‘That might be a bit sexy for somebody your age’: Older adult sexual health conversations in primary care

Bacterial vaginosis after menopause: factors associated and women's experiences: a cross-sectional study of Australian postmenopausal women

Background Bacterial vaginosis (BV) is the most common cause of vaginal discharge in reproductive age women; however, little is known about it after menopause. We aimed to learn more about BV in Australian postmenopausal women. Methods We conducted an online survey (July-September 2021). Participants were recruited via social media and professional networks and asked about demographic characteristics, sexual history and BV experiences. Outcomes of interest were the proportion who had heard of BV, had BV ever, or had BV after menopause. Factors associated with these outcomes were assessed using logistic regression. Results Of 906 participants, 83% were included in the analysis. Overall, 37.9% had heard of BV, 11.0% reported having a BV diagnosis ever, 6.3% reported having a BV diagnosis after menopause and 4.4% reported having a BV diagnosis only after menopause. Multivariable analysis found that among all women the odds of having a BV diagnosis after menopause were increased for those who had BV before menopause, had douched in the past 12months, or had a previous STI diagnosis. Among those in a sexual relationship, a BV diagnosis after menopause was associated with a BV diagnosis before menopause, or being in a sexual relationship of 5years or less in duration. About half who reported BV after menopause described recurrences, distress, and a detrimental effect on sexual relationships. Conclusions BV in postmenopausal women is associated with sexual activity, and impacts negatively on their lives. Research into BV should not be limited to reproductive age women.

Engaging older Australians in sexual health research: SHAPE2 survey recruitment and sample

BACKGROUND

Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar 'Sex, Age and Me' study from 2015.

METHODS

We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook.

RESULTS

The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60-92years (median 69years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means.

CONCLUSIONS

Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

The rules of mature sex: Sexual scripts and the global challenge of rising STIs

Sexual health continues to be a socially complex problem globally with rising rates of sexually transmitted infections (STIs) despite extensive government and health marketing initiatives. In particular, STIs are rising at a greater rate in mature consumers than any other age group with the main reason cited as lack of condom use. The rules around condom use are based on sexual scripts or internalised guidelines and thus a key step in developing social marketing initiatives to increase condom use and address this global challenge is identifying the sexual scripts that motivate and inhibit condom use by mature consumers. Using sexual script theory, this research involves interviews with 24 mature single heterosexual Australian consumers to identify the sexual scripts that can be leveraged in health marketing to address the grand challenge of increasing mature consumer participation in protective sexual health behaviours.

A Systematic Review on Psychological Interventions for Sexual Health in Older Age

Objectives

The present review aims to identify the existing evidence on outcome-treatment studies of psychological sexual health interventions in older age.

Methods

A systematic search was conducted for studies published until October 2022. Data search was conducted on EBSCO, MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials databases.

Results

From 30,840 screened records, 12 reports were selected. Results were grouped into four categories according to the intervention that was implemented.

Conclusions

Despite results presenting some bias concerns, this review suggests that educational and cognitive-behavioral approaches seem to be effective for promoting sexual health in older age.

Barriers and facilitators to accessing sexual health services for older LGBTQIA+ adults: a global scoping review and qualitative evidence synthesis

