Tuesday, April 14, 2015

Older Adults and Sexuality

The majority of my blog posts focus on how I infuse my professional passion for counseling and sexual health in my personal experience as a parent. Today I shift gears, and I give you a glimpse of some of the work I am doing with older adults on the topic of sexual health. 

In 2007, I embarked on a career that would forever change my life. I began working with older adults in low income housing. My work focused on case management, advocacy, increasing self-sufficiency, and reducing early institutionalization (long term nursing care) of older adults. It was love at first sight! How did I not know how incredibly amazing our older adult generation was until now? Working with older adults was the best decision I ever made. I learned older adults are vibrant, energetic, empowered to learn, and full of wisdom. I wanted to fuse my passion for working with adults throughout my career with my practicum placement at Turner Professional Group, therefor I created a graduate project around these two themes.

Throughout this past year I have developed a psycho-educational group entitled, Sexuality and Aging. It’s like Sex Ed 101 for adults 65+. The intent of this assignment was twofold. The first was to empower older adults to start a conversation, and begin communicating thoughts and concerns about sexuality in a safe environment. The second was to provide educational information on sexually transmitted infections, HIV, and AIDS. It wasn’t easy convincing people to let me, a student, come in and discuss the issue of sexuality and aging. I found a fair amount of resistance, further convincing me that SEX is a dirty word (but shouldn’t be!) and the idea that older adults don’t need to learn about sexuality (but they do!). So, after begging and pleading to some extent, I managed to get my program out into the community through a few trusted colleagues. Together we learned that those in attendance really enjoyed talking about sexuality! With my sex positive attitude, I managed bring comprehensive sex ed to three housing communities for older adults.

Where did I begin you ask? A simple Google search brought me to two very important issues. As I began my research I was quickly thrilled to learn that older adults are still getting jiggy with it! Surveys by AARP and the CDC found that older adults continue to have fulfilling sex lives well into their advanced age! With (and often without) medical intervention and simple accommodations to our changing physiology we can engage and maintain a healthy sex life, almost indefinitely. This lead to equally intriguing research in the incredible spread of sexually transmitted infections with this population. So…from these two fun factoids I gave birth to a brief one hour psycho-education presentation on SEXUALITY and AGING! 

I was over the moon when I walked into my first presentation and we had to bring in more chairs! I was particularly excited to have men enter the equation on my second presentation, and boy did they challenge me! Barking up and down my tree tell me a thing or two about sexuality. What is so incredible about working in the community is that you get the thrill of never know who your audience will be. I had a few very highly educated feminists, members of the LGBTQ community, and ultra conservatives, all from a variety of different cultures. Most of these folks came from a generation that did not receive comprehensive sex education and from an era where you didn’t discuss sex. Our society has created a sex-crazed culture, yet a critically silent approach on sex education. We don’t know what we don’t learn…IT’S A CONUNDRUM!

A large part of the presentation with this population was to break the silence. To empower adults to take their sexuality by the reigns and engage in it. So many of our older adults are already isolated, and silence contributes to AGEISM. Ponrat Pakpreo, the author of Medical Evaluation: Why we take a sex history, discloses low rates of sexual health assessment by physicians and other health care professionals. A variety of barriers are admittedly shared by physicals including: time constraints, underestimation of patient risk, lack of information, and embarrassment. These barriers prevent some clinicians from conducting sexual assessments (Pakpreo, 2013). I found this to be true in each of the presentations I gave with older adults. In a nonscientific experiment (show of hands), the majority shared that their primary physician doesn’t asses their sexual health. They admittedly agreed that they too as patients don’t disclose to or ask questions about their sexual needs with their primary care physicians. Empowering older adults to be their own advocate with their doctors was a crucial message to share. 

Building new perspectives on tolerance and respect to gender roles and stereotypes in this population was also an important message.  We dove into all the circles of sexuality…intimacy, sensuality, sexual health/reproduction, sexualization, and sexual identity (Dailey, 1981). With age, many of these can vary with intensity, however they continue to exist. My favorite part of these talks was hearing the love stories they had to share. Loving and losing was a theme that was shared each and every class. I encourage all of those reading this to engage with a parent, grandparent, or older adult about their love story. Their wisdom is worth its weight in gold. 

Informing facts of STI/HIV…
The presentation sought to inform adults 55+ that they are a high at-risk group for sexuality transmitted infections as well as HIV/AIDS. Data from the Centers for Disease Control state that this age is just as at-risk as young Americans. Older adults ages 55+ make up 19% of the populations living with HIV (Centers for Disease Control, 2013). In addition, sexually transmitted infections (STI’s) are on the rise in adults age 50 and over, 50% in fact (Centers for Disease Control and Prevention, 2013). 

We know that adults 80+ years are sexually active and we know sexually transmitted infections are on the rise! What is happening? I will tell you what’s happening…the baby boomers and beyond are physically active, sexually spirited, and bursting at the seams! Truth: less than 1/3 of the surveyed adults used a condom during their most recent sexual encounter (Schick et al. 2010). We are talking about 80% of sexually active older adults not using protection! Many older adults believe the myth that they are exempt from STI’s is wreaking havoc and must be stopped! A fantastic PSA from safersex4seniors.org, provides a very impactful message to free spirited sexually active older adults. See full PSA at this link: https://youtu.be/1Pfa07ijUCE

What I learned…
It was refreshing that I was able to connect current research that tells us that older adults are sexually active, with a unanimous response from my classes that they are also very excited to talk about sex. We are breaking the silence and addressing concerns and issues related to sexuality and answering the health questions and providing resources in order for older adults to get them help them need.
I am happy to report to all my dear readers that despite your age, size, and physical ability, a person’s need for affection, desire, and pleasure extends well into advanced age…to our last breath really. There are hundreds of ways to engage in sex…please remember to increase your safety by using a condom! For help or assistance in safe contraception please contact your doctor or wellness provider. 

Special thank you to Phoenix Family (www.phoenixfamily.org) for their continued support of my work with older adults and allowing me the privilege and trust to present Sexuality and Aging to the following communities: Landmark Towers, Nowlin Hall, and Cathedral Square Towers. 

Atlanta: U.S. Department of Health and Human Services; 2013.
Centers for Disease Control and Prevention. Factsheet: HIV among older adults November
2013. Retrieved at www.cdc.gov/hiv
Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2012.
Dailey, D.M. (1981). Sexual expression and aging in F.J. Berghorn & D.E. Schafer (Eds.). The dynamics of aging: Original essays
on the process and experiences of growing old (pp. 311-330. Boulder, CO; Westview Press.
Fortenberry, J. D. (2010), Sexual Behaviors, Condom Use, and Sexual Health of Americans Over 50: Implications for Sexual
Health Promotion for Older Adults. Journal of Sexual Medicine, 7: 315–329. doi: 10.1111/j.1743-6109.2010.02013.x
Pakpreo, P. (2013, October 1). Medical Education: Why do we take a sex history? Retrieved
November 10, 2014, from http://virtualmentor.ama-assn.org/2005/10/pdf/medu1-0510.pdf
Schick, V., Herbenick, D., Reece, M., Sanders, S. A., Dodge, B., Middlestadt, S. E. and