Geriatric Experts Say Doctors Must Talk to Older Patients More About Sex

Kay Mautz, a 69-year-old divorcee from LeGrange Park, Ill., says that she can’t remember the last time she had sex.

“If I knew it was going to be the last time for a while, I wish I would have enjoyed it more,” she said.

Mautz recalls having sex about once a week in her younger years. Now no longer sexually active, she attributes the decline to the fact that she no longer has a trustful relationship — plus, she thinks men her age are “not particularly attractive.”

But while many seniors like Mautz report a decline in sex as they get older, a new study shows that a significant number of older Americans are still having it — in many cases, well into their 80s.

Yet doctors don’t appear to be talking to their older patients about sex — a trend that may have to change as more treatments for age-related sexual dysfunction become available.

“Sex among older adults is the last taboo in the United States,” said Dr. Virginia Sadock, professor of psychiatry and director of the Program of Human Sexuality at New York University.

The study, released Wednesday in the New England Journal of Medicine, surveyed 3,005 men and women in the United States over the age of 57. Researchers hoped to better understand the decline in sexual activity as one ages, as well as the differences between the sex lives of older men and older women.

What they found was that among adults 57 to 64 years of age, 73 percent reported recent sexual activity.

That number declined to 53 percent among those aged 65 to 74 and to 26 percent among those who were 75 to 85 years old.

But although the percentage of individuals who are sexually active decreases with age, the study highlights the fact that a “substantial number of men and women continue to engage in sexual activity.”

Lead study author Dr. Stacey Lindau, an obstetrician and gynecologist at the University of Chicago, said a general lack of basic information on sexuality and the elderly prompted her to look for more information in this area.

“When I asked questions in my practice [about sexuality], I found that people had a lot to say,” she said. “They also said, ‘No one ever asked me that before.’”

Dr. Robert Butler, professor of geriatrics and director of the International Longevity Center in New York, thinks this study presents an important message.

“Clinicians need to realize that older individuals are still sexually active,” said Butler, who was not affiliated with the study.

A New Look at Old Sex

Butler also thinks the age range of the patients in the study is important because it includes individuals older than 59.

“That is the maximum age that prior research had looked at” regarding sexuality and adults, he said.

But as aging baby boomers progress into their 60s and 70s, Lindau said, such research is becoming more relevant to the population as a whole.

“There is an aging population in the United States, and we need to know about their sexuality and health,” she said.
(more…)

Our correspondent on the ethical – and personal – dilemmas in the consulting room

A heavy drinker facing a teetotal GP will be familiar with that frisson of disappoval – especially since the advent of the blood test betrayed the lies about how many units have been consumed. A woman with an inconvenient pregnancy who asks a Catholic doctor for an abortion will know the same feeling; as will the odd – one uses the word advisedly – Jehovah’s Witness who is admitted to Accident and Emergency and refuses a blood transfusion.

Doctors, for their part, face just as unpleasant an encounter with those patients unable to hide their dislike at being treated by someone who is black, Catholic, Jewish, Muslim, gay, foreign or female.

Never was the irony of this conflict zone better encapsulated than in the case, some years ago, of a member of an exceedingly posh Scottish golf course who had a heart attack. The female doctor who rushed to treat him was initially ejected from the clubhouse because she had used the men-only entrance.

Up until now, though, both patients and professionals have tended to muddle through. And generally patients have become more tolerant – or at least less vocal in their intolerance – than they were.

In all this, doctors have relied on longstanding advice from the General Medical Council (GMC), which requires them to treat patients with respect, whatever their life choices and beliefs. If carrying out a particular procedure conflicts with a doctor’s belief, he or she has been obliged to tell patients this and to make sure they understand that they can see another doctor.

But this simple advice is no longer sufficient in a more complicated world, where religion casts its cloud more darkly than ever. Militancy of belief is increasingly pressing. When airport check-in staff fight to wear a cross, and teachers go to court to wear a veil, we know we live in a challenging world.

In all too many instances, the medical profession is at the sharp end. As if we needed reminding, last week a 53-year-old consultant paediatrician, Victoria Anyetei, was fatally stabbed in her car in her driveway in Dartford. Police are to investigate her patients’ relatives.

The new conflicts in medicine include the signing of cremation certificates; the wearing of the veil; offering IVF to gay patients, circumcision and gender reassignment. Old problems, specifically abortion, have intensifed. (Did you know, for instance, that some doctors now refuse to offer either abortion or contraception, and advertise this fact in leaflets in their practice? Almost like that old pub sign: please do not ask for credit as refusal often offends.)

The GMC, responding to a growing number of pleas for help, has reviewed its practical guidance and been specific for the first time on some issues. The new code has gone out for consultation on www.gmc-uk.org and meaty stuff it is.

