Prioritizing health care for older LGBT individuals

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Clinicians should familiarize themselves with appropriate language regarding both sexual orientation and gender identity.
Clinicians should familiarize themselves with appropriate language regarding both sexual orientation and gender identity.

Lesbian, gay, bisexual, and transgender (LGBT) individuals have specific health needs that become increasingly important as they age, but these concerns are often not addressed by the healthcare system.

In a recent article published in JAMA Internal Medicine, Alexia M. Torke, MD, and Jennifer L. Carnahan, MD, MPH, of Indiana University Center for Aging Research, Indianapolis, Indiana, recommend that clinicians welcome LGBT older adults, address their health concerns, and provide high-quality care.

Among their specific recommendations:

  • Use language that is inclusive of the LGBT experience
  • Learn about the experience of unequal treatment, which may have had financial, social, and health consequences
  • Become familiar with the experience and medical concerns of transgender persons
  • Address advance care planning, especially the selection of a surrogate decision maker

Clinicians should familiarize themselves with appropriate language regarding both sexual orientation and gender identity. They should address transgender individuals by their preferred name and pronoun, and clinicians should not make assumptions regarding past or current sexual behavior based on sexual orientation. Some patients may not wish to disclose their identity or sexual orientation to clinicians, and clinicians should respect such wishes.

In some cases, LGBT individuals may have limited access to regular health insurance, resulting in worse physical and mental health. Older LGBT adults may be more likely to require long-term care as they are less likely to have children or may be estranged from their biological family. They may rely on “chosen family” or a friend or unmarried partner for support and visitation.

The authors note that transgender persons make varied choices about hormone treatment or gender surgery. Those who have not undergone surgery require screening and diagnosis of medical conditions based on their anatomy. Because state laws often list spouses and legal next-of-kin as primary decision makers, those who rely on a friend, unmarried partner, or chosen family must name a power of attorney for health care. Ensuring equal access to quality care requires an educated staff and implementation of policies that respect the patient's wishes.

Reference

Torke AM, Carnahan JL. Optimizing the clinical care of lesbian, gay, bisexual, and transgender older adults [published online October 16, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.5324

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