Baby boomers and the modern day sexual revolution: Part 1

In the first of a two-part series on older patients and healthcare, newsGP looks at the way this generation is changing how people view the lives of older patients.

A female patient, 72 years old and a widow, comes in for a consult and tells her GP, ‘I’ve met someone and we want to have sex. The only problem is, I haven’t had sex for 15 years. Is there anything I should do?’
 
This type of situation is likely going to increase as the baby boomer generation – generally defined as those born between 1946 and 1964 – continues to age and changes notions of the lives older people want to lead.
 
‘The baby boomer ageing cohort are very different to previous generations of older groups,’ Prof Ann Roche, Director of the National Centre for Education and Training on Addiction at Flinders University, told newsGP. ‘They’re very assertive, they’re clear about quality of life and what they expect and demand, and they’re not going to be patronised.’
 
Dr Keri Alexander, a former GP who now works as an addiction specialist, believes the baby boomers are going to revolutionise ageing, just as they revolutionised youth.
 
‘They’ve rewritten everything through every life-stage, and I’m convinced they’re going to rewrite ageing and living well in retirement and the old, golden years, and challenge our thinking on that like they have throughout everything else,’ she told newsGP.
 
So what will this revolution in ageing mean for the GPs who are helping to provide care to baby boomers? How will they have to change their ideas of what an older person might represent?
 
The dating game
Research is clear that the sexual behaviours in older people, as Bob Dylan would say, are a changin’.
 
‘Older Australians are more sexually active, with more partners, than they have ever been before,’ Dr Lara Roeske, GP and Chair of the RACGP Specific Interests Sexual Health Medicine network, told newsGP.
 
Greater social acceptance of divorce and remarriage has driven changing patterns of partnering and re-partnering, while the ubiquity of the internet has dramatically increased opportunities to meet new partners – and that goes for all age groups.
 
‘The fastest-growing demographic accessing online dating sites is older Australians, and recent research tells us that older internet dates become sexual much faster than younger internet dates,’ Dr Roeske said.
 
While the ever-increasing availability of internet dating and mobile apps has opened previously unavailable avenues for older people to meet others, it has also led to another, less desirable increase – namely in the rates of notifiable sexually transmitted infections (STIs).
 
‘Part of that is that more people are getting tested, so that’s a good thing,’ Dr Deborah Bateson, Medical Director at Family Planning, New South Wales, and Co-Chair of the Australasian Sexual Health Alliance, told newsGP. ‘But with a lot of STIs we only see the tip of the iceberg, so we’re only counting what we actually test. We know there’s a lot of undiagnosed infections like chlamydia and gonorrhoea.’
 
Dr Bateson’s research has revealed a variety of contributors to these increases, including that older men and women are less likely to use condoms in new relationships.
 
‘Often, older people just have not been exposed to that school-based sex education. In fact, it probably wasn’t even there,’ Dr Bateson said.
 
‘Most safe-sex campaigns are aimed at younger people, so I think there’s a lack of information and awareness about the risks of STIs with new partners for older people. Perhaps there’s also some misinformation; for example, that you can tell if someone’s got an STI, not realising that most STIs have got no symptoms.’
 
There can also be problems in communication between partners.
 
‘There may be a bit of embarrassment about that conversation, negotiating condoms, and I think that’s particularly the case for women. We know they can still find it very challenging to actually buy and carry condoms, and if no-one’s got one, that can be difficult,’ Dr Bateson said.
 
A lack of concern about pregnancy is also a significant disincentive for using condoms among older heterosexual people.
 
‘We know from the research that prevention of pregnancy is higher up on people’s concerns than preventing STIs,’ Dr Bateson said. ‘So when that risk is gone, that can lead to lower condom use.’
 
Dr Bateson emphasises that ‘STIs don’t recognise age’, and it is therefore important for GPs to keep this in mind when they are seeing older patients. Sexual health is a topic that can be difficult for patients to bring up in consults, especially if they are older, so opportunistic screening can be a useful approach.
 
‘When women come in for cervical screening, that’s an ideal time to raise the issue,’ Dr Bateson said. ‘Another useful time is when you know a patient is preparing to go off travelling somewhere; it does seem that there’s more risk-taking when people are away on holiday.
 
‘Also, if your patient is separated or divorced. We know that recently separated or divorced people who are meeting new partners may be more susceptible to unsafe sex.
 
‘It’s just about raising the topic non-judgementally. Patients might not be that keen to disclose straight away, but then they may come back and make another consultation.’
 
Above all, it’s about treating older patients with kindness and respect and recognising that older people have not necessarily withdrawn from the ‘romantic’ side of life. It is also about GPs feeling confident in discussing the topic.
 
‘GPs just need to be unfazed and seek help if they need a bit of support about how to discuss sexual health with older patients, because it’s really important to make people feel comfortable around these sensitive areas,’ Dr Bateson said.
 

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