It is critical to keep an open mind and accepting attitude when discussing sexuality or intimate issues with older patients. Paying attention to patients’ verbal and nonverbal cues is also essential. Clinicians should never assume older adults are sexually inactive, no longer care about sex, or are necessarily heterosexual. There was an excellent article in the Journal of Family Practice a few years ago on “How to discuss sex with elderly patients” that is worth rereading. In it, the authors suggest using the PLISSIT model to facilitate a conversation with your elderly patient. As explained in the article, the acronym “is a reminder to seek Permission to discuss sexuality, share Limited information about sexual issues that affect the older adult, provide Specific Suggestions to improve sexual health, and offer to provide a referral for Intensive Therapy if needed.”4 The Table offers some examples of how to address each step of PLISSIT.
So, as we wrap up our examination of this issue, I encourage you to open this dialogue with your older patients. In light of the increasing number of older patients with STIs, it is essential for clinicians to obtain an accurate and complete sexual history for patients of any age. That starts with asking the appropriate questions, preferably in a manner that puts the patient at ease to share important details. If you have additional ideas about what we can do to reverse this STI trend, please share them with me at PAeditor@MDedge.com.