1. STIs (sexually transmitted infections) in the geriatric population
Jean Harken, Morgan Howe, Erin Ludwick

2. Problem Statement / Nursing Diagnosis
Sexually Transmitted infections are a problem among the elderly population, related to difficulty understanding the diseases and transmission process as evidence by an increase number of elderly patients being diagnosed and treated with sexually transmitted infections.

3. Risk / Problem
Sexually transmitted infections can be troubling for someone at any age for a person that is sexually active
Sexually transmitted infections can happen to anyone that participates in unsafe or unprotected practices that involves intimate person to person contact with the exchange of any bodily fluid, such as blood, semen or vaginal fluids.
Anyone could be a carrier of an STI, even those that look perfectly healthy, and no symptoms need to be present to pass on the infection.
It doesn’t matter if you are young, at your sexual peek or barely walking. If you are engaging in any type of sexual activity without any type of protection, you are at risk of contracting a STI. Many people are still under the impression that if there is no penetration of some type then they can not contract an STI. This is not the case at all. By coming in contact with the bodily fluids of any other individual whether is be vaginally, rectally or orally, you could be exposed to an STI.

4. Community / Target Group
It is not often that the elderly population is thought about when talking about sexually transmitted infections
The elderly population has an increasing number of STI’s
The group being examined is the population over the age of 65 that are currently sexually active
The Specific group being looked at is the elderly population of Kent County
People do not often think about the elderly population when talking about STI’s. In the age group of 65 and over, there is an increase in STI’s.

5. Related to:
Not regularly being screened for potential sexual problems that can go on for years
Women have less elasticity in their vaginal tissue after menopause that can cause micro tears leading to a area that the infections can enter
Many elderly people do not use condoms due to lack of education of STI’s and they do not consider themselves at risk
The elderly are more immunocompromised putting themselves at greater risk of STI’s
This population believes that STI’s can not happen to them so they do not regularly get screen or checked for STIs. Often times lesions or other symptoms of STIs can get ignored for a great length of time therefore they are not treated. If that person is sexually active, the infection then becomes passed on to any partner that they come in contact with. This population was not educated well on the use of condoms and protecting yourself, therefore they do not often times use condoms or any other type of protection.

6. Analysis of Data

7. Demonstrated By:
Rates of STI’s among the elderly increasing over the last several years
People living longer and enjoying sexual relationships for a longer amount of time
Increase rate of Chlamydia of over 17% between in people age 65 and older
Increase amount of people 65 and older being diagnosed with Gonorrhea
85% of men and 61% of women 65 and over state that a healthy sex life (sex at least once a week) was important to them
With the assistance of erectile dysfunction medications for both men and women, people are experiencing the enjoyment of sexual intercourse for many more years than they could previously. Many people believe that a healthy sex life is partly what keeps them young. Although it is not thought about as much among the elderly population, infidelity remain to be a problem. Many of these people whether married or single admit to having more than one sexual partner in a years time frame.

8. Sexually Transmitted Infections
With more than 25 infectious organisms, sexually transmitted infections (STIs) are behavior-linked diseases that result from having unprotected sex. STIs are harmful to the body and may often cause costly and possibly irreversible damage to reproductive health. Untreated, STIs can also cause chronic diseases such as cancer.
(Kent County Health Department, 2005)

9. STIs in the Elderly
STIs do not discriminate by age and seniors are at even greater risk due to certain practices that increases the chances of an infection. These infections often go undiagnosed for extensive periods of time due to either embarrassment to seek medical attention or lack of awareness of the serious nature of some of the symptoms.
(Seniorhealth365.com, 2012)
People can become infected with an STI at any age, and are at greater risk of contracting an STI if safe sex practices are not utilized. Many people poses symptoms and are not seen by a physician due to embarrassment, denial, or lack of awareness of the symptoms

