Health professionals who care for older adults can pioneer fairer and more equitable treatment for lesbian, gay, bisexual, and transgender (LGBT) individuals subject to unfair discrimination in health care and society, this according to a new position statement from the American Geriatrics Society (AGS). The statement tackles the present realities of prejudice due to age, sexual orientation, gender, and other personal traits, and also charts a path forward by advocating policies for equal treatment, professional training on LGBT needs, deeper awareness of unique circumstances facing LGBT older adults, and an enhanced research agenda supporting the same.
“Like aging, sexual orientation, gender, and other stigmatized personal characteristics can pose barriers to high-quality, patient-centered care. These unnecessary barriers need to be addressed head-on, particularly as the number of older adults requiring complex, sensitive care continues to grow,” saidJoseph Shega, MD, who chairs the AGS Ethics Committee responsible for the statement. “This AGS initiative is about more than equitable standards of care. It’s about supporting and sustaining a dialogue that can open quality health care to those who have been disenfranchised, and keep it accessible for generations to come.”
Rooted in the belief that high-quality care for older LGBT adults necessitates interdisciplinary collaboration, the AGS statement outlines concrete measures for organizations, advocacy groups, and medical specialties committed to discrimination-free health care. These measures include 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.
Such recommendations come at a crossroads for the older LGBT community: health care and society continue to wrestle with an unfair past and a more hopeful future, even as the nation’s older population continues to grow. Studies still put compliance with existing regulations prohibiting LGBT discrimination in health facilities well below 100 percent. Additionally, evidence suggests that LGBT patients who sense a clinician’s discomfort or lack of knowledge–unintentional or otherwise–may be less inclined to pursue important healthcare decisions. Two-thirds of LGBT baby boomers, for example, have not completed a health proxy, and only 22 percent of older LGBT adults in supportive living facilities feel comfortable being open with staff about sexual orientation or gender identity.
LGBT research also represents only a small subset of overall health scholarship. A 2011 study found that 0.3 percent of articles in the PubMed database addressed LGBT health. 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.
“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 equipped to 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.”
“Care of Lesbian, Gay, Bisexual, and Transgender Older Adults” was developed by the AGS Ethics Committee, with assistance from the AGS Ethnogeriatrics Committee and the AGS LGBT Special Interest Group. The AGS Executive Committee, as well as Services and Advocacy for GLBT Elders (SAGE) and Loree Cook-Daniels of the advocacy group FORGE, reviewed the final statement, which is available from the Journal of the American Geriatrics Society via GeriatricsCareOnline.org–the online portal for AGS products and publications.