Sue Malta

Objective: To explore whether sexual health is discussed in regional settings between primary care clinicians (General Practitioners (GPs) and Practice Nurses (PNs)) and older patients (aged 60 and over), and the barriers and enablers of sexual healthcare for older adults in regional areas. Setting: Participants were based throughout regional Victoria, with all five regions of Victoria represented. Participants: Two participant groups were included: older adults aged 60 and over, and primary care clinicians (GPs and PNs). Nine older adults (5 women, 4 men, ranging in age from 60 to 87 years), and 8 clinicians (4 women, 4 men, 6 GPs and 2 PNs) were interviewed. Design: Data were collected via semi‐structured interviews between July and December 2024. Data were analysed using qualitative content analysis. Results: Sexual health conversations were rare and ad‐hoc between older adults and primary care clinicians. Key barriers for both groups included stigma around sexual activity and ageing, privacy concerns in small communities, high staff turnover, and structural challenges such as cost and time. Key enablers for both groups included telehealth, systematic inclusion of sexual health in routine care such as the 75+ health check, training for regional clinicians, and health promotion campaigns for older adults living regionally. Conclusion: Older adults and primary care clinicians agree that sexual health is important to older adults' quality of life, although such conversations are rarely prioritised. This study offers suggestions for clinicians to broach sexual health so that it stays on the agenda as part of older patients' overall care within regional primary care.

Sexual expression is important to many older adults, but this population may be overlooked by sexual health campaigns and services. This study sought to understand the sexual health information-seeking behaviors and preferences of older adults, including whether and where they seek this information, the characteristics associated with seeking it, as well as satisfaction, preferences, and reasons for not seeking it. The data were gathered in 2021 via a cross-sectional online survey of Australians aged 60 and over. There were seven quantitative outcomes and one set of free-text comments. Quantitative outcomes were analyzed using descriptive statistics, chi² test, and logistic regression. The free-text comments were analyzed using qualitative content analysis. The survey sample was comprised of 1,470 respondents with an equal balance of men (49.9%) and women (49.7%) and a median age of 69 years (range of 60–92 years). Findings showed that 41.2% (602/1,461; 95%CI 38.7–43.7) had sought information, and 63.6% were satisfied with the information found. Being male, STI testing, online dating, age 70–79, and urban-living were associated with information-seeking. Healthcare providers were the most utilized and trusted information source, and many respondents were willing to look online. One in five did not seek information when they needed it, outlining various barriers preventing them from doing so. Many older adults seek sexual health information, and with some experiencing access barriers and one-third unsatisfied, there is room for improvement. Relevant, accessible information should be provided by healthcare professionals and credible websites.

Background: Sexual health research rarely includes older age groups and the sexual health needs of older Australians are not well understood. Older adults are online in increasing numbers; however, internet surveys involving samples of older adults and sensitive topics remain uncommon. In 2021, we developed an online survey to explore the sexual health needs of Australians aged 60+ years. We describe here survey recruitment and sample obtained, comparing it with national population data (Australian Bureau of Statistics) and the sample of the similar ‘Sex, Age and Me’ study from 2015. Methods: We recruited 1470 people with a staggered three-phase strategy: (1) emails to organisations and community groups; (2) paid Facebook advertising; and (3) passive recruitment. Half (50.6%) found out about the study via an organisation or group and just over a third (35.7%) from Facebook. Results: The sample was equally balanced between men (49.9%) and women (49.7%) (0.4% other gender identities). Participants were aged 60–92 years (median 69 years) with all Australian States/Territories represented. Facebook recruits were younger, more likely to be working rather than retired, and more likely to live outside a major city, than those recruited by other means. Conclusions: Using the recruitment methods described, we successfully obtained a diverse and fairly representative sample of older Australians within the constraints of a convenience sample and on a modest budget. This research sheds light on ways to engage an under-served demographic in sexual health research. Our experience shows that many older adults are amenable to recruitment for online sexual health surveys using the approaches outlined.

Background: Our objective was to explore what people receiving and providing care consider to be ‘good’ in-home care for people living with dementia. Methods: We conducted 36 in-depth interviews and two focus groups with key stakeholders in Australia in the first quarter of 2018. Participants included those receiving care (4 people living with dementia, 15 family carers) or providing care (9 case managers, 5 service managers, 10 home care workers). Qualitative thematic analysis was guided by Braun and Clarke’s six-step approach. Results: Consensus was reached across all groups on five themes considered as important for good in-home dementia care: 1) Home care workers’ understanding of dementia and its impact; 2) Home care workers’ demonstrating person-centred care and empathy in their care relationship with their client; 3) Good relationships and communication between care worker, person with dementia and family carers; 4) Home care workers’ knowing positive practical strategies for changed behaviours; 5) Effective workplace policies and workforce culture. The results contributed to the co-design of a dementia specific training program for home care workers. Conclusions: It is crucial to consider the views and opinions of each stakeholder group involved in providing/receiving dementia care from home care workers, to inform workforce training, education program design and service design. Results can be used to inform and empower home care providers, policy, and related decision makers to guide the delivery of improved home care services. Trial registration: ACTRN 12619000251123.

