Running Head: SENIORS AND STIs 1

Seniors and Sexually Transmitted Infections in Sarasota County

Catelyn Suttmiller

University of South Florida College of Nursing

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Every county has its ups and its downs, Sarasota County for instance. For the areas that counties

need improvement policies are put in place to help give the plan structure and a goal to achieve.

Local versus State

Sarasota County is an urban area right on the coast of the Gulf of Mexico, which had a

population size of 389,911 in 2014 (County & State profile reports, 2013). According to

scgov.net Publix, Walmart, and Sarasota Memorial Hospital are Sarasota Countys largest

employers, Sarasota Memorial Hospital being the main healthcare branch, and thirty percent of

Sarasota Countys residents are over the age of sixty-five. Meanwhile only 8.1 percent of people

over 25 in the county do not have a diploma; as well as only 2.4% of kids over the age of 14 do

not understand or speak any English. (County & State profile reports, 2013) Unfortunately

19% of children live in poverty, and there is only one primary care physician for every 1,300

patients. (Health Rankings, 2016)

Analysis and Interpretation of Data

On the other hand, there are some very positive statistics for Sarasota County, the percent

of obese adults is 21% in Sarasota County (County & State profile reports, 2013), compared to

the National Benchmark which is 25% (2013 National Benchmarks, 2013). Sarasota is right on

the Gulf of Mexico providing the opportunity to exercise for free, such as swimming, biking

along the beach, and walking along the shore during the sunset. Preventable hospital stays are 33

(Health Rankings, 2016) in Sarasota County and the national benchmark is 47 (2013 National

Benchmarks, 2013). That means there are 13 less unnecessary hospital stays in Sarasota than the

national goal. Mammography screenings in Sarasota County is 74% (Health Rankings, 2016.)
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where the national benchmark is 73% (2013 National Benchmarks, 2013). One percent may not

seem like a huge deal but it is. Since more people are getting a mammography preformed, then

there are more people getting screenings done to detect early signs of disease, which causes there

to be less unnecessary hospital stays.

But there are also some not so favorable statistics for Sarasota County. According to

Florida Charts 23% of Sarasota County is uninsured, the national benchmark is only 11% (2013

National Benchmarks, 2013). Sexually Transmitted Infections (STIs) are 253.5 in Sarasota

County verses the national benchmark being over half of that at 92 (2013 National Benchmarks,

2013). Unemployment in Sarasota County is 11.4% (County & State profile reports, 2013)

compared to the national benchmark being at 5% (2013 National Benchmarks, 2013). The fact

that more people are unemployed, it makes sense that less people have insurance, which can also

be correlated to the high number of sexually transmitted infections. Less people have the

financial means to get tested and screened for STIs, therefore less people are getting treated for

sexually transmitted infections, which is playing a hand in the further spread of these infections.

Healthy Peoples 2020 goal towards sexually transmitted infections is to promote

healthy sexual behaviors, strengthen community capacity, and increase access to quality services

to prevent sexually transmitted diseases (STDs) and their complications. This can be done by

bringing attention to the number of STIs and promoting healthy sex practices. Sexually

transmitted infections are not talked about enough as well as the complications that they can

cause such as reproductive problems and even cancer. (Sexually transmitted diseases, 2014)

Identification of Priority Heath Issue

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The amount of Sexually Transmitted Infections are significantly higher in Sarasota

County compared to the national benchmark, even though sexually transmitted infections are one

hundred percent preventable, by practicing abstinence, using a condom, or getting screened with

your partner before having unprotected sex.

Discussion and Application of Community Health Models

The Determinants-of-Health Model aides in creating effective interventions for a health

priority issue, by breaking down the issue into smaller factors that can effect ones health; such

as age, income, education, and even the presence of a support system. The context of peoples

lives determine their health, and so blaming individuals for having poor health or crediting them

for good health is inappropriate. (The determinants of health, 2016) One cannot expect someone

who grew up in poverty, whose idea of a doctor visit is going to a health fair; to have the same

health status as someone who grew up in the upper class, who has the financial ability to see a

specialist for every runny nose. Some people do not have the financial ability to properly take

care of themselves, while some just do not have the proper knowledge.

