Posted: February 16th, 2023

Population health paper: STIs in the elderly 65+ years old

Addressing the Rise of Sexually Transmitted Infections in the Elderly Population

The increasing prevalence of sexually transmitted infections (STIs) among the elderly population, aged 65 and above, is a growing public health concern. This demographic group, often overlooked in sexual health education and preventive efforts, faces unique challenges that contribute to the spread of STIs. Factors such as limited knowledge about safe sexual practices, stigma surrounding discussions of sexuality in later life, and physiological changes associated with aging can exacerbate the risk of contracting STIs.

Target Population:
The target population for this intervention is individuals aged 65 and above residing in urban areas within the United States. Particular focus will be placed on retirement communities, assisted living facilities, and senior centers, where social interactions and intimate relationships among the elderly are common.

Goals and Objectives:
The primary goal of this intervention is to reduce the incidence of STIs, including HIV, among the elderly population by promoting safe sexual practices, increasing awareness, and facilitating open discussions about sexual health. The specific objectives are:

1. To educate the target population on the risks, symptoms, and prevention methods associated with STIs.
2. To destigmatize conversations about sexuality and sexual health in later life.
3. To provide accessible and age-appropriate resources for STI testing and treatment.
4. To encourage regular STI screening among sexually active elderly individuals.

Intervention:
The proposed intervention will consist of a multi-faceted approach, incorporating educational workshops, peer support groups, and targeted media campaigns.

1. Educational Workshops: Trained healthcare professionals and counselors will conduct interactive workshops at retirement communities, assisted living facilities, and senior centers. These workshops will cover topics such as safe sexual practices, STI prevention, and open communication about sexual health.

2. Peer Support Groups: Facilitated by trained counselors, these support groups will provide a safe and non-judgmental environment for elderly individuals to discuss concerns, share experiences, and support one another in practicing safe sexual behaviors.

3. Media Campaigns: Age-appropriate media campaigns, including print materials, public service announcements, and social media outreach, will be developed to raise awareness, challenge stigma, and promote healthy sexual habits among the elderly population.

The intervention will require a team of healthcare professionals, counselors, and outreach coordinators to deliver the educational components, facilitate support groups, and manage media campaigns. Partnerships with local health departments, community organizations, and senior advocacy groups will be crucial for effective implementation and sustainability.

Measurable Indicators:
To evaluate the success of the intervention, the following measurable indicators will be utilized:

Outcome Measure: Reduction in the incidence of STIs among the target population, as reported by local health departments and medical facilities.
Process Measure: Participation rates in educational workshops, support groups, and media campaign engagement (e.g., website visits, social media interactions).

Potential Challenges and Strategies:
1. Stigma and reluctance to discuss sexual health: The intervention will prioritize creating a non-judgmental and open environment for discussions. Peer support groups and age-appropriate messaging will be utilized to normalize conversations about sexuality and sexual health in later life.

2. Access to resources and healthcare services: Partnerships with local organizations and healthcare providers will be established to ensure accessible and affordable STI testing and treatment options for the target population.

3. Limited mobility and transportation barriers: The intervention will explore the possibility of offering mobile testing units and home visits for individuals with limited mobility or transportation challenges.

The rising prevalence of STIs among the elderly population demands a comprehensive and sensitive approach. This intervention aims to address the issue through education, destigmatization, and the provision of accessible resources. Through promoting open discussions, safe sexual practices, and regular screening, this intervention has the potential to improve sexual health outcomes and overall well-being for the elderly population.

References:

Altschuler, J., & Schift, K. (2020). Sexual health and aging: A life course perspective. Annual Review of Gerontology and Geriatrics, 40(1), 129-147. https://doi.org/10.1891/0198-8794.40.129

Centers for Disease Control and Prevention. (2022). Sexually transmitted disease surveillance 2021. https://www.cdc.gov/std/statistics/2021/default.htm

Fileborn, B., Lyons, A., Heywood, W., Hinchliff, S., Minichiello, V., Brown, G., … & Crameri, P. (2018). Talking about sex and ageing: Ageing, sexual literacies and the challenge of building an agenda for older gender and sexuality diversity. The Journal of Sex Research, 55(2), 149-162. https://doi.org/10.1080/00224499.2017.1404539

