Dr Dylan Fisher-Barry is an ST5 in Geriatrics at West Middlesex Hospital, Chelsea and Westminster Hospital NHS Foundation Trust. He is the Trainee Representative for the BGS Equality, Diversity and Inclusion (EDI) Group and Less Than Full Time (LTFT) Trainee Representative on the BGS Trainees Council.
June is Pride Month. It is a time to celebrate LGBTQ+ communities, reflect on progress and recognise the challenges that remain. It is important not to overlook the experiences of older LGBTQ+ adults in these conversations. Our Trainees Council is focusing on different aspects of LGBTQ+ experience and care needs relevant to older LGBTQ+ people.
Visibility and Pride
There were more than four times as many people in the UK self-reporting as LGBTQ+ aged 45-64 compared to those aged over 65 in the 2021 Census. Therefore, as the population ages there will be an increasing number of older people self-identifying as LGBTQ+ and services may need to adapt to the unique needs of LGBTQ+ individuals.
Older LGBTQ+ people have experienced living through a period of social change and may have experienced higher levels of inequality, have different perspectives on community and rely on non-traditional social support structures. The Centre for Ageing Better has been exploring older LGBTQ+ adults’ perspectives on this theme with the photo and experience collection #AgeingwithPride.
Comprehensive Geriatric Assessment (CGA)
CGA is a structured multidisciplinary approach to providing the gold standard in holistic individualised care for older adults. Due to its multidimensional and holistic nature, each aspect of the CGA may touch on or identify unique needs for LGBTQ+ individuals.
Older LGBTQ+ adults face health inequalities such as worse health outcomes resultant from barriers causing delays in accessing healthcare services. LGBTQ+ adults may be more likely to live alone and utilise non-traditional social support systems.
Of key importance in creating an equitable CGA is to use open language, for example asking about partners or support systems rather than husband or wife and understanding how social support may affect long term health decisions. Similarly, it is worth recognising the diversity of lived experience of older people undergoing CGA (not just LGBTQ+ people) ensuring that an individualised and agreed management plan is created.
Community and Social Care
Older LGBTQ+ adults may have specific needs and experience distinct challenges when accessing community and social care. Older LGBTQ+ adults may delay or put off accessing community and social care for fear of judgement or discrimination based on previous experiences. There may also be a lack of confidence that their needs will be understood and met by care providers with many fearing they will have to hide their sexual orientation when being visited in the community or when moving to a care facility. It's also worth noting that LGBTQ+ older adults are more likely to live alone and have less traditional social support systems in place.
Recognising the importance of increasing education to health care providers, certain charities such as LGBT Foundation and Skills for Care are developing resources, training and accreditation that can be used to break down some of these barriers and ensure more equitable care for LGBTQ+ older adults.
Dementia
Older LGBTQ+ adults are more likely to have experienced discrimination and stigma during their lives. This may in part be due to changing societal attitudes that have occurred during their lifetime, with sex between men being a criminal act until 1967, homosexuality being classified as a mental illness until 1973 or the negative media portrayal of the AIDS epidemic in the 1980s.
This may bring additional challenges for an LGBTQ+ adult living with dementia or for their support network. As the dementia progresses and older memories become more prominent, they may forget that they have come out, believe they live in a time when they had to hide their sexual orientation or relive experiences of negative attitudes or discrimination.
The importance of recognising social support remains vital. As is advanced care planning, allowing an individual to express their wishes and consider LGBTQ+ friendly services and care settings. This may become easier as the LGBT Foundation rolls out its Care Home Plus Award in addition to its Pride in Care Award.
End of Life Care
Approaching the end of life can be a difficult time both for an individual and for their family. LGBTQ+ people have been shown to access palliative and end of life care services at a later stage or not at all due to fear of intentional or unintentional discrimination from service providers.
There are some considerations that can be made to ensure an inclusive and holistic approach towards the end of life, through the use of open conversation.
- Acknowledge that questions may be personal
- Ask what pronouns a person would use and use the same pronouns that they use
- Ask who the person would want to involve in their care, for example asking, "who supports you?" rather than asking about husband or wife. It is important to acknowledge relationships important to the individual and not to diminish non-kin relations
- Creating an advance care plan and recording expressed wishes or a Power of Attorney, for example some LGBTQ+ individuals may worry about being "erased" or their birth name or gender being used on their death certificate.
The LGBT Foundation has a "Box of Me" workshop which help LGBTQ+ people think about plans for their care and future wishes.
If you're interested in getting involved with the BGS Equality, Diversity and Inclusion (EDI) Group or to see more EDI resources head to https://www.bgs.org.uk/equality-diversity-and-inclusion-group
This blog is based on content that our Trainees Council is sharing on the BGS Trainees Instagram. Have a look and give them a follow.
