It is essential that NPs counsel older sexually active women and men that age is not a barrier to sexually transmitted infections, including human immunodeficiency virus (HIV)/AIDS. Surprisingly, the incidence of sexually transmitted diseases, including HIV/AIDS, is growing faster among people over the age of 50 than any other age group.The Centers for Disease Control and Prevention (CDC)in the US estimated that 24% of AIDS infections in the US in 2011 occurred in people aged 50 years and older. The CDC recommendations specify routine testing for persons up to age 64. However, according to the CDC, persons 64 and older should be counseled to receive HIV testing if they have risk factors for HIV infection.

Making testing routine for older persons can provide an opportunity for the practitioner and older person to discuss risky sexual behaviors.Thus, it is prudent practice for the NP to consider that older adults are vulnerable to a late or missed diagnosis of HIV/AIDS and poorer treatment outcomes because of the misconception that they are not an at-risk population. Asking about frequency or nonuse of condoms is important because it is typical for this age group to view condom use primarily as a means of contraception.Awareness of HIV as a possible differential diagnosis in older adults is also important for NPs to keep in mind.

The first step in improving sexual health for older adults is recognizing that sexuality is an important consideration for many elders. From an NP perspective, the most critical aspect to consider in optimizing the sexual health of the older patient is to ask about it. Applying Hillman's theoretical perspectives can guide the NP clinician in assessing sexuality from a holistic perspective(ie, looking at biological, psychological, social, cultural factors, environmental, and institutional factors that may be contributing to any sexual concerns or difficulties). NPs must also acknowledge the barriers and biases that impede conversations about sexuality and consider how best to openly discuss sexual issues and safe sex practices with patients. Including sexual questions in the health history and review of systems will help identify patient concerns and factors impacting sexual health.

The NP role offers the opportunity to assist older adults in being sexually creative and expanding patients' understanding that there is more to a satisfying relationship than the purely genital approach. A loving relationship includes encouragement of couples' intimacy, sensuality, companionship, and friendship, as well helping individuals understand the effects that health, illness, medications, and treatments can have on sexual functioning. Sexual health counseling for older individuals requires a positive and respectful approach to sexuality and sexual relationships as well as the possibility of having pleasurable and safe sexual experiences, without any fear of coercion, discrimination, or intimate partner violence. For optimal sexual health to be achieved and maintained, the sexual rights of all people must be respected, protected, and fulfilled.

Amen's research supports the position that thoughtful sexual activity with a committed partner improves well-being by enhancing longevity, immune system function, joy, pain management, and sexual health. He also posited that sexual activity may be a preventive measure against the 2 leading causes of death in the US, heart disease and cancer.

Knowledge about herbal and prescribed medications that may aid a diminished libido and ED is important for all health care providers. However, the lack of FDA approval and concerns about safety, comorbidities, and polypharmacy in older adults limits both prescriptive and over-the-counter options for this problem. Knowledge of sex aids can be useful in counseling patients and their partners. If the topic is too sensitive to discuss, having an informational handout of resources may be a discrete way of imparting knowledge to your patients.

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