For instance, there will be less senior citizens with sexually transmitted infections in

Sarasota County by 2017. This can be done by the education of not only the elderly, but also the

healthcare personnel educating them. Sex is not always the most comfortable conversation to

have, but it needs to be had. Building rapport with a client can encourage them to be more

compliant and confide in their healthcare team. Changing patterns of sexual practices, including

high rates of divorce and partner change in the older age groups, indicate that focus and concern

with sex and sexuality later in life will become part of routine prevention and maintenance of

sexual health. (Minichiello, Hawkes, & Pitts, 2011) If geriatric doctors offices handed out
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condoms like other doctors offices do then it could help remind the elderly that they need

protection, as well as normalizing sex. Nursing homes and Assisted Living Facilities should also

have condoms easily assessable to encourage safe sex, also the staff should be educating the

clients whenever they can on the risks of unprotected sex. Age does not protect you from

sexually transmitted diseases. (STDs in older adults, 2016)

There are many factors that contribute to the high number of STIs, but one main factor is

a significant number of the population is over the age of sixty-five. The generation that is sixty-

five and older did not get the same amount of sex education as the generations after them did.

Even in 2012 there was still a lack of health education and health programmes directed towards

older people. (STI epidemiology in the global older population: emerging challenges, 2012) The

fact that they no longer have to worry about getting pregnant, protection does not seem

necessary. Most people who live in nursing homes and assisted living facilities are lonely or even

widowed, which makes these places perfect for people to meet and start a sexual relationship,

even with multiple people.

Population Diagnosis

The elderly are at risk for sexually transmitted infections, related to the lack of sexual

education. If the elderly get the proper education as well as the tools that are necessary to have

healthy sexual encounters, the number of STIs in Sarasota County will drastically decrease.

Due to the prediction that Sarasota County it is predicted that by 2030, 40 percent of the

population with be over the age of 65 (Sarasota County, How are we aging, 2012) this problem

needs to be dealt with immediately.

Community based Interventions

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An example of a primary prevention would be, educating senior citizens in nursing

homes, assisted living facilities, and even just at the doctors office. The education should be

taught community wide to promote healthy sexual decisions as well as teach the elderly that age

does not protect from sexually transmitted infections. There are still precautions that need to be

taken when sleeping with someone. If doctors handed out condoms and had brochures on

sexually transmitted infections it would reinforce the importance of protection. The stakeholders

that would be affected are the healthcare personnel; they would need to take special training to

properly deal with sexual education for the elderly. The reason healthcare personnel would need

special training is due to the results of a study that showed, healthcare professionals often

consider older people's sexuality as outside their scope of practice and there is lack of knowledge

and confidence in this area (Haesler, Bauer, & Fetherstonhaugh, 2016). The generation over 65

needs to be taught the signs and symptoms of the sexual transmitted infections, as well as the

simple ways of practicing safe sex. The community health nurse would need to ensure that the

clients understood the education, as well as stress the importance of the patient reporting any

unusual symptoms to their healthcare team. Something as easily treated as a urinary tract

infection can cause severe symptoms such as change in level of consciousness in the elderly. Sex

needs to be normalized in the elderly community so they do not feel as embarrassed talking to

the doctors or nurses about their sex lives.

There should be more STI screenings done in the elderly community. There is recent

evidence indicating that people over the age of 50 are increasingly at the risk of HIV and

sexually transmitted infections (Minichiello, Hawkes, & Pitts, 2011). The community members

are the biggest stakeholders, but the healthcare personnel will be affected as well. Community
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members are the ones receiving the STIs, while healthcare personnel are the ones who need to do

the screenings and teach the importance of getting tested before participating in sexual activity.

At this level of prevention the patient has already received the infection, so it needs to be treated,

as well as the client needs to be reeducated on the ways of preventing STIs. The signs and

symptoms also need to be taught again; a pamphlet or brochure can be handed out so they have a

reference to look back at when they have an unusual symptom. There needs to be an emphasis on

the importance of remaining abstinent, while waiting on the results of the second test to ensure

the infection has cleared, to prevent the further spread.

Tertiary Preventions are trying to decrease the complications of STIs. Such as decreasing

the symptoms of HIV and AIDs by treating with the proper medications. The individual is the

recipient in this level of prevention. The patient must comply to the medications diagnosed as

well as in some cases remaining abstinent. Their compliance can be measured by their attendance

at their regular doctors visits, as well as by the progression of their disease. If they are following

the treatment plan set for them and there is no sign of their health getting better, they may need a

new treatment regimen. Trying to control the symptoms and return these clients health back to

their baseline is the goal. There are some steps towards their recovery that may not be easy for

them, but are necessary to return to good health; such as abstinence, daily medications, frequent

doctor visits, and even refraining from consuming alcohol. Abstinence may not be easy for

certain patients, but the importance of not spreading the STI needs to be stressed. If they are

sleeping with the same person that gave them the STI and that person has not received treatment

they will just continue to get the same sexually transmitted infection over and over again until

they follow they doctors orders.

