Predictors of Provider Discussions of Sex and Sexual Health with Older Adults

Background and Purpose: Discussions of sexual issues can be difficult for providers of health services, particularly with older patients. Ageist assumptions often contribute to providers not asking about sexual functioning, sexuality, or sexual risk (Williams & Donnelly, 2002). In light of the increasing incidence of HIV infection in the US aging population, neglect of these issues can have dangerous implications. Older adults often rate sexual activity as important to their quality of life and participate in sexual activity throughout their lifespan (AARP, 2005). It is unclear how often providers are asking clients about sex or sexual health. This study seeks to provide information to fill this gap. It explores the impact of provider characteristics as predictors to addressing sex and sexual health in clinical practice. Methods: This study used a cross-sectional research design to examine how often providers in gerontological health are asking clients about sex and sexual health and what factors are important to this happening. Data were collected systematically through a self-administered survey that was mailed to a national sample of 903 physicians, nurses, and social workers who specialize in gerontology or geriatrics. Survey methods followed a tailored design approach (Dillman, 2000). Data were analyzed via logistic regression, ANOVA to examine group differences, and descriptive statistics. The survey included the HIV Knowledge Questionnaire- 45 (Carey, Morrison-Beedy & Johnson, 1997), a measure of general HIV knowledge. Participants were asked about their practice behaviors as they related to discussions of sex and sexual health with older clients.

Results: Response rate to the survey was 65%, resulting in an analyzable N of 486. Providers differed significantly in their practice of asking about sex and sexual health. Significant predictors of asking about sex or sexual health included: profession, score on the HIV knowledge measure, and level of experience in providing care for people with HIV/AIDS (Model χ²= 87.59, df =9, p<.0005; NR2= .24). Age, gender, years of experience, and number of HIV patients in the past year were not significant predictors. The complete model predicted accurately 70.2% of the time, in comparison to 59% of the time without any predictors (χ²= = 25.73, df= 7, p=.001). Odds of a provider discussing sex or sexual health are highest when the provider is a physician, then a social worker, then a nurse. Providers who scored higher on the HIV KQ-45 were more likely to discuss sex and sexual health, as were providers who judged their level of professional experience with HIV patients as very competent or competent.

Conclusions and Implications: Physicians are more often approaching their older patients about sex and sexual health, in comparison to nurse and social work providers. Knowledge of HIV and comfort with HIV care were important to whether or not providers discussed sex and sexual health with their clients. This has important implications for clinical care and education of providers. It has been suggested that providers often do not think that older adults are sexual. This myth may be impacting the nurse and social work providers in this study.