Sex and seniors: A perspective

Baby boomers are the large group of individuals born between 1946 and 1965. In Canada, for the first time, this group comprises a larger percentage of the population (with 16.12% being 65 years and older) compared to youth less than 14 years of age (16.04% of our population). This trend is expected to continue into the mid-2030s, when it is projected that up to 25% of the population will be 65 years and older.¹ Baby boomers are the first generation to experience educational, employment and welfare services that are better than those experienced by the generations before them, and they expect that these services – with their associated economic and social costs – will continue to be available to them into their retirement.¹ From a health perspective, the aging of this cohort will likely introduce new demands on the health care system, including the need for more long-term care facilities, health care workers, and age-related specialty services. The coinciding exit of baby boomers from the working population could result in a smaller tax base to support these increasing demands.

Baby boomers have also experienced improved health care benefits compared to previous generations, as a result of immunization, antibiotics, improved diagnostic procedures, pharmacological and surgical therapies, and access to oral contraceptives during their productive years. These advances have allowed them to have longer, healthier, more active lives.^2–4 Consequently, the current generation of boomers are more active into their 60s than previous generations were when they were in their 40s.⁵

Along with better health and active aging comes sex! A nationally representative sample of 3,005 Americans between 57 and 85 years of age revealed that nearly three quarters of seniors aged 57 to 64 were sexually active; while more than half of seniors aged 65 to 74 and more than a quarter aged 75 to 85 reported being sexually active.⁶

This increased activity has also led to increases in drug use and sexually transmitted infections (STIs).^4,7,8  A study in the UK demonstrated that the rates of chlamydia, genital herpes, genital warts, gonorrhoea and syphilis infections are rising among those aged 45 years and older, while in the US, persons aged 50 and over accounted for 15% of new HIV/AIDS diagnoses and 24% of persons living with HIV.⁸ Of interest, a recent US study showed that the risk of STIs were higher among recently widowed men compared to recently widowed women in the age group 67 to 99 years.⁹

The elevated rate of sexual activity coupled with the increasing rates of STIs may be surprising to some, as common thinking is that sexual activity and desires gradually diminish with age. Thus, one would expect to see a lower risk of STIs.¹⁰ Pharmacological advances such as Viagra, Cialis and Levitra, as well as progesterone and estrogen products, however, have led to increased sexual activity later in life, which has led to the increased spread of STIs among this age group.^33,9 The latter situation is likely exacerbated by the fact that infections are more common in those of advancing age due to deteriorating immunity. As well, since STIs may be asymptomatic for longer periods, diagnosis and treatment may be delayed, resulting in an increased likelihood of spread of these infections in the interim.³ Further, seniors are now more likely to gather and socialize in retirement communities, assisted living facilities, and nursing homes than previously, which can indirectly contribute to this spread.⁴

Responses to this issue are for the most part ill structured as the potential risk of infection is often ignored, largely due to the incorrect assumptions about sexuality and sexual health among the elderly. These assumptions exist even though intimacy, and sexual expression and activity are integral parts of the human experience, and are essential components of healthy living, regardless of age, disease or disability.^11,12

Meanwhile, this older population group has been excluded from over two thirds (73%) of clinical trials related to STIs,^13,14 and there is an overall lack of health education programs that target seniors.⁸ Physicians have been shown to avoid discussing the subject of STIs with senior patients, unless the case is obvious.^3,10,11 As physicians and health care professionals are the preferred source of health information, their approach will influence healthy sexual practices. These messages, however, have to be discussed sensitively. A review of behavioural interventions for older adults with HIV found that it was particularly difficult to convey sexual safety information to older women.¹³ This review also noted that behavioural sexual educational programs specifically targeting an older age group showed promising results.

The transforming demographics and changing lifestyles, coupled with human nature, are resulting in a need for effective and integrated approaches to health care and health communication with seniors. The problem is not that seniors are healthy and highly active, but that there is a lack of awareness, risk perception, and preventive strategies for safe sex among seniors.^15,16 Preventive and screening measures for STIs that generally target younger and middle-aged populations need to be refined and extended to include seniors. Furthermore, it is important that the societal norms around aging and sexuality change.