10. Michigan Statistics
Syphilis: 20.9% of recorded cases are from both males and females over the age of 45
Gonorrhea: 4.2% of recorded cases are from both males and females over the age of 45
Chlamydia: 1.4% of recorded cases are from both males and females over the age of 45
HIV: 70% of recorded cases are due to unprotected sex (both male-male and male-female). 29% of persons diagnosed with HIV were 40 years and older.
(Michigan Department of Community Health, 2014 a)

11. U.S. Statistics
Syphilis rates increased by 2.5% and chlamydia rates increased by 3% in adults aged years in a ten-year span
9% of gonorrhea cases and 3% of chlamydia cases are found in males and females over the age of 40
85% of men and 61% of women said sex was important in their lives, yet only 12% of men and 36% of women used protection when having sex
(Boyles, 2012)
(CDC, 2012)

12. Kent County Statistics
Kent County had a higher than average rate of chlamydia (national average per 100,000; county average per 100,000)
Kent County had a lower than average rate of HIV (national average per 100,000; county average per 100,000)
Kent County had a slightly lower than average rate of gonorrhea (national average per 100,000; county average per 100,000)
(findthebest.com, 2014)
In Kent County, cases of Chlamydia are higher than the national average, with gonorrhea and HIV being slightly lower than the national averages

13. Kent County Statistics (continued)
6,568 clinic visits for HIV or STI
4,604 HIV tests with 23 positive results;
101 ambassadors recruited others to get HIV tested
34 off-site outreach and counseling venues
.(Kent County Health Department, 2012, p. 11)

14. Existing Programs
The Kent County Health Department engaged in social network strategies for targeted outreach and increase testing for high risk populations
 There is a lack of programs directed towards older adults, particularly the elderly
(Kent County Health Department, 2012, p. 11)

15. Accurate Sexual History
Obtaining an accurate sexual history is an important responsibility of the nurse.
It is the nurses responsibility to develop a trusting relationship with the patient to be able to obtain an accurate sexual history. This is done over time during the patients visit to either the doctors office or a mobile clinic. To help develop a trusting relationship the nurse should introduce herself/hiself and be attentive to the patient. While obtaining the sexual history the nurse must be mindful of sex practices that include other body parts and not only the genitals (Letvak, Schoder, 1996).

16. Interventions Accurate sexual history Safe sex practices
Regular STI screening
Prevention education
Encourage communication between patient and partner
Further research on STIs in the elderly

17. Safe Sex Practices Use of latex condoms
Limit the number of sexual partners
Other forms of intimacy
How to use condoms correctly
The nurse should provide education to the patient on safe sex practices. This can be done after obtaining the sexual history. The elderly patient may not have a clear understanding of safe sex practices (Letvak, Schoder, 1996) so providing the patient with information on the risks associated with not using condoms, how to properly don a condom as well as the difference in the various types of condoms. The nurse should also inform the patient that to reduce their risk of contracting an STI they should limit the number of partners they have. Other forms of intimacy should be discussed as well. These include cuddling, massage, and mutual masturbation. These activities limit the exchange of bodily fluids reducing the patients risk of contracting an STI (Letvak, Schoder, 1996).

18. Regular STI screening What is involved in the screening
When it should be done
The nurse should encourage the sexually active elderly patient to get regular STI screenings. These should be done with the annual physical and any time the patient participates in sex without a condom or when the condom breaks. The nurse should explain that most STI screenings are done with a simple blood test while others require samples to be obtained and how these samples are obtained. The nurse should explain that test may include a physical exam, a urine sample, any discharge or fluid sample, and a blood sample (itsyoursexlife.com, n.d.).

19. Prevention Education Limiting the number of partners
Using latex condoms and doilies
Celibacy
The CDC(2014) states that primary prevention includes changing high risk sex behaviors and treatment of other STIs due to the risk of transmission to others. The nurse must educate the elderly patient that the best ways to prevent STI transmission is to either abstain from sex, be in a long-term monogamous relationship with an uninfected person and correctly and consistently use latex condoms (Mayo Clinic, 2014). According to the National Survey of Sexual Health and Behavior, only 6 percent of seniors aged 61 and up use condoms in sexual encounters (International Business Times, 2014). The nurse can provide education on prevention during visits to their physician and should be given written information to take home and review. According to the Cochrane Collaboration (2008) verbal and written information greatly increased patient knowledge.

