Promoting sexual health in older adults

This project is based on the need to adopt a life course approach to sexual health.

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 wellbeing. Social attitudes have changed towards sex in later life.

The public health issues tying in with these trends need to be identified and documented to inform England’s upcoming sexual and reproductive health action plan.

As people live longer, their relationship status may change. The acquisition of new partners has implications for risk of a sexually transmitted infection (STI). The incidence of STIs is lower in older people than in younger people, but it is increasing faster.

New STI diagnoses in men aged 20-24 fell by just over 7% between 2014 and 2018, while rates among 45 to 64-year-old men rose by nearly 14% (Age UK).

Due to advances in HIV treatment and care, people living with HIV are living longer; in 2018, 14,923 women attending HIV care were aged 45 years or over, a fivefold increase over 10 years (Journal of Virus Eradication). The impact of COVID-related disruptions to in-person care such as screenings on older people have yet to be determined.

Studies show a decline in sexual function with advancing years (see Nicolosi et al (2004); Field et al (2013); Mitchell et al (2013)). 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, while depression has been shown to be associated with poorer sexual function (BMJ Open).

Evidence suggests that the sexual health needs of older people are not adequately met (see Gott et al (2004); Haesler et al (2016)). Understanding these needs and what works in terms of approaches to meeting them is vital in informing policy and developing effective interventions.

This is a collaborative project with the Public Health Policy Research Unit and the Sexual and Reproductive Health team, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine.

Aims

• 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 STIs 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?

Research methods

The planned research will consist of two main parts:

• desk-based rapid evidence synthesis;
• a workshop attended by key stakeholders.

Policy relevance

To date, sexual health has rarely been included in policies concerned with the health of older people and, conversely, the health of older people is rarely included in policies concerned with sexual health.

The planned research will create an evidence base to inform the design of public health initiatives, including the establishment of a research agenda, the development of sexual health interventions, and the planning and commissioning of sexual health services provision.

The policy relevance of the research extends beyond sexual health. The benefits of extending the scope of the sexual and reproductive health action plan to include older people will contribute to health status more generally: men and women in better health also have higher sexual function (Field et al (2013); Mitchell et al (2013)).

At the same time, higher levels of sexual function are linked with increased quality of life and wellbeing (Lancet). Research shows that poor sexual function and dissatisfaction has significant adverse effects on mental health (BMJ Open).

Delivery timeline

May 2022 to November 2022

Associated publications and resources

• Report: Promoting Sexual Health in Older Adults – integrated summary of findings
• Stowell et al (2023) “Promoting Sexual Health in Older Adults: Findings from two rapid reviews”, Maturitas Journal. DOI: 10.1016/j.maturitas.2023.107795  
• Sexual Health and HIV in Older Adults webinar hosted by HIV Prevention England 06.07.23: Dr Gemma Spiers slides; Prof Kaye Wellings’ slides. Watch the webinar: