Sep 09, 2019
What we need to know: Developing knowledge and awareness about LGBT older adults
- Many LGBT older adults have faced a lifetime of discrimination, including within the healthcare system. These experiences have had a negative impact on their overall health and have created fear and mistrust for many when accessing care and services.
- Gender and sexuality are only two aspects of each person’s identity. It is important to consider each person’s unique needs and lifetime of experiences and influences.
- To improve sensitivity and access to services, nurses must become aware of the challenges this population has faced, avoid making assumptions based on labels and stereotypes, and gain an understanding of terminology used to describe LGBT people.
A significant number of lesbian, gay, bisexual, and transgender (LGBT) older adults have experienced a lifetime of prejudice, social stigmatization, and discrimination within the health care system (LGBT MAP & SAGE, 2010). These experiences have resulted in mistrust of health care providers and our health care system, causing fear and avoidance of services (Institute of Medicine, 2011). In order to meet the needs of this community, health care providers need to have a better understanding of how these experiences have affected the health and well-being of many LGBT older adults and recognize the barriers they face when accessing care and services.
Meeting the needs of Canada’s growing aging population presents many challenges for nurses today. We are faced with even further challenges when we take into consideration the complex generational, cultural, and individual differences within this growing demographic. LGBT older adults are a segment of the aging population that has been somewhat overlooked and misunderstood. While LGBT older adults experience the same aging challenges as the general population, they face unique challenges that many people are not aware of. Canada has made great strides in protecting the rights and freedoms of the LGBT community, with improved recognition of gender and sexual diversity in recent decades (Government of Canada, 2018). However, many older LGBT adults have lived much of their lives throughout a time in which they were openly discriminated against, treated with hostility and even violence, and were labelled as criminals or mentally ill (Brotman, Ryan, & Cormier, 2003; Fredriksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, 2013).
While LGBT older adults experience challenges with aging similar to other older adults, many face unique barriers that can erode the quality of life in their later years. The overall negative effects of social stigma and prejudice over the course of a lifetime puts many LGBT older adults at increased risk for physical and mental illnesses, including increased risk for depression and anxiety, chronic illnesses, social isolation, poverty, poor nutrition, and premature mortality.
Discrimination within the health care system has also been prevalent and continues to occur, from both health care providers and other patients. For some LGBT older adults, this has resulted in fear and mistrust, causing many of them to avoid or delay accessing necessary care and services (Fredriksen-Goldsen et al., 2013; Institute of Medicine, 2011; Mayer et al., 2008; Shipherd, Green, & Abramovitz, 2010). Research has shown that older LGBT adults are less likely to access aging care services such as meal services and seniors centres (Fredriksen-Goldsen et al., 2011). Further, services (such as home care) that involve multiple strangers entering the home can be particularly stressful (Raidix & Maingi, 2018). At a time in life when health care needs often increase in frequency and intensity, this is a serious concern.
Many LGBT older adults have also voiced concerns about moving into long-term care homes, fearing discrimination, a lack of acceptance of their sexual identity, and social isolation (Brotman et al., 2003; Purdon & Palleja, 2018). Older LGBT adults are also more likely to be single, childless, and estranged from their families of origin, leaving them with fewer supports to help them remain in their homes (LGBT MAP & SAGE, 2010).
The question we are faced with is how we can improve our sensitivity, inclusiveness, and access to health care for these at-risk older adults. The first important step is becoming aware of their history of discrimination, challenges, and barriers to care.
Information on history, discrimination, barriers to service access, and practical strategies for inclusive care, are available through numerous online sources. The National Resource Centre for LGBT Aging offers a wealth of research, practical tips, and guides for families, caregivers, and service providers, resources, and local volunteer education ambassadors. Lavender Health provides information on LGBTQ+ health information and resources for health care professionals, policy-makers, and consumers. Another resource that targets older adults, the Senior Pride Network, is a group of service provider representatives offering education, resources, and advocacy for LGBT older adults. This resource provides links to additional community agencies and services for the LGBT community. Rainbow Resource Centre also offers support for the LGBT2SQ+ community in the form of counselling, education, and programming for all ages, as well as ally education and resources. (Editors’ note: See Additional Resources section below for URLs to these sites and other resources.)
