Engagement, Equality, and Respect Guide AGS Vision for Long-Term Care of LGBT Older Adults

Published online ahead of print March 9, 2015

Will I develop heart disease? What can I do to maintain my mental health? How will I plan for long-term health goals and expectations? These are common questions for baby boomers, 10,000 of whom turn 65 every day. But for a disenfranchised group of older adults who identify as lesbian, gay, bisexual, or transgender (LGBT), these concerns are compounded not only by heightened risks for unique health challenges, but also by unfair stigma and discrimination in society and healthcare. And these inequalities need to be addressed candidly as we support a vision for equitable long-term care of all people, according to a new position statement on LGBT elder care from the American Geriatrics Society (AGS).

Rooted in the importance of interdisciplinary collaboration for high-quality, long-term LGBT care, the AGS statement, available on GeriatricsCareOnline.org and published online ahead of print in the Journal of the American Geriatrics Society,¹ outlines measures for encouraging health providers and their institutions to:

• Create, evaluate, and publicize policies for equal treatment of LGBT patients regardless of age;

• Implement LGBT health training programs for professionals who treat older individuals;

• Support high-quality research addressing LGBT health and discrimination; and

• Ensure that older LGBT adult care reflects the particular healthcare and social circumstances these patients face, from the role of partners and chosen family members in health decisions to the need for a supportive culture of respect.

“Like aging, sexual orientation, gender, and other stigmatized personal characteristics can pose barriers to high-quality, patient-centered care,” said Joseph Shega, MD, who chairs the AGS Ethics Committee responsible for the statement. “That’s why we developed this new position statement—to give colleagues and partners for healthy aging a road map for addressing long-term needs with dignity and compassion.”

To be sure, the importance of that road map will only increase with the passage of time—and the growth of America’s senior population. Today, upwards of 1.5 million older adults in the US identify as lesbian, gay, or bisexual—and that number could more than double in the next 15 years. Sadly, many of these men and women still are not getting the treatment and respect they deserve. For example, employment discrimination and other factors contribute to a high poverty rate among LGBT adults, and this can detrimentally impact healthcare access and wellbeing. Both remain essential, since LGBT older adults face the range of common conditions associated with aging but also encounter increased risks for other health challenges from HIV/AIDS to depression.

Further still, compliance with existing regulations that prohibit LGBT discrimination in health facilities still falls well below 100%. And LGBT patients who sense discomfort or lack of knowledge on the part of their care professionals may be less inclined to be open about health or to pursue important health-related decisions. Two-thirds of LGBT baby boomers, for example, have not completed a health proxy, and only 22% of older LGBT adults in supportive living facilities feel comfortable being open with staff about sexual orientation or gender identity. Even in the research sphere, LGBT issues represent only a small subset of overall health scholarship. A 2011 study found that just 0.3% of articles in the PubMed database addressed LGBT health.²

Lack of scientific inquiry, unequal treatment, and the potential for additional racial or ethnic discrimination can make overcoming health barriers all the more pressing, and important, for LGBT adults—which is where the AGS position statement comes to the forefront.

“Raising the bar for high-quality, culturally sensitive geriatric care in all forms and for all people is so important to creating an empowered public that can advocate on its own behalf and in concert with health providers,” said Alexia Torke, MD, MS, who contributed to the statement. “We—patients and providers alike—need to share and celebrate these recommendations, and live them in our personal and professional lives. It’s our hope they’ll be a rising tide that lifts all ships.”

References

1. American Geriatrics Society Ethics Committee. American Geriatrics Society care of lesbian, gay, bisexual, and transgender older adults position statement. J Am Geriatr Soc. Published online ahead of print February 26, 2015.
2. Institute of Medicine Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health Of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: National Academies; March 31, 2011.