As the United States population ages, geriatric providers face a critical challenge: ensuring that the health needs of LGBTQIA+ older adults — an often overlooked but growing demographic — are not just fulfilled, but prioritized. The National Resource Center on LGBTQIA+ Aging projects that 7 million adults aged 65 and older will identify as LGBTQIA+ by 2030.1
Recent research findings indicate that 82% of LGBTQIA+ older adults have experienced at least 1 instance of victimization or discrimination during their lifetime.2 As this population expands, it is paramount to conduct further research to determine factors that promote health equity, reduce discrimination, and enhance the delivery of competent services.
Barriers to Care
LGBTQIA+ older adults encounter unique barriers to health care that heterosexual adults may not, including systemic discrimination stemming from insufficient cultural competency training in provider medical education. Social stigma can be more pronounced in rural settings, creating an environment where older LGBTQIA+ individuals may feel uncomfortable or unsafe seeking services. This stigma can lead to social isolation, as community support networks are often less accessible. Moreover, older LGBTQIA+ adults, who experience higher rates of disability and disease than heterosexual adults of the same age,3 face issues with electronic health records, in which providers may misgender them and undermine gender-affirming care.
“What we also find for those living in rural communities is that they may often have to rely much more on their chosen family or informal support groups, so sometimes we find…more tight-knit social circles [in rural communities],” Jason Flatt, an associate professor at the University of Nevada, Las Vegas, School of Public Health and co-principal investigator on 2 National Institute on Aging-funded studies, tells Endocrinology Advisor.
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LGBTQIA+ older adults may have more of a survival strategy. Older adults, in particular, have been to remain closeted, especially in environments like health care where you know there’s a power imbalance and they may feel unsafe.
Scarce resources within rural areas can also negatively affect the physical well-being of this demographic. Rural areas often lack health care providers and facilities, leading to insufficient specialized care and a general lack of awareness about LGBTQIA+ issues among professionals, resulting in inadequate culturally competent care.
Flatt explains, “[I]n terms of being in a rural community, there’s going to be sometimes [fewer] rich resources. So, [resources] we think about in urban settings — maybe access to LGBTQIA+ affirming senior services or senior programs. There’s probably going to be a lot less LGBTQIA+ people living in rural communities, so there may not be as many specialized services.”
Common Misconceptions
Misinformation and stigmatization often breed a strong deficit in LGBTQIA+ health outcomes.
Flatt comments, “There’s a large proportion of LGBTQIA+ people that choose to age in place in rural communities, so that creates unique challenges we find in rural communities. This is going to vary geographically when we look across the country.”
There exists a tendency to view the LGBTQIA+ community as a monolithic group, which results in failure to recognize the diverse experiences and identities within it, including race, gender identity, and socioeconomic status. Compared with their heterosexual counterparts, older LGBTQIA+ adults experience higher rates of anxiety, depression, loneliness, and suicidal thoughts, often exacerbated by dual discrimination related to their age and sexual or gender identities.3
This dual discrimination can contribute to various health challenges, including a heightened vulnerability to substance use disorders, such as tobacco, alcohol, and other drugs. Substance use among LGBTQIA+ individuals can stem from significant stress associated with their marginalized social status, experiences of bullying due to homophobia, biphobia, or transphobia, and unhealthy coping mechanisms in response to stressful life situations.4
Jennifer Carnahan, MD, an associate professor at Indiana University School of Medicine and a practicing geriatrician, relays, “LGBTQIA+ older adults may have more of a survival strategy. Older adults, in particular, have been to remain closeted, especially in environments like health care where you know there’s a power imbalance and they may feel unsafe.”
Policy, Practice, and Future Implementations
To address the unique needs of the geriatric LGBTQIA+ population, policies must prioritize cultural competency training for health care providers. As a result, providers can better understand the specific challenges faced by older LGBTQIA+ individuals, including the impacts of historical discrimination and social stigma. Additionally, health care facilities can implement inclusive practices, such as creating welcoming environments that reflect diverse identities and fostering supportive networks for both patients and staff.5
Dr Carnahan states, “It is damaging to force somebody to be out of the closet; I don’t think that that is helpful for anybody. If I’m wondering about gender identity or anything like that, I have my pronoun pins. I introduce myself with my pronouns, so that is almost as a signal of safety. But again, that’s their gift to give if they want to talk to their physician about it.”
Flatt advises practitioners “to hire members of the LGBTQIA+ community to work at health care facilities. Also, intake forms should allow people to use their chosen name…[and] self-select their gender identity.”
By integrating these considerations into health care policy and practice, we can create a more equitable system that honors the dignity and well-being of LGBTQIA+ older adults.
This article originally appeared on Endocrinology Advisor
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