Importance of Social Networks for LGBTQ Elders

In general, as people age, the size of their support system decreases.27,45 Social network size shrinks for older LGBTQ members as well.27 Because older LGBTQ adults are less likely to marry, partner, or have children than older heterosexual individuals, the social networks of older LGBTQ individuals may be comprised more of peers and friends than partners, spouses, or children.25,27 

There is an inverse relationship between social network size and depression, disability, and poor general health among LGB elders.24,46 In addition, for LGB elders, increased social networks weaken the connection between internalized stigma and poor general health.25,46


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Addressing Disparities and Barriers to Healthcare Access

To address disparities and barriers to healthcare access, it is important that healthcare providers bring up sexuality with their patients, as it is a difficult conversation for patients to initiate. Moreover, it is important to provide an “open and affirming practice style” to allow for older LGBTQ patients to feel more comfortable disclosing information regarding their sexuality.38 

It is important for clinicians to guarantee privacy, confidentiality, and professionalism with each interaction.47 When approaching sexuality and end-of-life care, providers should be nonjudgmental and purposefully use language that is applicable to any sexual orientation.39,49 

Clinicians should allow for patients to communicate their needs and desires to whatever extent they would like.38,48 It is imperative that providers ask for patients’ gender pronouns, which may include he, she, they, and so on. It is important to remember that one’s sexual orientation and gender identity may have changed and may continue to change with time.

Needs for Future Research

According to the Centers for Disease Control and Prevention, there is a huge need for research regarding sexual orientation and its relation to health disparities. Regarding palliative care for the LGBTQ community, a literature review noted that very few papers focused on the bisexual and transgender populations.44 

In general, there is a greater need for research on caring for older bisexual and transgender populations. In addition, there is a lack of research on caring for older gender nonconforming individuals who do not identify with the gender binary, as much of the existent research focuses on transitioning from 1 binary gender to another through hormone therapy or sex confirmation surgery. 

Research on the most effective training and protocols for providers is also necessary to ensure LGBTQ patients feel respected by providers. There is also a need for research on the effect of the national legalization on same sex marriage by the US Supreme Court in June 2015 and its effect on healthcare provision for older LGBTQ individuals. 

Research is needed to understand the differences and intersectionality of older LGBTQ individuals based on race, socioeconomic status, ethnicity, and so on, and how these statuses interact with one another. Finally, further research should be conducted from the perspective of older LGBTQ individuals on how providers can best care for them.

Conclusions

Older LGBTQ individuals face significant disparities, discrimination, and stigmatization. They experience disparities in healthcare as a whole, including in mental health and palliative care. There are greater rates of depression, anxiety, obesity, smoking, disability, and poor general health among this population. 

Increased social networks can be helpful in minimizing some of the disparities, but healthcare providers need to play a greater role as well. Members of this population are fearful of discrimination by healthcare providers, and some will avoid care for this reason. There is a need for greater research on caring for older LGBTQ adults and how to ensure the provision of the best possible care for them.

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This article originally appeared on Psychiatry Advisor