20. Encourage communication between patient and their partner(s)
Communicate
Wait and verify
Don’t have anonymous casual sex
Encouraging the sexually active elderly patient to communicate with their partners will assist in reducing their risk of STIs. The patient should communicate with their partners about getting STI tested before they become sexually active, and about condom use (Mayo Clinic, 2014). The nurse should encourage the patient to avoid anonymous sex due to its high risk of STIs.

21. Further research studies
Limited information
More research needed
There is limited research studies on the elderly and STIs. Boyles (2012) states, “the factors [contributing] to the rising STI rate in this age group is not clear…because very few researchers have studied this issue” (n.p.). The nurse can take on many roles in research studies. According to Nieswadomy (2012) it is the responsibility of all nurses regardless of their degree to identify areas requiring research.

22. Evaluation of Interventions

23. Desired Outcomes Decrease in STI prevalence among target population
Increase reporting of safe sex practices from target population
A decrease in the prevalence of STIs among the elderly would support the effectiveness of interventions. Elderly patients reporting safe sex practices such as regular condom use during doctor visits supports the interventions efficacy.

24. Length of Time for Desired Outcomes
1 month to
1 year
In Kent County a monthly communicable disease report is issued. If the interventions are effective it could be as soon as one or two months for the desired outcomes begin to show (Kent County Health Department, 2001).
The state of Michigan issues a communicable disease report annually. This report is for the entire state. Health care professionals are required to report cases of communicable diseases between 24 hours and 7 days depending on the disease. The Michigan Disease Surveillance System is a web based communicable disease reporting site to allow easy reporting by clinicians (Michigan Department of Community Health, 2014).

25. Interim Monitoring Patient self reporting
Asking the patient about their sexual history and current sexual behavior can provide some insight as to whether the interventions provided are being effective between implementation and government reporting.

26. Measure to Track STIs in Kent County monthly report
STIs in Michigan annual report
Sexually transmitted diseases are required by law to report to the department of health (Michigan Department of Community Health, 2014 b). Kent County’s monthly report will provide information on the current trends for STIs.

27. References
Boskey, E. (2014). STD’s & the Elderly - Age is Not a Condom: Old Sex Does Not Mean Safe Sex. Retrieved from
Boyles, S. (2012). Sex and the elderly: STD risk often ignored. Retrieved from
Centers for Disease Control. (2012). Reported STDs in the United States. Retrieved from
CDC. (2014). STD prevention today. Retrieved from
Cochrane Collaboration. (2008). Written and verbal information only for patients being discharged from acute hospital settings to home (Review). John Wiley & Sons. Retrieved from
Findthebest.com.(2014). Clinic. Retrieved from
International Business Times. (2014). STD epidemic spreads among elderly due to unprotected sex. General One File. Retrieved from

28. References
Itsyoursexlife.com. (n.d.). STD testing FAQs. Retrieved from
Kent County Health Department. (2001). Communicable diseases in Kent County. Retrieved from
Kent County Health Department. (2005). The health of Kent County Retrieved from
Kent County Health Department. (2012) annual report. Retrieved from
Nieswadomy, R.M. (2012). Foundations of nursing research. (6th ed.). Pearson. Upper Saddle Rive NJ.
Seniorhealth365.com. (2012). Sexually transmitted diseases in the elderly. Retrieved from
Stokowski-Bisanti, J. (2014). STDs are a growing problem among senior citizens. Retrieved from

29. References
Letvak, S., Schoder, D. (1996). Sexually transmitted diseases in the elderly: What you need to know: The young are not the only ones at risk for STDs. Geriatric Nursing. 17: Retrieved from
Mayo Clinic. (2014). Sexually transmitted diseases. Retrieved from
Michigan Department of Community Health. (2014).
Michigan Department of Community Health. (2014). Health care professionals guide to disease reporting in Michigan: A summary of Michigan communicable disease rules. Retrieved from