D588 Task 1 Sexual Health Promotion Strategy Example

Nobody Asks, So Nobody Tells: Rising Sexually Transmitted Infections Among Adults 55 and Older in a Composite Retirement County, and a Strategy Built With Senior Services

Student Name

Leavitt School of Health, Western Governors University

D588: Human Sexuality, Task 1

Course Instructor

Month Day, Year

Nobody Asks, So Nobody Tells: Rising Sexually Transmitted Infections Among Adults 55 and Older in a Composite Retirement County, and a Strategy Built With Senior Services

The Issue

Lakeland County is a composite county of about 160,000 people, a third of them 55 or older, with several large retirement communities. Over five years, reported cases of chlamydia, gonorrhea and syphilis among residents 55 and older rose by about 60%, far faster than among younger adults. Sexual health programs in the county, like most in the country, are designed for teenagers and young adults. Older adults see no messages aimed at them, and many clinicians never raise the subject. This paper examines the biological, social, cultural and psychological aspects of the problem, analyzes the behaviors that raise or lower risk and develops a prevention strategy.

Older Adults Are Sexually Active

The starting point is a fact public health programs often ignore. In a national probability sample of older Americans, 73% of those aged 57 to 64, 53% of those aged 65 to 74 and 26% of those aged 75 to 85 reported sexual activity in the previous year, and only 38% of men and 22% of women reported having discussed sex with a physician since age 50 (Lindau et al., 2007). A population that is sexually active but rarely asked about its sexual health is a population at risk of preventable infection.

Biological Factors

Aging changes the body in ways that affect risk. After menopause, thinner and drier vaginal tissue tears more easily during sex, which can make transmission of infections more likely. Immune function declines with age. Medications for erectile dysfunction, widely available since the late 1990s, have extended sexual activity for many men. At the same time, pregnancy is no longer possible for older women, which removes the reason many couples once had for using condoms.

Social, Cultural and Psychological Factors

Social change matters as much as biology. Divorce and widowhood return many older adults to dating, often after decades in one relationship, and dating apps and retirement communities create new social networks. In a study of more than 420,000 older married couples on Medicare, widowhood was associated with an increased risk of a sexually transmitted infection diagnosis for men, with the largest effect six months to a year after a wife's death and a larger effect after erectile dysfunction medication became available (Smith & Christakis, 2009).

Culture shapes what people say. Many of today's older adults grew up when sex was not discussed openly and sexual health education focused on preventing pregnancy. Ageist assumptions that older people are not sexual lead clinicians to skip the sexual history, and older patients rarely raise it themselves.

Psychology completes the picture. Embarrassment, loneliness and the belief that infections affect only the young lower perceived risk. Knowledge is often limited: in a study of adults aged 65 to 94, participants answered on average only about 11 of 27 questions on a standard sexually transmitted infection knowledge test correctly (Smith et al., 2020).

Behaviors That Raise and Lower Risk

The behaviors that raise risk are familiar ones in a new context: having new partners after years of monogamy, not using condoms, not being tested and not telling partners about an infection. The behaviors that lower risk are equally familiar: using condoms with new partners, getting tested before or early in a new relationship and talking about sexual history. The difference with older adults is that none of these behaviors is encouraged by the people or institutions they trust, and some older adults have never been taught how to use a condom or where to be tested.

Prevention Strategy

The strategy, called Still Dating, Still Healthy, is built with the county's area agency on aging, senior centers, retirement community activity directors and primary care practices, because those are the settings older adults already trust.

Component 1: peer-led workshops. Trained volunteers aged 60 and older lead 90-minute workshops at senior centers and retirement communities on dating after loss, sexually transmitted infections, condom use and testing, using plain, respectful language and humor where it helps.

Component 2: clinician prompts. Primary care practices add a brief sexual health question to the Medicare annual wellness visit template, so every older patient is asked whether they have a new partner and offered testing when appropriate.

Component 3: access. Free condoms and lubricant are placed discreetly in senior center restrooms and retirement community wellness rooms, and the health department holds quarterly confidential testing days at senior health fairs.

Component 4: messages. Brochures and local newspaper and radio pieces use images of people their own age and focus on staying healthy in new relationships rather than on fear.

Why the Strategy Fits This Population

Each component answers a cause identified above. Peer leaders address the cultural silence, because older adults are more likely to talk openly with someone of their own generation than with a young educator. Clinician prompts address the finding that most older patients have never discussed sex with a physician, and they place the conversation in a routine visit where it seems normal rather than alarming. Free supplies and testing days address access and embarrassment by putting help where people already go. The positive framing of the messages addresses the psychological barriers of shame and low perceived risk without lecturing.

The strategy also respects autonomy. Its aim is not to discourage older adults from dating or intimacy, which contribute to well-being, but to help them enjoy new relationships safely. Staff and volunteers will be trained to use inclusive language that fits people of every sexual orientation and relationship history, since older gay, lesbian and bisexual adults are often doubly invisible in both aging services and sexual health programs.

Evaluation

The workshops will measure knowledge before and after with the same standard knowledge questionnaire used in research with older adults. Practices will report the share of annual wellness visits that include a sexual health question, with a target of 60% within a year. The health department will track testing among residents 55 and older and, over three years, reported infections in that age group. Participant feedback will guide revisions to the workshops and messages.

References

Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O'Muircheartaigh, C. A., & Waite, L. J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357(8), 762-774. https://doi.org/10.1056/NEJMoa067423

Smith, K. P., & Christakis, N. A. (2009). Association between widowhood and risk of diagnosis with a sexually transmitted infection in older adults. American Journal of Public Health, 99(11), 2055-2062. https://doi.org/10.2105/AJPH.2009.160119

Smith, M. L., 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