Sex, sex and more sex. Lately it seems wherever I go (speaking event, supermarket, funeral etc.) I get asked questions about seniors having sex. In honor of the Center for Disease Control (CDC) having designated April "STD Awareness Month" I'll share a relevant experience from a recent PTA sponsored social gathering at my daughter's school.
As unfamiliar parents meet each other and search for something of common interest to talk about the question of "what do you do for a living" frequently comes up. In my case a detailed and accurate answer would be: "I'm the author of a well-respected book on eldercare, a consultant, speaker, business owner and advocate for the elderly". But, saying all of that sounds pompous (and simply takes too long). So normally I just say "I'm in the eldercare space". Usually, the conversation goes one of two ways after that. Either, the person immediately tells me about their personal eldercare challenges-which is a fairly common response since 1 in 3 U.S. adults is a caregiver to an elderly person, or their eyes glaze over and they immediately change the topic. This time, I received a response that fit squarely into the first category.
The gentleman immediately started telling me about how his favorite 86 year old uncle (Dominic) was the main topic of conversation at "damn near every holiday family gathering" because he contracted an STD while living in an Alabama nursing home. The guy became so animated while recounting various family member's perspectives that it became difficult to determine when he was angry and when he was amused. Either way, his retelling of the family's ideas regarding how Uncle Dominic got an STD made this the best PTA event EVER!!! My two favorite theories (and there were many others) were: 1) that some "diseased young nursing home worker" had her way with "good ole Dominic" or 2) that some "idiot doctor" got it all wrong because Dominic is 86 years old, was "clean" when he moved in, and hadn't left the facility (except for family gatherings)-consequently, he was must be suffering from something else and is STD free. His colorfully detailed, profanity laced retelling of all the theories were so funny I could barely bring myself to tell him that they were all likely wrong (or at least not fully informed). Eventually, my professionalism overwhelmed my desire to keep laughing and I explained the realities of seniors and STDs
STD transmission among the elderly is unfortunately a common and growing problem. For example, between 2007 and 2011, chlamydia infections among Americans 65 and over increased by 31 percent, and syphilis by 52 percent. Most caregivers are surprised because they never imaged sexually transmitted diseases to be one of the many issues they could encounter when caring for an elderly loved one. After hearing the bad news the caregiver's first question is usually "how did this happen"?
The high-level answer is older men take potent little pills to help with erectile dysfunction coupled with (pun intended) post-menopausal older women, with no pregnancy concerns, using progesterone and estrogen creams that help arouse them and makes sex more enjoyable for them. This combination of factors adds up to a whole lot of unprotected sex. In fact, what goes on in nursing homes, assisted living facilities or other large residential congregations of elderly people is a lot closer to what goes on in spring break hotels than most people would ever imagine. With lots of sex comes the possibilities of lots of STDs. The reality is your college-aged daughter on spring break and your grandmother in the nursing home should each be equally worried about catching chlamydia from the guy (or the grandfather) next door.
Seniors across the board are contracting STDs at an alarming rate and the STDs cover the same spectrum as younger people. Everything from syphilis (see above) to HIV (in 2013, people aged 50 and over accounted for 27% HIV diagnoses in the United States). Professionals within the eldercare industry are now more frequently and openly discussing the problem and the reasons for it.
While the numbers are commonly accepted, the exact reasons for the high infection rates are open to discussion. Personally, like most things involving humans and sex, I think the truth is multifaceted. Overall, seniors' lack of recognition that a problem exist gives rise (really bad pun intended) to situations that allow diseases to be contracted or shared. A more detailed examination runs the gamut from the simple to the complex:
• Men using E.D. drugs plus post-menopausal women (without fear of pregnancy) equals unprotected risky sex
• Significantly fewer older men are available, so women in an effort to please (an keep) a partner have risky unprotected sex
• Older people are now using on-line dating and thus are relatively unfamiliar with their partners and their sexual histories
• Many of today's "Baby Boomers" came to maturity during the sexual revolution of the 1960s/1970s and are now reverting back to their previous risky sexual behavior
• A lot of seniors were already married when sex education gained prominence and therefore missed the "safe sex" talks and never learned "safe sex etiquette"
• As people age their immune systems tend to weaken making them more susceptible to contracting ANY disease - including STDs
• Seniors because of embarrassment are less likely to discuss sexual issues with their doctors - which can further lead to the spread of STDs
• Many doctors don't think to test seniors for STDs as a standard examination protocol.
Individually or in combination, the reasons above can lead to the spread of STDs amongst seniors. In the short term, what's more important than why STDs are spreading is what needs to be done to slow or stop the progression. Here are a few quick thoughts:
• Seniors should be getting the same basic "safe sex" education as young people (learning about STDs and how to recognize the signs, how they can complicate other existing chronic medical conditions, and most importantly the importance-and proper use of-condoms)
• Doctor's should inquire about sexual activity with seniors as they do with teenagers and younger adults.
• Information of detection and treatment options need to be well publicized (ex: Medicare provides free STD screenings and low cost treatments)
• Distribute free condoms in places where seniors live and congregate
Whatever the reason or the chosen solution, the critical first step is having a conversation with your loved one and educating them on the dangers of having unprotected sex.
As interesting as the conversation was at the PTA event, from experience the "you must use condoms" conversation with Uncle Dominic is going to be that and then some. Whomever, engages him will have to first get over their embarrassment and then help him get over his. No matter the difficulties, the caregiver must have the conversation. This discussion is arguably even more important for seniors than it is for kids given the elderly's weakened immune systems and the possibility of STDs complicating other previously existing medical conditions. Better Uncle Dominic hears the cold realities of sex in the new millennium then he fall victim to his lack of knowledge and a grandma with a cute smile.
Derrick Y. McDaniel
"Mr. Eldercare 101"
Author of "Eldercare, The Essential Guide To Caring For Your Loved One And Yourself" is a professional Speaker, Consultant, and Advocate for the Elderly.