Barriers exist for older LGBT adults in health care settings

Research Topics > Barriers exist for older LGBT adults in health care settings

Good relationships with health care providers can be instrumental to the well-being of older adults. However, barriers exist for older lesbian, gay, bisexual, and transgender (LGBT) adults and the providers who serve them. For many years, I have been trying to improve communication between health care providers and their LGBT patients. Many providers have had no training in working with LGBT patients and, therefore, are not sure what to do to ensure they are delivering competent care. On the flip side, LGBT older adults often do not feel comfortable sharing details about their sexual orientation or gender identity due to fear of negative reactions or biased treatment.

A national survey of LGBT older adults found that only 20% of the population come out to their health care providers. Many older LGBT people have had experiences of discrimination and bias due to their sexual orientation and gender identity, so they choose to protect themselves by remaining silent. However, older LGBT adults are more likely, when compared to cisgender, heterosexual older adults, to have disabilities, mental distress, and social isolation. It is essential that their health care providers are aware of these potential concerns so that good care can be provided. Last year, I interviewed older LGBT adults to learn more about their interactions with providers and health care systems.

While many that I interviewed did not have any negative interactions to report, all stated that things could be improved. Several people shared stories of painful, biased interactions with health care providers or facilities. These experiences have resulted in avoidance of health care and a fear of aging services such as home health care, assisted living or nursing home facilities, and primary care.

A recurring theme in the interviews was that older LGBT adults do not feel seen by their health care providers. They do not see themselves and their experiences reflected in waiting rooms, forms to complete, or questions asked by providers. Some acknowledged that their sexual orientation or gender identity wasn’t always relevant to the service they were seeking, but they were concerned about how providers might respond when their health issues were relevant. A common fear of those I interviewed was that they felt invisible as an older adult, as lesbian or gay, and as transgender or queer. This contributed to their worry about needing services in the future. Sadly, several reported feelings of hopelessness and despair when facing the reality of needing some care in the future. Past studies have shown that as a consequence of these feelings, LGBT older adults go back into the closet if they need residential care. This further isolates an already at-risk population.

Anne Hughes film project being made

I used the interview data I collected to inform several scripted pieces that will be used to educate providers about the needs of older LGBT adults. Kickshaw Theatre and I partnered to develop six vignettes that range in content from basic to advanced so that providers at all levels can benefit from the educational pieces. In partnership with Adventures in New Media, we created six filmed pieces this summer. These short films depict patient–provider interactions that reflect a range of practices with LGBT older adult patients, all based on the interviews done previously. The six videos are called: “Welcoming Space,” “I Hate Doctors,” “Replay,” “I Need a Doctor,” “Isolated and Afraid,” and “It’s Like We’re Invisible.” The films range in time from 5 to 15 minutes each and include a discussion guide to enhance the learning prompted by viewing the films. The “Replay” film was recently awarded Honorable Mention in the 2018 MARCOM Awards.

Anne Hughes film project being made

In an effort to improve the education of the next generation of providers about the issues faced by older LGBT adults, these films will be made available for use by faculty members in the MSU professional schools—medicine, nursing, and social work. Next semester, I will work with colleagues in social work and these other colleges to share the films with their students and develop some teaching materials to support further education around the topics raised by the films. In this way health professional students will be exposed to quality content about the range of needs of LGBT older adults, and faculty will have resources to teach with. This work is supported by grants from the Pearl J. Aldrich Faculty Research Award and the MSU School of Social Work.

I hope I have sparked your interest in improving care for LGBT older adults. There are things you can do right now to improve services for LGBT older adults. First, don’t assume heterosexuality, partnership status, or gender identity. Second, work with your agencies to create an open, affirming, safe environment for older adults who are LGBT. Inclusive forms are essential to competent practice. Most importantly, try to learn more about the community and its needs. If you’d like to learn more about improving services, please visit these resources: National Resource on LGBT Aging; American Society on Aging LGBT Aging Issues Network; Aging with Pride.

Anne Hughes film project being made

Hughes, A., K., Luz, C., Hall, D., Gardner, P., Hennessey, C. W., & Lammers, L. (2016). Transformative Theatre: A Promising Educational Tool for Improving Health Encounters With LGBT Older Adults. Gerontology & Geriatrics Education, 37(3), 292-306. doi: 10.1080/02701960.2015.1127812
Hughes, A., K., Waters, P. Herrick, C. D., & Pelon, S. (2014). Notes From the Field: Developing a Support Group for Older Lesbian and Gay Community Members Who Have Lost a Partner. LGBT Health, 1(4), 323-326. doi: 10.1089/lgbt.2014.0039