Questions & Answers: Prevention of sexually transmitted and blood borne infections among older adults

Contents

Preface

Questions & Answers: Prevention of sexually transmitted and blood borne infections among older adults is intended to address the most commonly asked questions about the prevention of sexually transmitted and blood borne infections (STBBIs)Footnotei among older adults. The goal of this resource is to help community organizations, health professionals, educators, and others develop and implement sexually transmitted and blood borne infection prevention interventions and programs that address the needs of this population. For the purpose of this resource, 50 years of age and older was the criteria applied to define older adult. This document examines factors that impact vulnerability to and resilience against sexually transmitted and blood borne infections (STBBIs) and provides a basis to address the prevention needs of this population.

The Canadian Guidelines for Sexual Health Education (Guidelines) were first published by the Public Health Agency of Canada (the Agency) in 1994Footnote1 and most recently revised in 2008. They were developed to help health professionals and educators in their efforts to provide broadly based sexual health education for the prevention of sexually transmitted and blood borne infections (STBBIs). Feedback from a national evaluation of the Guidelines indicated the need for companion documents to provide more detailed information, evidence, and resources on specific populations to support sexually transmitted and blood borne infection prevention.

In response, the Agency identified a 'question and answer' format as a means to provide this population-specific information. These question and answer documents are evidence-informed, use inclusive language, and cover a range of key issues for the prevention of sexually transmitted and blood borne infections (STBBIs) among diverse populations. This resource is the fifth in the series, which also includes Questions and Answers documents on sexual orientation, gender identity, sexual health education for youth with physical disabilities, and inclusive practice in the prevention of sexually transmitted and blood borne infections (STBBIs) among ethnocultural minorities.

Acknowledgements

The Agency would like to thank Michele Cauch, Heather Cobb, Paula Migliardi, Kate Murzin, and Alex McKay, whose feedback and guidance ensured that this resource contains current and relevant evidence about sexually transmitted and blood borne infections (STBBIs) among older adults. In addition, the Agency would like to acknowledge the staff of the Centre for Communicable Diseases and Infection Control and the Centre for Chronic Disease Prevention for their contributions to this document.

Introduction

Canadians are now living longer and healthier lives. As life expectancy continues to increase, so do issues related to the physical, mental and social health and well-being of an aging population. There is a continued need to create and maintain opportunities for individuals to age well. The burden of infectious and chronic diseases among an aging population is a public health concern due to its impact on quality of life for both individuals and communities.

Older Aged Adult: For the purpose of this resource, 50 years of age and older was the criteria applied to define older adult.

Although younger people continue to account for the highest rates of sexually transmitted and blood borne infections (sexually transmitted and blood borne infections (STBBIs)), epidemiological data indicates that rates among older adults are increasing. At the same time, advances in medical technology have improved our ability to treat many chronic sexually transmitted and blood borne infections (STBBIs), including HIV and hepatitis C, allowing those who acquired these infections at an earlier age to manage and maintain good health as they age.

Healthy Aging: The development and maintenance of optimal mental, social and physical well-being and function in older adults.

It is important to take into consideration the social, economic, and cultural contexts that shape individual experiences and health outcomes. In particular, the transition from earlier to latter stages of adulthood is marked by many changes, and can be a time of evolving social roles and relationships. While some older adults can experience decreased or limited sexual activity or desire, a large majority remain sexually activeFootnote2. Studies have also indicated that sex, sexual desire, and sexuality continue to be important and relevant to adults regardless of their ageFootnote3. Furthermore, sexual activity and desire for those over 50 is more strongly associated with their overall physical and mental health than their ageFootnote4.

Lifecourse: A culturally defined sequence of events and roles that one passes through as they progress from birth to death.

For some, older age may also include the continuation of substance use or the onset of new drug use as a result of social isolationFootnote5. Additionally, there are some who may have received infected blood products from medical procedures or experimented with injection drug use when younger and have been unknowingly exposed to hepatitis C, and are only now experiencing symptoms.

Social Isolation: The absence of personal interactions, contacts, and relationships with family, friends and neighbours on an individual level, and with "society at large" on a broader level.

Risk behaviours such as unprotected sex and drug use can be affected by individual, community and structural factors, and can place those over 50 at increased risk of sexually transmitted and blood borne infections (STBBIs) if not properly addressed. Adopting a lifecourse approach to healthy aging allows for the development of programs and services that address sexually transmitted and blood borne infection risks specific to those life changes and experiences unique to this population, including ones tailored to support those living with chronic sexually transmitted and blood borne infections (STBBIs).

Lifecourse Approach: An approach which takes into consideration how different historical, socio-economic and cultural factors intersect with one's lifecourse to shape individual experiences.

While there are common factors influencing the vulnerability of older adults to sexually transmitted and blood borne infections (STBBIs), this population is highly diverse. Within this age group exists individuals who are either in the workforce or retired, who live independently or who may require varying degrees of care, and those who are supported by family/friends or those who are experiencing periods or feelings of increased isolation. Similarly, they come from a vast array of backgrounds, cultures and ethnicities and their lived experiences may be wide ranging.

While acknowledging the complexity and diversity of this age group, this resource attempts to address the commonalities at various stages of the lifecourse which can impact on sexually transmitted and blood borne infection prevention. It is important for health care and service providers to understand the particulars of the population with which they are engaged and tailor the information provided in this resource to their specific needs and life stages.

This resource is intended to help community organizations, health professionals, and educators to develop and implement programs and interventions for the prevention of sexually transmitted and blood borne infections (STBBIs) and support those living with HIV and hepatitis C infections to ensure that:

  1. programming is inclusive of the needs of older adults, including those living with HIV and/or hepatitis C;
  2. the experiences of older adults are reflected in sexually transmitted and blood borne infection prevention and support programming;
  3. professionals working with older adults are aware of key issues and determinants of vulnerability to sexually transmitted and blood borne infections (STBBIs);
  4. professionals working in sexually transmitted and blood borne infection prevention, care and support have the necessary tools to address these key issues.

Limitations

At present, the available Canadian research on sexually transmitted and blood borne infection prevention for older adults is scarce and, as such, many of the reported findings in this resource are drawn from international literature on the topic. Additionally, most of the available literature focuses primarily on HIV, although lessons learned from HIV in many instances can be applied to other sexually transmitted and blood borne infections (STBBIs) when adopting an integrated approach to prevention. Furthermore, many of the articles reviewed are based on relatively small and geographically specific samples which limit the generalizability of the findings. Also of note, while injection drug use can impact sexually transmitted and blood borne infection vulnerability in older adults, there is very little evidence in the literature that investigates this relationship. As a result, this document focuses primarily on the sexual risks that affect sexually transmitted and blood borne infection vulnerability in older adults.

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