The number of older adults identifying as lesbian, gay, bisexual, transgender and other sexual and gender diverse identities (LGBTQIA+) is growing as populations age and social environments become more accepting. This study uses a global evidence synthesis to understand perceived barriers and facilitators to access to sexual healthcare globally for older LGBTQIA+ adults. We used a scoping review and qualitative evidence synthesis. Embase, PubMed and PsycInfo were searched with terms related to LGBTQIA+ populations, adults aged 45years, and sexual health care. We used the Cochrane Handbook and the review protocol was registered. Primary and secondary textual data were coded and grouped into themes using PRISMA-SCR and the Minority Stress Model. The certainty of review findings was assessed using the GRADE-CERQual approach. We identified 19 studies and 15 were included in the qualitative evidence synthesis. All studies were from high-income countries. Heterocentricity and male-centricity of sexual healthcare services contributed to feelings of exclusion for older LGBTQIA+ adults. Both anticipated and enacted stigma from healthcare providers resulted in older LGBTQIA+ adults, especially those with chronic conditions, avoiding health services (seven studies each, low certainty). Older LGBTQIA+ adults have unique sexual health needs and may feel their age empowers them to access appropriate care (four studies, low certainty). This review highlights the need for additional research and interventions to improve sexual health services for older LGBTQIA+ adults. Practical strategies to make sexual health less heterocentric (e.g. gender neutral signage) may increase uptake of essential sexual health services.

Sexualidade como fator associado à qualidade de vida da pessoa idosa

Resumo Objetivo analisar a associação entre as vivências em sexualidade com as variáveis biossociodemográficas e a qualidade de vida de pessoas idosas. Métodos estudo transversal, desenvolvido com 1.922 pessoas idosas brasileiras, cujos dados foram coletados por meio de web survey. Utilizaram-se três instrumentos para a obtenção dos dados biossociodemográficos, da sexualidade e da qualidade de vida. A análise foi realizada com os testes de Mann-Whitney, Kruskal-Wallis, correlação de Spearman e regressão linear multivariada, com método de entrada “inserir”, adotando Intervalo de Confiança de 95%. Resultados a avaliação geral da sexualidade esteve associada fortemente com estado civil (p<0,001); religião (p=0,001); não ter filhos (p<0,001); orientação sexual (p=0,008) e recebimento de orientações sobre sexualidade pelos profissionais de saúde (p=0,002). A sexualidade correlacionou-se de forma positiva e com diferentes magnitudes com todas as facetas de qualidade de vida (p<0,001). A análise de regressão demonstrou que todas as dimensões da sexualidade permaneceram associadas, positivamente, com qualidade de vida: ato sexual [β=0,154; IC95%=0,083-0,225; p<0,001]; relações afetivas [β=0,335; IC95%=0,263-0,407; p<0,001] e adversidades física e social [β=1,388; IC95%=1,206-1,571; p<0,001]. Conclusão e implicações para a prática: a sexualidade associou-se, significativamente, com algumas variáveis biossociodemográficas e esteve correlacionada, positivamente, com a qualidade de vida das pessoas idosas investigadas.

Sexuality as a factor associated with the quality of life of the elderly

Abstract Objective to analyze the association between experiences of sexuality with bio-socio-demographic variables and quality of life of elderly people. Methods cross-sectional study, developed with 1,922 Brazilian elderly people, whose data were collected through a web survey. Three instruments were used to obtain bio-socio-demographic data, sexuality and quality of life. The analysis was carried out with the Mann-Whitney, Kruskal-Wallis, Spearman correlation and multivariate linear regression tests, with the “insert” input method, adopting a 95% confidence interval. Results the overall assessment of sexuality was strongly associated with marital status (p<0.001); religion (p=0.001); not having children (p<0.001); sexual orientation (p=0.008) and receiving guidance on sexuality from health professionals (p=0.002). Sexuality correlated positively and with different magnitudes with all facets of quality of life (p<0.001). Regression analysis demonstrated that all dimensions of sexuality remained positively associated with quality of life: sexual act [β=0.154; 95%CI=0.083-0.225; p<0.001]; affective relationships [β=0.335; 95%CI=0.263-0.407; p<0.001] and physical and social adversity [β=1.388; 95%CI=1.206-1.571; p<0.001]. Conclusion and implications for practice sexuality was significantly associated with some bio-socio-demographic variables and positively correlated with the quality of life of the elderly people investigated.

Tailoring Sexual Health Interventions for Middle-Aged and Older Adults, Including Vulnerable Populations: A Scoping Review

Objective

This scoping review aims to synthesize existing literature on good practice in sexual health interventions for adults over 45 years and in vulnerable groups.