Lindau, S. T., & Gavrilova, N. (2019). Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ, 365, l2222. https://doi.org/10.1136/bmj.l2222

Rosen, R. K., Polzer, K., & O’Neill, J. (2021). Addressing the sexual health needs of older adults: Perspectives from healthcare providers in an urban setting. Sexuality Research and Social Policy, 18(2), 349-362. https://doi.org/10.1007/s13178-020-00462-0

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Population health paper: STIs in the elderly 65+ years old are increasing (min 12 pages/ 12 resources)
This is a theoretical exercise grounded in the literature and population health practices. You are not expected to conduct this in “real life.”
1. Choose a population health problem from a list provided by the instructor. You are welcome to choose a different population health problem as long as the instructor approves it.
2. Clearly identify your population (think small! Don’t solve the world’s problems).
3. Define your goals and objectives to move the population to a healthier existence.
4. Describe your intervention – be mindful of costs including staff needed to conduct the intervention.
5. Identify measurable indicators (i.e., how to measure success), including a minimum of one outcome measure and one process measure.
6. Identify potential challenges and provide strategies to address the challenges

Long Beach Older Adults and STIs: Problems and Solutions
The senior population faces many challenges regarding their health, and one problem that seems to be forgotten about is their ability to still contract sexually transmitted infections (STI). As adults age, additional screenings and tests are required to ensure individuals are remaining healthy, adding to the cost and burden of healthcare as we age. The senior population are no longer in their reproductive years, which relieves the worry of pregnancy during sexual encounters. The problem is that even though there is no risk of pregnancy, there are still risks of very serious STIs. Through additional screening and education, seniors can be more informed of the risks, and be prepared with preventative measures to stop the spread of STIs.
As a general definition, the senior population is described as individuals over the age of 65 years old. Over the past few years, there has been a dramatic increase in STI prevalence in the senior population, showing that STIs have more than doubled in the past 10 years (Smith, 2020). This increase is due to a large volume of individuals in this age group who are looking for new sexual partners due to the loss of a spouse or divorce. These seniors seeking new sexual partners tend to be a bit reckless in regard to practicing safe sex and leave themselves open to potential infection. Seniors living in congregate settings or those recently who are recently widowed or divorced have reported increased sexual activity stemming from a new sense of freedom and openness to sexual experimentation (Smith, 2020).
Additionally, these older adults have been shown to have low levels of STI knowledge, leading to more risky sexual behavior. The less these seniors know, the more likely that they may have misconceptions and inaccuracies in their knowledge. If seniors are unaware of the risks that certain STIs pose, they may be more likely to contract and subsequently pass along these infections. This lack of understanding can be attributed to additional conditions that older adults face, so alternative methods of communication or information should be considered. Continual discussions and education are imperative for seniors understanding, to ensure that they are up to date on the most relevant information. Many common STIs have no side effects and can go unnoticed and untreated if providers aren’t communicating the importance of preventative screenings.
STI’s have varying levels of risk, ranging from infections that can be resolved with a simple antibiotic, to those that will cause lifelong side effects and even increase mortality. Syphilis, gonorrhea, chlamydia, and trichomoniasis are hard to detect because they generally don’ have symptoms but they are generally treatable. While this is good news as these are some of the most highly transmittable diseases, there are a few STIs that are not curable and can lead to many future complications. Herpes (HSV), Hepatitis B (HBV), Human Immunodeficiency Virus (HIV), and Human Papillomavirus (HPV) are not curable and generally have many negative side effects on one’s health. Even though these aren’t curable diseases, there are treatments to help manage the conditions. The sooner these serious infections are identified, treatments can help with unwanted side effects, and also prevent transmission to future sexual partners.
The target population will be seniors residing in the local Long Beach area. Focusing on a small area will provide the bandwidth to test different solutions and create recommendations to be provided on a larger scale. The problem of rising STI infection has been discussed above, and potential solutions will be provided to help this population gain more understanding of the risks and maintain a healthier existence. Screening and education are two of the most important tools that will be utilized, providing accessible information to these seniors. Providers seeing these seniors will be crucial in the education and screening for potential STIs and should become a normal routine screening process for all age groups. Many studies exist discussing sexual health, but a review of these studies shows that seniors are generally not quantified, and studies tend to focus on younger populations (Lyons, 2017).