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Reflections and Synthesis of Health Policy

There will be a stronger emphasis on sexual education in the population 65 and older, in

Sarasota County. To prevent STIs spreading even further, the education is the most vital aspect of

this policy. Once this population is properly educated, it is more likely that they will use

condoms, get screened before having unprotected sex, and know the signs and symptoms to look

out for. Not only will the community need more education, but the healthcare workers will need

proper training to deal with sexually transmitted infections in the elderly community. Nursing

homes, assisted living facilities, and geriatric doctors offices will hand out condoms; to have

protection easily assessable, as well as visible will encourage the use of this tool. The funding

concerns would be whether the facilities could afford to supply the condoms for free, as well as

the cost of the specialized education for the healthcare personnel. Some family members of the

adults in these type of facilities may see the education as encouraging their loved ones to have

sex, which could make them uncomfortable and they may not totally support the education. In

the end of it all the elderly are adults and will do what they choose to do, but they should have

the knowledge and tools to make the smart decision.

The places this policy would be most influential are communities for older adults, such as

nursing homes and assisted living facilities. These will be the most influential because it is

common for the residents to create new relationships with fellow residents, often sexual

relationships. If there was enough funding then the policy would go into the local hospitals,

especially Sarasota Memorial Hospital because it is the main source of healthcare in Sarasota

County. The staff would be first to receive the education: how to bring sex up to the elderly, as

well as the detailed signs and symptoms to look out for, how to build rapport with these clients,
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and most importantly the education they will need to teach these clients. This policy will increase

the knowledge and awareness of STIs in this county, and encourage the healthcare personnel and

the elderly to work together to decrease the occurrence of these infections.

Conclusion

Sex may not be an easy subject to bring up to patients, but it is vital to the patients

health. Doctors teach the patients about the signs and symptoms to look out for, as well as what

specific infection they have; while nurses are the line of defense that ensure these patients

understand their diagnosis, as well as the steps to their recovery. I will not shy away from asking

my patients the uncomfortable questions because I know it will benefit them in the end. Sex

education needs to be taught throughout our lifetime, not only when we are in middle and high

school. Sexually transmitted infections are preventable, and the proper steps on preventing them

should be advertised at a community level.

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Resources

County & state profile reports. (2013). Retrieved June 20, 2016, from

http://www.floridacharts.com/charts/DisplayHTML.aspx?

ReportType=1341&County=58&year=2014&tn=24

Haesler, E., Bauer, M., & Fetherstonhaugh, D. (2016). Sexuality, sexual health and older people:

A systematic review of research on the knowledge and attitudes of health professionals.

Nurse Education Today, 40, 57-71. doi:10.1016/j.nedt.2016.02.012

Health Rankings. (2016). Retrieved July 21, 2016, from

http://www.countyhealthrankings.org/app/florida/2016/rankings/sarasota/county/outcome

s/overall/snapshot

Minichiello, V., Hawkes, G., & Pitts, M. (2011). HIV, Sexually Transmitted Infections, and

Sexuality in Later Life. Current Infectious Disease Reports, 13(2), 182-187.

doi:10.1007/s11908-010-0164-6

Minichiello, V., Rahman, S., Hawkes, G., & Pitts, M. (2012). STI epidemiology in the global

older population: Emerging challenges. Perspectives in Public Health, 132(4), 178181.

doi:10.1177/1757913912445688

Pages - www.scgov.net. (2016). Retrieved July 12, 2016, from

https://www.scgov.net/Pages/default.aspx

Sarasota County, How are we aging. (2012, July). Retrieved from

https://scginternet.scgov.net/PlanningServices/Demographic Profiles/How are we

aging.pdf
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Sexually transmitted diseases. (2014). Retrieved July 24, 2016, from Healthy People 2020,

https://www.healthypeople.gov/2020/topics-objectives/topic/sexually-transmitted-

diseases

STDs in older adults. (2016). Retrieved July 11, 2016, from Benjamin Rose Institute on Aging,

http://www.benrose.org/resources/article-stds-older-adults.cfm

The determinants of health. (2016) Retrieved July 10, 2016, from

http://www.who.int/hia/evidence/doh/en/

2013 National Benchmarks. (2013). Retrieved from

http://www.countyhealthrankings.org/sites/default/files/resources/2013 National

Benchmarks.pdf