Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 134

Clinicians should be mindful that older adults remain at risk for sexually transmitted infections (STIs) and that sexual risk‐taking behaviour is not only a problem of younger people. Postmenopausal women are considered to be at a higher risk of contracting STIs than younger women due to increased friability of the vaginal mucosa, leading to abrasions and tears during intercourse. Older adults are less likely than younger adults to have adequate knowledge about STIs and human immunodeficiency virus (HIV).⁵¹ It is essential that older people are informed and equipped to enjoy sexual activity safely. Older people are increasingly at risk of sexually transmitted disease, and, compared to younger adults, they tend to delay seeking help after the onset of symptoms.⁵² The US Centers for Disease Control reported increasing rates of chlamydia, gonorrhoea, and syphilis among Americans over the age of 65 from 2013 to 2017.⁵² A study in the UK showed increased rates of syphilis, gonorrhoea, chlamydia, anogenital warts, and anogenital herpes between 1996 and 2003 among older adults.⁵³ In the US, people over the age of 50 constituted 17% of new HIV diagnoses in 2016, and 35% of people 50 and older already had AIDS when they received their HIV diagnosis.⁵⁴

There are many misconceptions about STI and HIV prevention among older adults, including perceptions that personal hygiene, physical characteristics of partners, personal behaviour, and monogamy are protective.⁵⁵ It is important for health professionals to recognize that many older people have not benefited from health education programmes and may be unaware of the protection provided by condoms.⁵³ One large survey of Americans aged 14–97 revealed that adults over the age of 70 had the lowest rates of condom usage out of all age groups surveyed, at 5.4% of men and 1.9% of women.⁵⁶ Healthcare providers should use age‐appropriate educational materials and increase education for older adults about sexual health and sexually risky behaviours.⁵¹ As stated above, patients should also be counselled that oil‐based lubricants can affect the efficacy of condoms in preventing STIs.

Additionally, many older adults who lived through the worldwide HIV/AIDS epidemic in the 1980s and 1990s are now ageing. Due to the efficacy of highly active antiretroviral therapy, patients with HIV who receive appropriate treatment can generally expect a normal or near‐normal life expectancy. It is essential that older adults recognize the increased prevalence of HIV among their demographic and familiarize themselves with issues unique to ageing and HIV. Specifically, older adults with HIV may have unpredictable pharmacology due to a decline in liver and kidney function. As older adults are often on multiple medications for chronic conditions, they are at higher risk of drug‐drug interactions due to unpredictable drug clearance and polypharmacy. Appropriate dosing of HAART medications in older adults is an area of active research. Older adults may need more frequent laboratory monitoring of liver and kidney function than younger patients. In addition, older adults with cognitive impairment or functional mobility are at increased risk of nonadherence, leading to treatment failure. Simplified regimens, combination pills, reducing non‐essential medications, and behavioural modifications such as phone alarms and pillboxes can all help to improve adherence. Even with appropriate treatment, HIV increases the risk of dementia, bone loss, and certain cancers due to effects on the immune system. Finally, older adults may face stigmatization from their diagnosis and are at increased risk of social isolation.⁵⁷