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.

References

  1. American Psychological Association. Guidelines for psychological practice with lesbian, gay, and bisexual clients. Am Psychologist. 2012;67(1):10-42. doi: 10.1037/a0024659
  2. Department of Gender, Women, and Health. Gender mainstreaming for health managers: a practical approach. Geneva: World Health Organization; 2011. http://apps.who.int/iris/bitstream/10665/44516/1/9789241501071_eng.pdf. Accessed April 26, 2017.
  3. Merriam-Webster Dictionary. Definition of gender. http://www.merriam-webster.com/dictionary/gender. Accessed April 26, 2017.
  4. Mayer KH, Bradford JB, Makadon HJ, Stall R, Goldhammer H, Landers S. Sexual and gender minority health: what we know and what needs to be done. Am J Public Health. 2008;98(6):989-995. doi: 10.2105/AJPH.2007.127811
  5. Cruz, T. Assessing access to care for transgender and gender nonconforming people: A consideration of diversity in combating discrimination. Soc Sci Med. 2014;110:65-73. doi: 10.1016/j.socscimed.2014.03.032
  6. Bockting W, Coleman E, Deutsch MB, et al. Adult development and quality of life of transgender and gender nonconforming people. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):188-197. doi: 10.1097/MED.0000000000000232
  7. Oxford Dictionaries. Definition of cisgender. http://www.oxforddictionaries.com/us/definition/american_english/cisgender. Accessed April 26, 2017.
  8. Vincent GA, Velkoff VA. The next four decades, the older population in the United States: 2010 to 2050. Current population reports. Washington, DC: US Census Bureau; 2010. https://www.census.gov/prod/2010pubs/p25-1138.pdf. Accessed April 26, 2017.
  9. Fredriksen-Goldsen KI, Emlet CA, Kim HJ, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. Gerontologist. 2013;53(4):664-675. doi: 10.1093/geront/gns123
  10. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press; 2011. https://www.nap.edu/read/13128/chapter/1. Accessed April 27, 2017.
  11. Gates, W. How many people are lesbian, gay, bisexual, and transgender? Los Angeles, CA: Williams Institute; 2011. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Gates-How-Many-People-LGBT-Apr-2011.pdf. Accessed April 27, 2017.
  12. Orel NA. Investigating the needs and concerns of lesbian, gay, bisexual, and transgender older adults: the use of qualitative and quantitative methodology. J Homosex. 2014;61(1):53-78. doi: 10.1080/00918369.2013.835236
  13. Cahill S, South K, Spade J. Outing age: Public policy issues affecting gay, lesbian, bisexual and transgender elders. Washington, DC: National Gay and Lesbian Task Force; 2000. http://www.thetaskforce.org/static_html/downloads/reports/reports/outingage_final.pdf. Accessed April 27, 2017.
  14. Fredriksen-Goldsen KI. Caregiving with pride. Binghamton, NY: Haworth Press; 2007.
  15. Espinoza R. Out & visible: the experiences and attitudes of lesbian, gay, bisexual and transgender older adults, ages 45-75. New York: Services and Advocacy for GLBT Elders; 2014. http://www.sageusa.org/files/LGBT_OAMarketResearch_Rpt.pdf.
  16. 1Fredriksen-Goldsen KI, Kim H-J, Emlet CA, et al. The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Seattle: Institute for Multigenerational Health; 2011. http://caringandaging.org/wordpress/wp-content/uploads/2011/05/Full-Report-FINAL-11-16-11.pdf. Accessed April 26, 2017.
  17. MetLife Mature Market Institute. Still out, still aging: The MetLife study of lesbian, gay, bisexual and transgender baby boomers, New York: MetLife Mature Market Institute; 2010. https://www.metlife.com/assets/cao/mmi/publications/studies/2010/mmi-still-out-still-aging.pdf. Accessed April 26, 2017.
  18. Sagie, O. Well-being in older gays and lesbians: a comparison of predictors. Soc Indic Res. 2015;126(1):395-409. doi: 10.1007/s11205-015-0894-9
  19. Hughes AK, Harold RD, Boyer JM. Awareness of LGBT aging issues among aging services network providers. J Gerontol Soc Work. 2011;54(7):659-677. doi: 10.1080/01634372.2011.585392
  20. Tinney J, Dow B, Maude P, Purchase R, Whyte C, Barrett C. Mental health issues and discrimination among older LGBTI people. Int Psychogeriatr. 2015;27(9):1411-1416. doi: 10.1017/S1041610214002671
  21. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex. 2011;58(1):10-51. doi: 10.1080/00918369.2011.534038
  22. Balsam KF, Beauchaine TP, Mickey RM, Rothblum ED. Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family. J Abnorm Psychol. 2005;114(3):471-476. doi: 10.1037/0021-843X.114.3.471
  23. King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8:70. doi: 10.1186/1471-244X-8-70
  24. D’Augelli AR, Grossman AH. Disclosure of sexual orientation, victimization, and mental health among lesbian, gay, and bisexual older adults. J Interpersonal Violence. 2001;16:1008-1027. doi: 10.1177/088626001016010003
