Promoting sexual health in older adults

This will be a collaborative project delivered in partnership between the Public Health PRU and the Older People and Frailty PRU.

Background

By extending its remint to include older people, the new Sexual Health Strategy developed by DHSC in 2022 is responding to a number of contemporary trends. The UK’s population is ageing, men and women today live longer and reach older age in better health. New stages of the later life course are emerging when sexual expression is increasingly recognised as important in maintaining relationships, promoting self-esteem and contributing to health and well-being.

The public health issues contingent on these trends need to be identified and documented to inform the sexual health strategy. As people live longer, their relationship status may change. The acquisition of new partners has implications for risk of sexually transmitted infection (STI). The incidence of STIs is lower in older people than in younger people, but it is increasing faster. The impact of COVID-related disruptions to in-person care (e.g. screenings) on older people have yet to be determined.Studies show a decline in sexual function with advancing years. Chronic health conditions such as cardiovascular disease, diabetes and some cancers, and medications required to treat them, affect sexual function in older people. Physiological changes including loss of mobility limit sexual activity whilst depression has been shown to be associated with poorer sexual function.

Evidence suggests that the sexual health needs of older people are not adequately met. Understanding these needs, and what works in terms of approaches to meeting them, is vital in informing policy and developing effective interventions.

Aims

The aim of this research is to provide an overview of existing evidence on sexual health needs and sexual health promotion in later life.

Research Questions:

• What does the published literature tell us about the sexual health needs and preferences of older people?
• What are the barriers and facilitators to accessing sexual health services, including those dedicated to the prevention and treatment of STI and HIV.
• What do health, social care and third sector professionals perceive to be necessary to maintain and promote sexual health in later life?
• Which interventions are effective in maintaining and promoting sexual health?

Methodology

The planned research will consist of two main components:

1. Desk-based rapid evidence synthesis.
The rapid evidence synthesis will aim to summarise current evidence on the sexual health of older people (50+)[1] and to describe key findings and gaps in the research to inform practice, policymaking, and future research. The evidence synthesis will be guided by the need to maintain a holistic focus on sexual health. It will focus initially on the sexual health needs of older people (part 1, months 1-3), and subsequently on interventions with the potential to meet those needs (part 2, months 4-6). The same methods will be used in both parts.

2. Stakeholder and expert workshops
We will invite key stakeholders and experts to attend two workshops to discuss the sexual health needs of older people and how they might be met. We envisage the first workshop including 10-12 stakeholders representing professional organisations (e.g. the FSRH; RCOG, RCGP, RCN); organisations focussing on relationship and sexual health issues (e.g. Tavistock Institute, BASHH; SexRightsAge; Relate); third sector organisations (including the Terrence Higgins Trust, Age UK), and Sexual Health Commissioning Groups. The aim of the second workshop will be to capture users’ voices and to this end we will work with Age UK to recruit a meaningful group, of similar size to the first, to engage older users with different sexual health requirements, in the research.

[1] Categories of age beyond 50+ are not pre-defined. Consideration of age in the reviews will take account of intersections with life stage, and hence categorisations will not be seen as discrete and universal but will vary with specific sexual health needs and service requirements.