Debunking labels and stereotypes
The next step is to address any misconceptions and assumptions we may have about LGBT people in general, which are often based on labels or stereotypes. It is erroneous and harmful to assume that all LGBT older adults will look or act the same. Each LGBT older adult is an individual with unique needs and life experiences. Gender and sexuality, while important, are only two aspects of their identity—they have an entire lived experience we must consider. We must also be aware of terminology used to describe LGBT people, knowing that terminology continues to evolve, and depending on a person’s age, experiences, and cultural background, may have different meanings. By asking all patients which pronouns they use, how they prefer to be addressed, or leaving blank spaces on forms for gender, we can prevent individuals from feeling excluded, singled out, or unsafe to answer.
LGBT older adults may be less willing to share this information openly given the experiences of discrimination many have had within the healthcare system, making it crucial that we explain why we need this information. Assurances of confidentiality, and not forcing anyone to answer if they seem uncomfortable, helps to establish safety and trust for the LGBT older adult. How we ask questions about marital status—such as asking who patients consider to be family, and asking about a partner or significant other rather than a husband or wife—conveys acceptance of family diversity. Service providers can revise intake forms, emergency contact forms, and other personal documents with language that includes the LGBT community and its full spectrum of diversity. People who have a history of marginalization also often “scan the room,” or look for signs that they are in an inclusive and safe space. Including signs or posters that demonstrate diversity (such as older adults of varied race or same-sex couples), rainbow or trans flags, or advertising LGBT community events can help communicate that a space is inclusive, accepting of diversity, and safe (LGBT MAP & SAGE, 2017).
By improving our knowledge of the lived experiences and health risks faced by LGBT older adults, we take important steps in meeting their needs and giving truly person-centred care. As nurses, we can play an essential role in providing care that is safe and respectful, and that protects the dignity of LGBT older adults.
Brotman, S., Ryan, B., & Cormier, R. (2003). The health and social service needs of gay and lesbian elders and their families in Canada. The Gerontologist, 43(2), 192–202. doi:10.1093/geront/43.2.192
Fredriksen-Goldsen, K. I., Kim, H. J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103(10), 1802–1809. doi:10.2105/AJPH.2012.301110
Fredriksen-Goldsen, K. I., Kim, H. J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P., . . . Petry, H. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle, WA: Institute for Multigenerational Health.
Government of Canada. (2018). Rights of LGBTI persons.
Institute of Medicine (IOM). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.
LGBT Movement Advancement Project (MAP) & Services, Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders (SAGE). (2017). Age-friendly inclusive services. A practical guide to creating welcoming LGBT organizations. National Resource Centre on LGBT Aging.
LGBT Movement Advancement Project (MAP) & Services, Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders (SAGE). (2010). Improving the lives of LGBT older adults.
Mayer, K. H., Bradford, J. B., Makadon, H. J., Stall, R., Goldhammer, H., & Landers, S. (2008). Sexual and gender minority health: What we know and what needs to be done. American Journal of Public Health, 98(6), 989–995.
Purdon, N., & Palleja, L. (2018, June 28). “We’re going back into the closet”: LGBTQ seniors wary of being “out” in long-term care facilities. Canadian Broadcasting Corporation.
Radix, A. & Maingi, S. (2018). LGBT Cultural competence and interventions to help oncology nurses and other health care providers. Seminars in Oncology Nursing, 34(1), 80–89.
Shipherd, J. C., Green, K. E., & Abramovitz, S. (2010). Transgender clients: Identifying and minimizing barriers to mental health treatment. Journal of Gay & Lesbian Mental Health, 14(2), 94–108.