  25. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, Hoy-Ellis CP. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. Am J Public Health. 2013;103(10):1802-1809. doi: 10.2105/AJPH.2012.301110
  26. Fredriksen-Goldsen KI, Emlet CA, Kim HJ, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. Gerontologist. 2013;53(4):664-675. doi: 10.1093/geront/gns123
  27. Fredriksen-Goldsen KI, Kim HJ, Shiu C, Goldsen J, Emlet CA. Successful aging among LGBT older adults: physical and mental health-related quality of life by age group. Gerontologist. 2015;55(1):154-168. doi: 10.1093/geront/gnu081
  28. Leonard W, Pitts M, Mitchell A, et al. Private lives 2: the second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT). Melbourne: Australian Research Centre in Sex, Health and Society; 2012. http://www.glhv.org.au/files/PrivateLives2Report.pdf. Accessed April 26, 2017.
  29. McFarland PL, Sanders S. A pilot study about the needs of older gays and lesbians: what social workers need to know. J Gerontol Social Work. 2003;40:67-80. doi: 10.1300/J083v40n03_06
  30. Stein GL, Beckerman NL, Sherman PA. Lesbian and gay elders and long-term care: identifying the unique psychosocial perspectives and challenges. J Gerontol Socl Work. 2010;53:421-435. 10.1080/01634372.2010.496478
  31. Guasp A. Lesbian, Gay and Bisexual People in Later Life. London: Stonewall; 2011.
  32. Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, et al. Physical and mental health of transgender older adults: an at-risk and underserved population. Gerontologist. 2014;54:488-500. doi: 10.1093/geront/gnt021
  33. Ettner R, Wylie K. Psychological and social adjustment in older transsexual people. Maturitas. 2013;74(3):226-229. doi:10.1016/j.maturitas.2012.11.011
  34. Fredriksen-Goldsen KI, Kim HJ, Goldsen J.  The health report: Resilience and disparities among lesbian, gay, bisexual and transgender older adults—Preliminary findings. Seattle, WA: University of Washington, Institute for Multigenerational Health; 2011.
  35. Grant J, Motte M, Tanis J, Harrison J, Keisling H, Keisling M. Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011. http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf. Accessed April 26, 2017.
  36. Witten TM, Eyler AE, Ettner R, Monstrey S, Eylered AE. Transgender aging and the care of the elderly transgendered patient. Principles of transgender medicine and surgery. New York: The Haworth Press; 2007;343-372.
  37. Shell JA. Sexual issues in the palliative care population. Sem Oncol Nurs. 2008;24:131-134. doi: 10.1016/j.soncn.2008.02.007
  38. Griebling T L. Sexuality and aging: a focus on lesbian, gay, bisexual, and transgender (LGBT) needs in palliative and end of life care. Curr Opin Support Palliat Care. 2016;10(1):95-101. doi: 10.1097/SPC.0000000000000196
  39. Redelman MJ. Is there a place for sexuality in the holistic care of patients in the palliative care phase of life? Am J Hospice Palliat Med. 2008;25:366-371. doi: 10.1177/1049909108318569
  40. Duffy F, Healy JP. A social work practice reflection on issues arising for LGBTI older people interfacing with health and residential care: rights, decision making and end-of-life care. Soc Work Health Care. 2014;53(6):568-583. doi: 10.1080/00981389.2014.914119
  41. Cartwright C, Hughes M, Lienert T. End-of-life care for gay, lesbian, bisexual and transgender people. Culture Health Sex. 2012;14:537-548. doi: 10.1080/13691058.2012.673639
  42. Cagle JG, Bolte S. Sexuality and life-threatening illness: implications for social work and palliative care. Health Soc Work. 2009;34(3):223-233. doi: 10.1093/hsw/34.3.223
  43. Bern-Klug M, Gessert C, Forbes S. The need to revise assumptions about the end of life: implications for social work practice. Health Soc Work. 2001;24:38-48. doi: 10.1093/hsw/26.1.38
  44. Harding R, Epiphaniou E, Chidgey-Clark J. Needs, experiences, and preferences of sexual minorities for end-of-life care and palliative care: a systematic review. J Palliat Med. 2012;15(5):602-611. doi: 10.1089/jpm.2011.0279
  45. Cornwell B, Laumann EO, Schumm LP. The social connectedness of older adults: A national profile. Am Sociol Rev. 2008;73:185-203. doi: 10.1177/000312240807300201
  46. Erosheva EA, Kim HJ, Emlet C, Fredriksen-Goldsen KI. Social networks of lesbian, gay, bisexual, and transgender older adults. Res Aging. 2016;38(1):98-123. doi: 10.1177/0164027515581859
  47. Lawton A, White J, Fromme EK. End-of-life and advance care planning considerations for lesbian, gay, bisexual, and transgender patients. J Palliat Med. 2014;17(1):106-108. doi: 10.1089/jpm.2013.9457
  48. Stausmire JM. Sexuality at the end of life. Am J Hospice Palliat Care. 2004;21:33-39. doi:10.1177/104990910402100109

This article originally appeared on Psychiatry Advisor

Topics:

General Psychiatry Geriatric Illnesses LGBT