Some Muslim doctors, according to the tenets of their faith, are unwilling to sign cremation certificates. On this, the GMC is admirably hardline, declaring that doctors, regardless of their religious objection to cremation, must sign, largely because delay could cause unnecessary distress.

Veils – as worn by doctors, not patients – are another area of contention. The GMC has recently received a considerable number of inquiries from hospital managers and doctors asking for advice on this.

Its view, the result of long internal discussions, is that doctors must respond to a patient’s individual needs and overcome any barrier to effective communication. To do this may require them to set aside personal and cultural preferences. In other words, take it off if it’s an issue for the patient. Cop out or clever solution? There will certainly be patients unable to express their unease, and what of their rights?
(more…)

Ads for prescription drugs: you see them on TV, online and in magazines and newspapers.

Drug companies are spending a huge and growing amount of money on those ads in spite of criticism.

“The impact of it is to create anxiety, to create people thinking they might have a condition they don’t have,” Dr. Joshua Freeman said.

Drug companies spent more than $4 billion on prescription drug ads in 2005. That was the last year covered in a new report in the New England Journal of Medicine. Since 1996, the spending by drug companies on these ads has increased more than three-fold.

The report says most of the ads are for newer drugs, more expensive drugs, to treat long-term conditions.

The report found the more than $4 billion spent on ads was still far less than the $18 billion spent on drug samples and the $7 billion on marketing to health professionals. That includes the gifts drug companies offer doctors.

Those gifts and talks by drug reps have largely been banned in the family medicine clinic at the University of Kansas Hospital.

“We believe the best way for physicians to learn about drugs is through legitimate scientific channels,” Dr. Freeman said.

The report says FDA oversight of the ads is weak.

The drug manufacturers group says the report overlooks the key role the ads play in “improving patient understanding of disease and available treatments.”

(see original)

Public Interest Watch (PIW) (www.publicinterestwatch.org)has just called it’s attention to a video which it believes is seemingly contradictory to testimony in sworn depositions presented in pending West Virginia medical malpractice lawsuits (Putnam Circuit Court, West Virginia).

Los Angeles, CA (PRWEB) August 3, 2007 — Public Interest Watch (PIW) (www.publicinterestwatch.org)has just called it’s attention to a video which it believes is seemingly contradictory to testimony in sworn depositions presented in pending West Virginia medical malpractice lawsuits (Putnam Circuit Court, West Virginia). The video can be viewed at: http://youtube.com/watch?v=Ai8T8mhCGuA

The link was published August 1 in the West Virginia Record (www.wvrecord.com). According to the article, Dr. John King was suspended in May 2003 by Putnam General.

“A look at the video could lead one to believe it’s the personal injury lawyers who need credentialing,” said Steve Cohen, executive director of West Virginia Citizens against Lawsuit Abuse (WV CALA), a grassroots legal watchdog group. “Lawsuit mills like what it appears we may have here are a major reason this state has a reputation as a ‘judicial hellhole.’”

PIW is a 501(c)4 tax-exempt organization, which means contributions to PIW are not tax-deductible. Initial funding for PIW has been provided by business organizations.

Research favors other drugs to control hypertension

Doctors should stop routinely using beta-blockers to control high blood pressure, said researchers who reviewed dozens of previously published studies and found that other hypertension pills work better and cause fewer side effects.

For decades, beta-blockers and diuretics, also known as water pills, constituted the cornerstone of treatment for the 50 million Americans with high blood pressure. But a growing body of medical evidence shows that diuretics and newer blood-pressure medications are superior to beta-blockers at reducing high blood pressure, which can lead to heart attacks and strokes, said researchers whose report appeared yesterday in the Journal of the American College of Cardiology.

“We in medicine like to say that we practice evidence-based medicine,” said Dr. Franz H. Messerli, an author of the study and a cardiologist at St. Luke’s-Roosevelt Hospital in New York. “What’s the evidence here” for continued use of beta-blockers to treat hypertension, Messerli asked. “Zero. To my way of thinking, this is pretty alarming.”

Heart specialists not involved with the study predicted that it is likely to accelerate a shift in hypertension treatment from beta-blockers, which can cause side effects such as fatigue and sexual dysfunction.

Still, those doctors as well as the authors of the study emphasized that there is strong evidence to support prescribing beta-blockers for patients who have suffered a heart attack or those with a progressive weakening condition called heart failure.

Data from IMS Health, a healthcare information company, show that from January through June of this year, more than 75 million prescriptions were written for various beta-blockers, widely available in generic form. The statistics do not indicate which conditions the doctors were treating.
(more…)