible, but also lonely, seniors, McElroy said.

“Maybe it’s romance and maybe they’re just ‘hooking up,’ but it’s not something that is funny or temporary, and it’s certainly not something that is perverse or wrong.”

 McElroy’s staff does not diagnose, but rather observes any minute changes in clients like variations in appetite, urination, odors, rashes, etc., that may suggest further investigation by a doctor. According to McElroy, the biggest issue that seniors face is how the outside world sees them. It’s the widespread assumption that they don’t have sex that she said is dangerous.

“Because there is no talk about it, no education, there’s a lot of embarrassment,” she told HCN. “Children will talk about healthcare proxies and living wills, and whether dad can still drive, but don’t think about asking dad about his dating or sex life now that mom is gone.”

Dr. Stephen Levine, who has practiced since 1979 in his Holyoke-based family practice and is affiliated with Holyoke Medical Center, agrees.

“The issue of STDs is far from the surface, and it’s usually the last thing that’s brought up,” he said. “It’s not something that can be allowed to be mistaken or overlooked, and needs to be discussed with the practitioner who is seeing the individual.”

Routinely, said Levine, his elderly patients have questions about physical changes that come with age and ask about ED treatments or lubrication for dryness, albeit somewhat indirectly. “A woman or a man may ask, ‘is there anything you have that can help me?’ and they know what they’re talking about, and I know what they’re talking about, and then the discussion goes in the direction of things that can be helpful, so it’s definitely on the majority of seniors’ minds that I see.”

Times are different, Levine went on, because the advent of ED drugs like Viagra for men and estrogen creams for women over the past decade has solved some of the issues of sex and aging. Now, with medical intervention, seniors are able to perform physically, with little effort, via a ‘little blue pill,’ a tube of cream, or hormone replacement therapy (HRT).

But the conversation has to start somewhere for these seniors when it comes to new sexual partners.

“Having sexual relationships is normal, expected, and OK, but it’s clear that this group is exposing one another to the possibility of STD risks,” said Levine.  “Bottom line, at the start of a life-changing situation like a new relationship, testing for everything one can think of that could be transmitted sexually is a good starting point.”

Ignoring the threat of STDs, especially if they go undiagnosed, can be detrimental, Levine said, because several types of STDs can be harbored without symptoms, including syphilis, chlamydia, HIV, and hepatitis B. Syphilis, in later stages, he explained, could cause dementia, which brings up one of the difficult issues in diagnosing STDs in the elderly: many STD symptoms are similar to the normal aspects of aging.

McElroy admitted that some of her clients who normally have issues with urinating — very common in older ages — would never identify that issue as a symptom of an STD, yet it could be one.

Elaborating, Levine added, “if something doesn’t appear to be anything other than a typical aging problem, the patient will probably have no intention of being tested, but they could be infected and unknowingly be spreading infection to one or multiple partners.”

Sherill Pineda, president of Care @ Home in East Longmeadow, has become very familiar with both the concept that seniors need a healthy sex life, and the issues related to STDs.

She started a volunteer Zumba dance group for seniors called Groove and Learn, which offers exercise as just one way to stave off Alzheimer’s disease, but to also learn about other aging issues. At a certain point, the more than 25 participants, mostly senior women, wanted to talk about sex, and Pineda realized there was a definite need for more openness and awareness regarding seniors and their inability, for whatever reason, to find answers for themselves. She also realized that awareness had to spread to the senior healthcare community, which was not nearly as open as it should be, for all the other seniors in the Western Mass. region.

Last May, Pineda staged a conference called “Never Too Old for Love” for the Western Mass. Eldercare Professionals Assoc. at Holyoke Community College. The symposium, crafted for nurses, social workers, and the public, drew more than 350 people, and 66 of them were seniors. (This year’s event will be held on May 29).

Pineda explained that depression is a big issue with many of her clients, largely due to the loneliness and isolation that seniors feel, especially after losing a spouse. “When I talk about ‘Never Too Old for Love,’ it’s not purely about sex; some people just want companionship, and wherever that leads, that’s their private business. As healthcare professionals, we need to be mindful about what is causing depression and other unusual changes in seniors. They are still longing for the one-on-one emotional needs and the physical aspect of it, and they’re just like us; they don’t think of themselves as old.”

Pineda has found that seniors typically won’t talk about their sex lives with their grown children, “but they are more than willing to open up to healthcare professionals, because sometimes their kids will say, ‘you’re too old for that.’”

McElroy agreed, noting that Home Instead has a resource called The 40/70 Rule, a booklet that contains suggested conversation starters concerning myriad issues in the aging process. “It means that if you’re 40, and your parents are 70, then conversations about all sorts of things should start happening.”

She said the publication has realistic ways of opening that door to at least promote a conversation between a senior and his or her physician.

Her best advice for the children of seniors, their caregivers, and doctors is to not assume anything. Financial issues, end-of-life wishes, questions or concerns about sex … no one knows unless they ask, or at least open up the opportunity for real discussion.

Research, news articles, education on the part of healthcare providers, and acceptance within immediate families is what McElroy, Kayan, Pineda, and Levine say will help remove the barriers to talking openly about seniors and their sexuality.

McElroy even sees this STD issue as a trend that will likely evolve over the next decade in the form of a welcome decline in prevalence because the more open-minded individuals in their 50s, 60s and early 70s have already integrated the Internet into their lives from their work life, and information and more education will make a huge difference in their knowledge of STDs and the concept of healthy sex.

“It’s all about respect and dignity,” she said, “which dictates that, if something isn’t hurting someone, I don’t care how old you are, you should be allowed to participate in it, safely.”