Methods

Using PRISMA-ScR guidelines, search terms focused on sexual health, good practice, and vulnerable groups, in over-45s.

Results

Of the nine studies that met the inclusion criteria, seven were focused on HIV and risk reduction. Use of alternative methods of communication, alongside inclusion of behavioral and cognitive measures such as condom use and perceived stigma, was key to tailoring interventions.

Conclusions

This review highlights the imperative for further research on sexual health interventions with these overlooked populations.

Social Cognitive Theory as a Theoretical Framework to Predict Sexual Risk Behaviors among Older Adults

OBJECTIVES

Older adults vary in their safe and unsafe sexual behaviors. While researchers are beginning to understand more about the sexual and intimate expression of older adults, only recently are they beginning to understand how older adults make decisions about sexual risk. Bandura's social cognitive theory offers a frame for understanding how self-efficacy, environmental factors, and goal motivation are related to sexual risk behaviors for older adults, including the interplay between these variables.

METHODS

Using a diverse sample of older adults (n = 720) age 50+ years, social cognitive theory was modeled to determine the relationship between environment variables (age, gender, and sexual health conversations with practitioners), behavioral variables (self-efficacy), and cognitive variables (importance of sexual wellness goals) with the outcome variable of sexual risk behaviors.

RESULTS

Self-efficacy had an indirect effect on sexual risk via sexual wellness goal motivation. Healthcare provider conversations had both direct and indirect effects on older adults' sexual risk through sexual wellness goal motivation. Models were similarly predictive for older men and women.

CONCLUSIONS

Sexual risk behaviors among older adults are more influenced by environmental factors in their healthcare settings and their perception and prioritization of sexual wellness goals.

CLINICAL IMPLICATIONS

Providers play a key role in initiating and maintaining sexual health discussions with older patients, potentially mitigating sexual risk and bolstering self-efficacy.

"It Just Hit Me Like a Ton of Bricks": Improving the Patient Experience of Receiving a Breast Cancer Diagnosis at an Older Age

The purpose of the current study was to describe the experiences of older women receiving a diagnosis of early-stage breast cancer. Thematic analysis informed by techniques from constructivist grounded theory was used to analyze interviews with 54 women aged ≥65 years an average of 19.6 months after diagnosis. Two themes were identified: The Overwhelming Shock of Receiving a Diagnosis and Contextualizing the Diagnosis in Relation to Age. Results suggest these participants were deeply shocked by a diagnosis that clinicians may view as highly treatable. Age-related factors impacting how the bad news was received include misunderstanding risk factors, the impact of comorbidities, concurrent life events, and evolving perceptions of cancer at her life stage. To establish a solid foundation for age-appropriate communication when giving bad news, these participants help clinicians acknowledge what women may be thinking. Potential clinician responses to the variety of concerns are presented. [Research in Gerontological Nursing, 14(2), 79-89.].

Do we need to worry about sexually transmissible infections (STIs) in older women in Australia? An investigation of STI trends between 2000 and 2018

Background This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018.

METHODS

Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55-64 and 65-74 years) and two younger groups (15-24 and 25-34 years). Poisson regression examined trends for 2000-18 and 2014-18 separately.

RESULTS

Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55-64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02-1.10] and declined in those aged 15-24 years (IRR = 0.99; 95%CI: 0.99-0.99). Gonorrhoea rates increased the most among those aged 65-74 years (IRR = 1.47; 95%CI: 1.23-1.77) and least in those aged 15-24 years (IRR = 1.12; 95%CI: 1.10-1.13). Syphilis rates increased the most among those aged 55-64 years (IRR = 1.58; 95%CI: 1.25-1.99) and least in those aged 15-24 years (IRR = 1.29; 95%CI: 1.23-1.35). Chlamydia test positivity declined among younger women but remained stable in older women.

CONCLUSIONS

In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.