In this article, I’ll review some key points about the health of LGBTQ+ elders, and what health professionals can do to make sure that sexual identity doesn’t get in the way of excellent Geriatric care.
Facts about LGBTQ+ elders:
- 20 % of LGBTQ+ elders don’t disclose their sexual orientation for fear of not getting the health care they need
- LGBTQ+ elders are more likely to be living with disability, social isolation, and mental distress than their heterosexual counterparts
- In the US, LGBTQ+ elders are less likely to have health insurance and may be more likely to have financial barriers when it comes to healthcare access. (Source: LGBT-Aging-A-Review.pdf (lgbtagingcenter.org)
Understanding Health Disparities
According to the Aging and Health Report (Disparities and Resilience among Lesbian, Gay, Bisexual and Transgender Older Adults), an unfortunate by-product of homophobia (and bi- and transphobia) is a negative effect on health parameters. The older the LGBTQ+ person, the longer they have been living with discrimination, which may contribute to the increased rate of smoking, alcohol overconsumption, depression, and cardiovascular disease in this group, compared to non-LGBTQ+ elders. Lesbians and bisexual older women are more likely to be living with obesity and cardiovascular disease than non-LGBTQ+ women, and gay and bisexual men are more likely to have poor physical health compared to men who identify as heterosexual.
Lesbian, gay, and bisexual adults are more likely to be living with a disability and less likely to be partnered later in life, and gay men are less likely to have children in their household, making their mix of care partners more likely to be composed of friends and neighbours, or “families of choice” rather than biologically related family.
There do appear to be some protective factors associated with homosexuality, and both gay men and lesbians are more likely to be tested for HIV. Gay men are less likely to be obese and more likely to get a flu shot, for example. And homosexual older adults are also a resilient group, with 91% regularly engaging in wellness activities, and 94% having a primary care provider.
What Health Providers Need to Know
1. Be aware of your own biases. Learning more about LGBTQ+ issues can foster genuine empathy when working with a lesbian, gay, bisexual or transgender person in a healthcare setting. The National Resource Center on LGBT Aging (lgbtagingcenter.org) is a great place to start.
2. Ask about sexuality. Little more than half of Geriatricians ask about the sexual health of their older patients, let alone about sexual orientation. Making sexual health a part of your Review of Systems checklist is a good way to ensure that your patient knows you are aware that this is an important part of their life and are open to talking about it with them.
3. Avoid assuming a person’s sexual orientation and/or gender identity. It’s OK to ask how the person wishes to be addressed and which pronouns they prefer and be sure to document and refer to the person in their preferred manner when making notes or handing over to other medical team members. A good practice is to ask ALL clients about these components of their identity, rather than relying on visual or language clues to determine if a person is a member an LGBTQ+ community.
4. Learn the terms associated with sexual orientation, gender identity, relationships, and health. Using the correct language will affirm acceptance of LGBTQ+ individuals and ensure clarity in health interactions. The National Resource Center on LGBT aging has a good document with a list of common terms and definitions.
5. Become familiar with the concept of Intersectionality. “An Intersectional Approach to Services and Care for LGBT Elders” is a great introduction to the topic as it related to older adults. This term refers to the potential for an older person to belong to more than one marginalized community – they may be lesbian, and also transgender, African American, disabled and living in poverty. This might amplify the challenges associated with each one of these characteristics and may require a specialized approach to develop a medical management plan.
6. Consider LGBTQ+ perspectives when setting up health services and networks for older adults. Enlist elders who are part of the lesbian, gay, bisexual and transgender communities to lend their voices to any project that involvers delivery of health services to elders.
Take Home Messages:
- Approximately 1 in 100 elders are LGBTQ+
- Gay, lesbian, bisexual and trans older adults are at higher risk for social isolation, disability, financial challenges, and mental distress than their non-LGBTQ+ counterparts
- To deliver the best Geriatric care, providers need to be aware of their own biases, learn more about the LGBTQ+ culture, and practice in a way that is inclusive and person-centered.
Related Articles and Videos:
Video: GERI-Minute#134 - What do you need to know about Gender?
Podcast :Sex and Seniors Part 3 - Sex and the Changing Brain
Article from the Journal "Geriatric Nursing", May 2015: Care of LGBTQ+ older adults: What geriatric nurses must know
Aging and Health Report (Disparities and Resilience among Lesbian, Gay, Bisexual and Transgender Older Adults)
National Resource Center on LGBT Aging (lgbtagingcenter.org)