The Catch-22 of sexual health discussions with older Australians: Patients’ perspectives of who should be doing the talking and how

Talk Code: 
Sue Malta
Meredith Temple-Smith; Adrian Bickerstaffe; Christina Bryant; Jenni Lyne; Declan McGavin; Jesse Hunter; Jane Hocking
Author institutions: 
Melbourne School of Population and Global Health, The University of Melbourne (SM, AB, JH) and National Ageing Research Institute (SM); Department of General Practice, The University of Melbourne (MTS, JL, DM, JH); School of Psychological Sciences (MTS)


Greater longevity coupled with increasing rates of later life divorce means there are more older singles in Western populations than ever before. Many seek new partners via dating websites; are the most likely group to have sex on the first date and are less likely to use condoms compared with their younger counterparts. The reasons for this are diverse, but appear linked to low levels of sex education/knowledge about the protection condoms provide. Unsurprisingly, rates of sexually transmissible infections (STIs) in older populations are rising. Sexual health and wellbeing is not a topic usually discussed in primary care between GPs and older patients, as they each wait for the other to initiate these conversations. This Catch-22 means that many symptoms of STIs go unrecognised and older patients may not receive the care they need. We sought to understand the barriers/enablers to sexual health discussions occurring from a range of perspectives: that of GPs, practice nurses/managers, sexual health clinicians, users/developers of digital and online interventions (DOIs), and older patients themselves.


This presentation reports our interviews with the older patient. Semi-structured face to face interviews were conducted with 21 patients aged 60 and older in Melbourne, Victoria. Participants were self-selected and recruited via partner organisations. Interviews were digitally recorded, transcribed, then thematically analysed using NVivo. Results then informed the development of a preliminary checklist of statements which could be used to initiate sexual health discussions. Follow-up telephone interviews were held with 14 patients in a co-design process designed to elicit the most appropriate content and language about sexual health and wellbeing they would like included in a discussion tool.


As other studies have found, many older patients felt unable to initiate discussions with their GPs because of a fear of judgement, privacy fears or because they were unable to articulate their needs. Others felt actively discouraged by their GPs from doing so, because of the GPs’ own embarrassment/ageist assumptions about their older patients. Patients favoured a checklist approach, either in a paper-based or DOI format, which they could use in the waiting room; and which would provide GPs with a starting point for discussions to occur. Follow-up interviews indicated older patients preferred broad statements in lay language which reflected issues of interest/concern to them.


Our study confirms the importance of GPs initiating sexual health discussions with their older patients and highlights a practical, and easy solution, to ensuring these discussions occur. Additional data will be provided and future research and innovation in primary care discussed.

Submitted by: 
Sue Malta
Funding acknowledgement: 
This project was made possible by seeding grants from the Hallmark Ageing Research Initiative and an internal joint SPS-MSPGH Project Grant.