The goal is to ensure that seniors have access to resources and trusted medical providers who can help them maintain a healthy lifestyle. Providers will be an important partner in providing both education and screenings, as the provider is generally the first point of contact when an individual is experiencing any medical condition. Having a conversation about sexual health is crucial to understanding a patient’s knowledge and risk factors, leaving providers responsible for having this conversation with seniors. Screenings are another important tool that will ensure seniors are regularly checked for STIs, and hopefully decrease the amount of STIs that go untreated. To ensure we achieve our goal of bringing the Long Beach senior population to a healthier existence, providers will need to continually screen for STIs in older adults during their annual wellness exam and provide additional education when necessary.
Screenings are an easy first step to initially testing seniors for possible infections, and alerting physicians when certain seniors need additional referrals to other providers or additional education. Screening for STIs is generally easy and painless and can be screened for by a urine sample and/or blood test. These screenings are generally covered by insurance, and low cost to the member. Creating a baseline will give providers an understanding of where the senior is starting from and help them diagnose any conditions that require further treatment. Early detection of infection can result in less transmission, and also less unwanted side effects from contracted infections. Screening for these infections should be included in the senior’s yearly wellness exam, to ensure that any newly contracted infection isn’t missed.
Studies have shown that many seniors aren’t screened for possible STIs, and that the topic is generally not discussed with their healthcare provider (Slinkard, 2011). This lack of dialogue on the topic is a major barrier to seniors receiving additional information and treatment. Providers should pose questions to seniors regarding their sexual activity and safety and encourage a healthy open conversation. Longevity of provider relationships has shown to have a positive impact on the occurrence of these conversations and can encourage seniors to be more forthcoming about their current circumstances. Through the use of conversational tools, providers can encourage seniors to discuss their sexual activities, and rely of their healthcare provider for guidance and treatments as necessary.
Education and preventative measures should be the front-line resource to ensure that these seniors are staying safe during their sexual encounters. Many resources are currently available, from pamphlets, to counseling, to additional credible websites and books. Providers can provide these resources to seniors, and review to ensure that they understand the potential risks with unsafe sexual behavior. Identifying low levels of STI knowledge can be an important first step in identifying high risk individuals who could benefit from seeing medical professionals who specialize in sexual medicine. These can include providers like social workers, sex educators, and sex therapists (Smith, 2020). These professionals have additional training specifically for sexual medicine and can provide expert care and advice around the topic of safe sex.
With the increased prevalence of behavioral health providers in multidisciplinary settings, these providers can provide additional training and education to primary care providers providing care for older adults. This additional training can provide talking points and increase the likelihood of providers asking older adults about their sexual activity and safety and increase awareness for providers to the risks factors older adults have. Two sexual health history models can be taught to providers, PLISSIT or the 5 P’s model, which will provide skills to facilitate sexual health discussion (Syme, 2017). Many reputable sources of information for seniors also have information about STI health and prevention such as AARP, and the AIDS Community Research Initiative of America. These organizations can provide information to provider offices to be displayed in clinical settings and provided to patients as needed.
The majority of seniors in Long Beach are covered by Medicare, a government funded program for qualified individuals over the age of 65 or with certain chronic conditions or disabilities. Many seniors are unaware that Medicare will reimburse for the cost of yearly STI testing, including testing for HIV. One potential barrier to receiving treatment may be cost, and providing seniors with the information that the cost is covered by Medicare may encourage more seniors to get tested. Additionally, Medicare provides coverage for members to receive behavioral counseling for adults at risk, which can provide additional resources and information to support our seniors. Both of these coverages can encourage Medicare eligibles to seek screenings and treatment, and hopefully lead to earlier detection of infection and provide support to Long Beach Seniors.
Screenings and Education are two useful interventions to help increase awareness and understanding of STI prevalence in older adults. Both of these options are generally low cost and rely on the delineation of information from provider to patient. The screening process is covered by most major commercial insurance carriers, and also by the government sponsored Medicare program. If more providers openly discuss sexual health with seniors, there is a possibility that just by word of mouth the topic can be more openly discussed. Creating an open line of communication would help prioritize the discussion of sexual health with seniors and initiate and facilitate prevention and treatment options as necessary (Syme, 2017).

