Many states and communities have developed innovative ways to ensure that key information about the health of older adults is available to those who need it to plan programs, set priorities, and track trends. The State of Aging and Health in America 2013 highlights the need to maintain the progress made on several health indicators and increase our efforts to address other important health issues. The State of Aging and Health in America 2013 presents several calls to action intended to encourage individuals, professionals, and communities to take specific steps to improve the health and well-being of older adults.
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More than 2.7 million adults over the age of 50 identify as lesbian, gay, bisexual, transgender (LGBT) in the United States (Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2014). With the aging population expected to double by 2030, it is imperative for healthcare professionals to acknowledge and understand the physical and psychosocial disparities in the aging LGBT population in order to provide competent care for successful aging.
Psychological and Sociological Aspects of the Aging Population Compared to their heterosexual counterparts, older adults in the LGBT community experience differences in psychological and sociological changes in aging. LGBT adults experience discrimination, ageism, and less access to healthcare and equal opportunities. They report discrimination from healthcare and social workers who deny, delay or provide sub quality care to them due to their sexual orientation or gender identity (Choi & Meyers, 2016). Healthcare professionals also report that they lack the knowledge and training, and are uncomfortable discussing with their patients about their sexual orientation or gender identity (Landry, 2017). Social disparities in employment, earnings, and opportunities cause financial distress amongst LGBT adults (Choi & Meyer, 2016). Discriminatory access to government legal and support programs that are often available to non-LGBT older adults further jeopardizes their financial burden (Choi & Meyer, 2016). The combination of discrimination and limited financial savings significantly impact their health and housing. Many older LGBT adults are less likely to have health insurance and caregivers and are often rejected or expected to pay more for housing facilities (Choi & Meyer, 2016; Schwinn, 2015). LGBT elders are more likely to be single or live alone and are less likely to have children who will care for them compared to non-LGBT elders (Choi & Meyers, 2016). Due to the changes in LGBT communities that was once a source of support, social isolation and ageism are becoming more apparent. The success of LGBT rights in America has dispersed the population across the country, which greatly reduced the amount of social support to those with limited access to transportation and lower socioeconomic status (Hoy-Ellis, Ator, Kerr, & Milford, 2016). Older LGBT adults often feel invisible and forgotten at Pride Parades and when funding that could go towards mental health and successful aging programs are mostly spent on youth programs (Hoy-Ellis et al., 2016). Social isolation is further exacerbated for the transgender population due to the transitioning treatment plan’s requirement of ceasing relationships from their previous life (Choi & Meyers, 2016).
LGBT older adults experience higher levels of psychological distresses and disparities compared to non-LGBT older adults. Since the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, homosexuality was categorized as a sociopathic personality disturbance until its removal from the manual in 1973 (Hoy-Ellis et al., 2016). However, the label of gender dysphoria is still a diagnosable psychiatric disorder (Hoy-Ellis et al., 2016). Given the history of labeling and discrimination from the public, many LGBT older adults remain fearful and distrustful of the mainstream health and government system (Hoy-Ellis et al., 2016). They often hide their sexual orientation, delay seeking help, or avoid accessing healthcare and support organizations due to anticipatory discrimination based on their sexual orientation or gender identity, which causes them to have poorer general health, disability, and mental distress (Fredriksen-Goldsen et al., 2014). Risk factors include lifetime victimization, internalized stigma, lack of healthcare access, obesity, and limited physical activity (Fredriksen- Golden et al., 2014). As a way to cope with these disparities, many engage in adverse health behaviors such as excessive drinking and smoking (Fredriksen-Goldsen et al., 2014). In concern with living conditions, those planning to live in senior communities fear the need to go back into the closet to avoid stigma and discrimination (Schwinn, 2015). Family is a major support system for most people regardless of their sexual orientation or gender identity. However, it is more difficult for those in the LGBT community to maintain their relationships with their biological families (Choi & Meyers, 2016). Many older LGBT adults who left or were rejected by their biological families developed “families of choice” which comprised of friends, partners, and other close individuals in their community in substitute of their biological families (Choi & Meyers, 2016). The challenges of older LGBT adults having families of choice are similar to non-LGBT adults. As they age, older LGBT adults find it difficult to make new connections or maintain relationships due to physical limitations of aging or disease process (Choi & Meyers, 2016). Other older LGBT adults have also reported of not revealing their sexual orientation to their biological family, particularly their children, in fear of rejection and shame (Choi & Meyers, 2016).