Background: Home care service providers are increasingly supporting clients living with dementia. Targeted and comprehensive dementia-specific training for home care staff is necessary to meet this need. This study evaluates a training programme delivered to care staff (paid personal carers) of clients living with dementia at home. Methods: This study is a pragmatic stepped-wedge cluster-randomised controlled trial (SW-CRT). Home care workers (HCWs) from seven home care service providers are grouped into 18 geographical clusters. Clusters are randomly assigned to intervention or control groups. The intervention group receives 7 h of a dementia education and upskilling programme (Promoting Independence Through quality dementia Care at Home [PITCH]) after baseline measures. The control group receives PITCH training 6 months after baseline measures. This approach will ensure that all participants are offered the program. Home care clients living with dementia are also invited to participate, as well as their family carers. The primary outcome measure is HCWs’ sense of competence in dementia care provision. Discussion: Upskilling home care staff is needed to support the increasing numbers of people living with dementia who choose to remain at home. This study uses a stepped-wedge cluster-randomised trial to evaluate a training programme (PITCH) for dementia care that is delivered to front-line HCWs. Trial registration: anzctr.org.au; ACTRN12619000251123. Registered on 20 February 2019.

Australia introduced ‘lockdown’ measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive heal... 目的：澳大利亚在2020年3月22日实施了长达2月的“封锁”措施以控制COVID-19。我们旨在调查这次封锁对性与生殖健康（SRH）的影响。材料与方法：于2020年4月23日至5月11日纳入18岁以上澳大利亚人参加线上调查。我们报告了518名年龄<50岁女性的经历。使用描述性统计分析生育意愿和避孕措施的使用。结果：大多数参与者年龄在18-24岁, 并表明她们在避孕。口腔避孕药是最常见的单一方...

Background: This study examined trends in chlamydia, gonorrhoea and syphilis diagnosis, and chlamydia testing and positivity, among older women in Australia between 2000 and 2018. Methods: Using national notifiable disease data and Medicare data, diagnosis rates were calculated for each sexually transmissible infection (STI), as well as testing and positivity rates for chlamydia. Data were compared between two older groups (55–64 and 65–74 years) and two younger groups (15–24 and 25–34 years). Poisson regression examined trends for 2000–18 and 2014–18 separately. Results: Rates for all STIs increased across all age groups and were highest in the two youngest age groups. From 2014 to 2018, chlamydia rates increased the most among those aged 55–64 years [incidence rate ratio (IRR) = 1.06; 95%CI: 1.02–1.10] and declined in those aged 15–24 years (IRR = 0.99; 95%CI: 0.99–0.99). Gonorrhoea rates increased the most among those aged 65–74 years (IRR = 1.47; 95%CI: 1.23–1.77) and least in those aged 15–24 years (IRR = 1.12; 95%CI: 1.10–1.13). Syphilis rates increased the most among those aged 55–64 years (IRR = 1.58; 95%CI: 1.25–1.99) and least in those aged 15–24 years (IRR = 1.29; 95%CI: 1.23–1.35). Chlamydia test positivity declined among younger women but remained stable in older women. Conclusions: In general, STIs are increasing among older women in Australia at a faster rate than among younger women. Although the greatest burden is among younger women, STIs need to be considered and monitored among older women.

Introduction Australia recorded its first case of COVID-19 in late January 2020. On 22P March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. Methods An online survey was open from the 23PP April 2020 to 11P May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (diff) (including 95% CIs) in the proportion of sex practices between time periods. Results Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall, 70% were female and 66.3% were aged 18–29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; diff=6.4%; 95% CI 3.6 to 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=−3.3%; 95% CI −7.0 to -0.4) or with casual hook-up (31.4% vs 7.8%; 95% CI −26.9 to -19.8). Solo sex activities increased; 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; diff= −14.8%; 95% CI −17.6 to -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95% CI 1.0 to 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95% CI 10.1 to 19.2) increased during lockdown. Conclusion Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

Introduction: Australia recorded its first case of COVID-19 in late January 2020. On 22 ^nd March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help ‘flatten the curve’. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. Methods: An online survey was open from the 23 ^rd April 2020 to the 11 ^th May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (including 95% confidence intervals) in the proportion of sex practices between time periods. Results: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall 70% were female and 66.3% were aged 18 to 29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; difference=6.4%; 95%CI: 3.6, 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95%CI: -7.0, -0.4) or with casual hook-up (31.4% vs 7.8%; 95%CI:-26.9, -19.8). Solo sex activities increased, 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; difference= -14.8%; 95%CI: -17.6, -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95%CI:1.0, 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95%CI:10.1, 19.2) increased during lockdown. Conclusion: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities during the pandemic, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies. KEY MESSAGES: Sexual activity declined among our participants during the COVID-19 lockdown restrictions in Australia, with more than half reporting having less sex than in 2019 Sexual practices also changed during lockdown, with more people reporting solo sex activities like masturbating alone or using a sex toy. Use of dating apps also declined among our participants. Of those still using apps, we saw increased use for chatting/texting and setting up virtual dates.