There is a great disparity regarding access and completion of medical care. It is an issue that affects LGBTQIA+ people in particular (Frediksen-Golden et al., 2018). LGBTQIA+ is an acronym for lesbian, gay, bisexual, transgender, queer or questioning, intersex person, asexual, that is, to refer to non-heterosexual, non-cisgender, or non-dyadic individuals (Defining LGBTQ, s. d.). In other words, these terms are used to describe a person’s sexual orientation or gender identity.
Access to care is an important issue to address, as LGBTQIA+ people are more likely to suffer from a variety of physical and psychological health problems. For example, Wang et al. (2007, 2012, 2014) observe higher rates of major depression, anxiety disorders, alcohol and/or drugs dependence and attempted suicide than the general population. It can be as a result of discrimination and social isolation. Besides, discrimination and isolation are more factors that can lead to precarity. And on the other hand, compared to men in the general population of the same age, gay men suffer more physical symptoms (more numerous and more severe) (Jablonski et al., 2010). In addition, they are more likely to have various health risk factors such as smoking, excessive alcohol consumption, drug use, high blood pressure, high blood sugar and high cholesterol (Wang et al., 2007).
Furthermore, access care issues also extend to geriatric care for LGBTQIA+ seniors (Van Der Linden & Juillerat Van Der Linden, 2018). The risk factors associated with the development of neurodegenerative conditions and the care of LGBTQIA+ seniors are topics that are not often addressed but nevertheless requires attention, as currently aging as an LGBTQIA+ person is complicated. For today’s LGBTQIA+ seniors grew up in a time when sexual and gender minority status was severely pathologized. For example, homosexuality has been removed only of the third version of the DSM (in 1973) which is an internationally recognized classification system for mental illnesses. As a result of this pathologization from a medical point of view and the vision of deviance from a societal point of view, discrimination and identity concealment also put LGBTQIA+ seniors at high risk for social isolation and loneliness. Those factors are linked to poorer physical and mental health, increased mortality, and a higher risk of developing cognitive impairment or neurodegenerative conditions (Fredriksen-Goldsen et al., 2016, 2018). In addition, these cumulative effects of multiple sources of stigma (i.e., sexual and gender minority status, old age, cognitive difficulties in ageing) create barriers to accessing mainstream health care. As a result, cognitive impairment is undetected and untreated because LGBTQIA+ older adults are nearly invisible (Association 360, 2017). For example, Fredriksen-Goldsen et al. (2016), observed a low rate of diagnosis (1%) of Alzheimer’s disease in the LGBTQIA+ older adult population while one-third of Americans aged 85 and older live alone with Alzheimer’s disease (Alzheimer’s Association, 2016). In other words, neurodegenerative diseases are less likely to be detected in LGBTQIA+ seniors. Moreover, these findings highlight the need to identify predictors of cognitive problems specific to LGBTQIA+ adults for better care. Additionally, in a study by the Aging With Pride collective, 13% LGBTQIA+ older adults in the program, including 40% of transgender participants, reported being denied health care or receiving substandard care because of their sexual or gender identity (Fredriksen-Goldsen et al., 2013). All these data show a significant barrier to accessing health care for LGBTQIA+ seniors.
Therefore, there is an urgent need to initiate action plans with the goal of identifying or clarifying the needs of social support and health of LGBTQIA+ seniors and implementing targeted actions. For this purpose, Association 360 (2017) offer different advice on caring for LGBTQIA+ senior. For example, implementation of some recommendations for welcoming and including LGBTQIA+ seniors in nursing homes should be encouraged. Institutions can especially foster an environment conducive to the expression of one’s gender identity and/or sexual orientation by proposing the organization of convivial moments in senior clubs/associations and strengthening support and assistance among LGBTQIA+ people. Furthermore, it seems important to develop the training of health personnel in caring for LGBTQIA+ seniors. In this regard, Moreno et al. (2017) offered different recommendations for healthcare professionals to improve their practice with LGBTQIA+ seniors :
- Professionals should be aware that sexual orientation and gender identity are inherently part of a person’s characteristics and therefore should avoid using the terms “preference,” “lifestyle,” or “choice.”
- Consider the extent to which LGBTQIA+ people wish to disclose their sexual orientation or gender identity, and discuss with them the potential consequences of disclosure.
- Use gender-neutral and non-heteronormative language to help connect with LGBTQIA+ people.
- Ensure that written materials used in the facility (e.g., brochures, facilitation texts, etc.) adopt language that reflects the inclusion of LGBTQIA+ people (e.g., partner or significant other rather than husband or wife; parents rather than father and mother; etc.)
- Challenging negative stereotypes that professionals may have, increasing awareness of sexual diversity is an integral part of professional and ethical responsibilities. To make professionals aware that their physical or psychological support may have an impact on their work with LGTBQIA+ people, and to identify ways to change these conceptions and attitudes when they are detrimental.
Fortunately, as we can see, more and more researchers are interested in LGBTQIA+ seniors and LGBTQIA+ people in general. It is a good thing because they can offer different recommendations for the care of these elderly, as Moreno et al. (2017) and Association 360 (2017). By understanding the causes of these differences in access to care, it also becomes possible to act on them by trying to fight against them upstream (i.e., prevention). Some cities such as Genève are trying to raise awareness of this issue by organizing the International Day against LGBTQ-phobias (Van Der Linden & Van Der Linden, 2018). For example in 2018, Genève posted the portrait of six LGBTQIA+seniors in the streets and put the Geneva waterjet in rainbow colors. Thanks to those initiatives and recommendations, we can hope that the situation for LGBTQIA+ people tends to evolve towards an adapted care.
In conclusion, LGBTQIA+ seniors’s cognitive health researches has demonstrated the importance of inclusive care to give them every opportunity to age well despite the presence of cognitive deficits or neurodegenerative conditions, regardless of their sexual orientation and/or gender identity. Thus, it is important to fight against LGBTQphobia earlier. Thus, sensibilisation of people from a young age would help global LGBTQphobia. For example, in 2019, 35% of LGBTQIA+ reported experiencing at least one form of discrimination in their lifetime because of their sexual orientation or gender identity. These discriminations and the violence suffered induct deleterious and lasting repercussions on people’s health, resulting in degraded mental health and sexual health indicators, and phenomena of care renunciation.
Words we have learnt :
Concealment = dissimulation;
Mainstream = grand public;
Nearly = presque;
Foster = accueillir;
Strengthening support = renforcement du soutien;
To raise = augmenter.
Bibliography:
Association 360. (2017). Phase préparatoire en vue d’une enquête-actions sur les besoins des aîné.e.s lesbiennes, gays, bi et trans* (LGBT) à Genève. association-viva.org. http://www.association-viva.org/LGBT_GE.pdf
Defining LGBTQ. (s. d.). The Lesbian, Gay, Bisexual & Transgender Community Center. Consulté le décembre 2021, à l’adresse https://gaycenter.org/about/lgbtq/
Fredriksen-Goldsen, K. I., Cook-Daniels, L., Kim, H. J., Erosheva, E. A., Emlet, C. A., Hoy-Ellis, C. P., Goldsen, J., & Muraco, A. (2013). Physical and Mental Health of Transgender Older Adults : An At-Risk and Underserved Population. The Gerontologist, 54(3), 488‑500. https://doi.org/10.1093/geront/gnt021
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Authors: BOULLAIS Charles, COLOSIEZ Rebecca & LECLAIRE Hugo (M2 PPCECC)