A theory that applies to the developmental issues of the LGBT population is the resilience theory due to the aforementioned adversities experienced by older LGBT adults. Richardson (2002) states that resilience arises from people who have undergone trauma and generally high- risk situations. He identified three waves of resiliency inquiry. The first wave is identified as resilient qualities that help people bounce back from stressful situations such as poor self-esteem, self-efficacy, and support systems (Richardson, 2002). The second wave, also known as the resiliency process wave, is the process of coping with stressors and overall traumatic situations (Richardson, 2002). From this wave, people who go through adversity should be able to strengthen their protective factors and apply them to future stressors. The third wave is the innate resilience, and it represents the motivational characteristics within each individual that drives the individual to strive for self-actualization (Richardson, 2002). The identification of individual strengths is crucial and should be used during critical events. Resilience is a defense mechanism; it can be productively used to improve the mental health of people who have experienced critical events. Resilience can also be used as prophylaxis of mental illnesses (Davydov, Stewart, Ritchie, & Chadieu, 2010). Positive emotions have been shown to contribute to higher resilience, therefore it is imperative, regardless of how difficult the situation might be, for the individual’s support system to remain positive. Other factors that can contribute to higher resilience during critical events are altruism, positive self-concept, optimism, humor, spirituality, and the ability to recuperate from or adapt to traumatic events (Davydov et al., 2010).
Resilience can lead to the individual’s growth and adaptation through adversity. The promotion and protection of human development across the lifespan can be achieved by resilience (Davydov et al., 2010). Fortified resilience has a positive effect on health by decreasing the individual’s risk of depression, anxiety, and cardiovascular disease; therefore, better health can contribute to successful aging and development (Davydov et al., 2010).
Although geriatrics and LGBT are two of the most rapidly increasing demographics in America, they are also the least received trainings for healthcare professionals. It is important to incorporate appropriate and culturally sensitive interventions for the older LGBT population. HEALE (Health Education About LGBT Elders) is a program devised for nurses and other healthcare professionals and it aims to enhance the care for elderly LGBT patients (Hardacker, 2014). The program incorporates six topics including introduction of elders in LGBT community, barriers to healthcare and health disparities, sex and sexuality of LGBT elders, legal concerns for LGBT elders, introduction to transgender community, and HIV and aging (Hardacker, 2014). Orel (2014) found that older LGBT adults are frustrated when the healthcare professionals assume they are heterosexuals or avoid discussions regarding sexual histories and orientations. Nurses should not assume somebody’s sexual preference solely based on appearance or gender. Any form of judgment or stereotypes must be avoided when reviewing sexual histories. Healthcare professionals should receive cultural sensitivity training in nursing school and hospital orientations in order to provide appropriate patient care. Other ways accommodate the aging LGBT population is through unisex restrooms and appropriate language usage. Community resources such as Services and Advocacy for LGBT Elders (SAGE), increases social support and network as well as addresses other LGBT elderly issues such as health disparities and financial burdens. Mary’s House, an alternative housing organization for LGBT elders, offers low-cost housing and coordinated activities to increase social interactions (Woody, 2016).
The aging LGBTQ population have faced countless hardships in life that can hinder their development. However, healthcare professionals can educate them on the power of resilience and provide other resources to help them triumph over those adversities. By providing them with culturally sensitive and competent care, healthcare professionals can aid older LGBT adults in their process of successful aging.
Choi, S. K., & Meyer, I. H. (2016). LGBT aging: A review of research findings, needs, and policy implications.
Davydov, D.M., Stewart, R., Ritchie, K., & Chaudieu, I. (2010). Resilience and mental health. Clinical Psychology Review, 30(5), 479-495.
Fredriksen-Goldsen, K., Kim, H., Shiu, C., Goldsen, J., & Emlet, C. (2015). Successful aging among LGBT older adults: Physical and mental health-related quality of life by age group. The Gerontologist, 55(1), 154-168.
Hardacker, C.T. (2014). Adding silver to the rainbow: The development of the nurses’ health education about LGBT elders (HEALE) cultural competency curriculum. Journal of
Nursing Management., 22(2), 257-266. Hoy-Ellis, C. P., Ator, M., Kerr, C., & Milford, J. (2016). Innovative approaches Address aging and mental health needs in LGBTQ communities. Generations, 40(2), 56-62.
Landry, J. (2017). Delivering Culturally Sensitive Care to LGBTQI Patients. The Journal for Nurse Practitioners, 13(5), 342-347. Orel, N. A. (2014). Investigating the needs and concerns of lesbian, gay, bisexual, and transgender older adults: The use of qualitative and quantitative methodology. Journal of Homosexuality., 61(1), 53-78.
Richardson, G. (2002). The metatheory of resilience and resiliency. Journal of Clinical Psychology, 58(3), 307-321
Schwinn, S.V. (2015). Changing the Culture of Long-Term Care: Combating Heterosexism. Online Journal of Issues in Nursing., 20(2), 1-1.
Woody, I. (2016). Mary’s house: An LGBTQ/SGL-friendly, alternative environment for older adults. Generations, 40(2), 108-109.
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