Conclusion 

In order to properly address the risk taking behaviors of the elderly, health care providers caring for this group need to be aware of these behaviors. Many healthcare providers may be reluctant to ask sensitive questions about sexuality due to a fear of embarrassing the patient or of being embarrassed themselves. Perhaps further education is needed on the part of healthcare providers related to how to begin these difficult conversations with their older adult patients and exactly how to ask these sometimes sensitive and intrusive questions. Changing demographics, including the increasing numbers of older adults with HIV or AIDS, warrant that attention be paid to the risk factors of HIV in this population. Not only do older adults need to be aware of the risk as individuals, but healthcare providers need to have awareness of the issue and to incorporate patient teaching on safe sex to the older adults they care for.

Risk behaviors of the older adult can be better documented through research. Research in this area however is much lower than health risk behavior research on the age fifty and younger population. A study by Levy, Kosteas, Slade, and Myers discovered that all research related to irresponsible sexual behavior published in any of the five most widely cited journals excluded people over the age of sixty-five (2006). This same study found that 74% of research related to substance abuse excluded people over age sixty-five. A similar study completed the following year uncovered that approximately 72% of clinical trials related to sexually transmitted disease risk-reduction excluded persons over the age of fifty (Levy, Ding, Lakra, Kosteas, & Niccolai, 2007). Nearly half of the studies had specific exclusion criteria that affected participants over age fifty. Also, no clinical trials related to sexually transmitted disease (STD) risk-reduction were discovered that were specifically limited to participants over the age of fifty. This lack of research may contribute to the minimization of HIV and STD prevention and outreach programs available for older adults. Older adults may be viewed as asexual or safe if there is no data to support that the older adult engages in risky behavior and is also at risk for contracting HIV.

Falvo and Norman (2004) tried to explain the reason for lack of research in the area of sexuality and older adults. They attributed it to “societal norms and beliefs that maintain many people over 50 no longer have any interest or desire to engage in sexual behaviors” (Falvo & Norman, 2004, p. 104) Some researchers, believe that people over age 50 no longer engage in sexual behaviors and purport that research in this area cannot be completed because older people may be reluctant to speak about their private lives, especially as it involves sex. It was also determined from the literature that this population does not perceive themselves to be at risk for contracting HIV making recruiting for research and educational programs difficult (Falvo & Norman, 2004). A brief twenty to thirty minute educational session performed by a nurse at twenty-four centers for older adults included in this study proved that in this brief session, preventative knowledge and perception of risk increased in this population (Rose, 1996)

Existing literature unanimously supports how important it is for the healthcare provider to obtain a sexual history from all patients, including those over the age of fifty. The Association of Nurses in AIDS Care “reccomends that nurses conduct a routine HIV risk assessments on all patients regardless of the presence of any perceived risk.” (Goodroad, 2003) “The taking of sexual histories must be encouraged no matter the age of the patient.” (Lieberman, 2000) Another study reported “ If physicians were willing to endorse and promote HIV/AIDS education in older patients, elders may be more willing to follow reccomendations made by their doctors”(Falvo & Norman, 2004, p. 115)

The CDC reported that “Contributing to the spread of HIV among the over 50 age group and the quick progression of AIDS, is that physicians are often reluctant to discuss sexually transmitted diseasess with older patients.” (Center for Disease Control and Prevention d , 2007, p. 4) The CDC recommends that screening for HIV be performed routinely for all individuals aged thirteen to sixty-four. All individuals regardless of age, requiring treatment for TB should be screened HIV infection. “All patients seeking treatment for STDs, including all patients attending STD clinics, should be screened routinely for HIV during each visit for a new complaint, regardless of whether the patient is known or suspected to have specific behavior risks for HIV infection” (Center for Disease Control and Prevention b, 2008). Health-care providers should test all persons at high risk for HIV annually or before each new sex partner.

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