References
Johnson. (2013). Sexually Transmitted Infections and Older Adults. Journal of Gerontological Nursing, 39(11), 53–60. https://doi.org/10.3928/00989134-20130918-01
Lyons, Heywood, W., Fileborn, B., Minichiello, V., Barrett, C., Brown, G., Hinchliff, S., Malta, S., & Crameri, P. (2017). The Sex, Age, and Me study: recruitment and sampling for a large mixed-methods study of sexual health and relationships in an older Australian population. Culture, Health & Sexuality, 19(9), 1038–1052. https://doi.org/10.1080/13691058.2017.1288268
Morgan, Dyar, C., & Feinstein, B. A. (2023). Differences in infection and prevention of HIV and other sexually transmitted infections among older adults in Columbus, Ohio. PloS One, 18(3), e0282702–e0282702. https://doi.org/10.1371/journal.pone.0282702
Slinkard, & Kazer, M. W. (2011). Older Adults and HIV and STI Screening: The Patient Perspective. Geriatric Nursing (New York), 32(5), 341–349. https://doi.org/10.1016/j.gerinurse.2011.05.002
Smith, Bergeron, C. D., Goltz, H. H., Coffey, T., & Boolani, A. (2020). Sexually Transmitted Infection Knowledge among Older Adults: Psychometrics and Test-Retest Reliability. International Journal of Environmental Research and Public Health, 17(7), 2462–. https://doi.org/10.3390/ijerph17072462
Syme, Cohn, T. J., & Barnack-Tavlaris, J. (2017). A Comparison of Actual and Perceived Sexual Risk Among Older Adults. The Journal of Sex Research, 54(2), 149–160. https://doi.org/10.1080/00224499.2015.1124379

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Intervention
To address the rising STI rates among the elderly population in Long Beach, California, there are several potential interventions that can be implemented. These interventions include education, screening, and support services.

Education: Education is a critical intervention to prevent STI transmission among seniors. Health providers should educate seniors on the risks of contracting STIs, the importance of practicing safe sex, and the various methods of prevention. Additionally, education can also involve improving seniors’ understanding of STI symptoms and the importance of seeking treatment as soon as possible to prevent complications.

Screening: Regular screenings are another important intervention to reduce STI rates among the elderly population. Seniors should be regularly screened for STIs during their annual wellness visits. Providers can also consider recommending additional screenings for those who are sexually active and those who have multiple partners. The screening process should include an explanation of the risks and symptoms of STIs, as well as advice on safe sex practices.

Support Services: Support services can also be implemented to support seniors with STIs. Support services can include counseling and social support groups for seniors who have been diagnosed with an STI. These groups can provide a safe space for seniors to share their experiences, receive emotional support, and learn more about managing their condition. Support services can also involve connecting seniors with resources to help them access affordable treatment options.

Measurable Indicators:
To measure the success of these interventions, it is important to establish measurable indicators. The following are examples of measurable indicators that can be used to evaluate the effectiveness of the proposed interventions:

Outcome Measure:

The percentage of seniors who receive regular STI screenings during their annual wellness visits
The percentage of seniors who have been diagnosed with an STI and receive treatment
The number of new STI cases reported among the elderly population in Long Beach, California
Process Measure:

The number of seniors who attend STI education sessions
The number of seniors who report improved knowledge of STIs after attending an education session
The number of seniors who receive support services after being diagnosed with an STI
Potential Challenges and Strategies to Address the Challenges:
One of the potential challenges with implementing the proposed interventions is the stigma associated with STIs, which can prevent seniors from seeking screenings and treatment. To address this challenge, providers can emphasize the importance of regular screenings and treatment to prevent complications and reduce the spread of STIs. Providers can also work to create a safe and non-judgmental environment for seniors to discuss their sexual health concerns.

Another challenge is the lack of resources and funding to support these interventions. To address this challenge, providers can seek grants or funding from community organizations or government agencies. Providers can also collaborate with other healthcare organizations or community groups to pool resources and share the cost of implementing these interventions.

Lastly, a lack of knowledge and understanding among healthcare providers about STIs in the elderly population may hinder their ability to provide appropriate care. To address this challenge, healthcare providers should receive education and training on the unique needs of the elderly population, including STI prevention and screening. Providers can also collaborate with other healthcare providers and organizations to share best practices and improve knowledge of STI prevention and treatment in the elderly population.

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