Lesbian_ Gay_ Bisexual_ and Transgender and Queer Elders Issues

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					  Lesbian, Gay, Bisexual, and
 Transgender and Queer Elders:
Issues of an Invisible Population

         Pat Burbank, DNSc, RN
   University of Rhode Island College of Nursing
           RI Geriatric Education Center
Purpose
 Provide foundation for group discussion on
  barriers, strategies and resources
 Discuss ageism and discrimination against
  LGBTQ people
 Describe LGBTQ elders from literature and
  SAGE survey
 Outline needs
What is Homosexuality?
 Covers broad range of sentiment and
  behavior
 Intense and enduring emotional attachment
  to people of the same sex and a life
  constructed around those attributes and
  interests
 May or may not include sexual acts with
  same-sex partners
Gay and Lesbian Identity
   Sexual desire, behavior, and/ or self identity?
      Large national study found 10% of men and 9%
       of women reported at least one of above
      Of these, only 26% of men and 16% of women
       self- identified as gay or lesbian
      This is population sampled in studies

   Kinsey‟s 0 – 6 scale
   Changing identity possible
   Much diversity among LGBT population
Ageism in America
   Pervasive negative attitudes toward older adults
   Least preferred specialty among health
    professionals
   Studies have shown:
      Shorter doctor visits

      Less time spent with them in hospitals
   Loss of power
   Loss of self efficacy
   Positive ageism – learned dependency; they need
    help, we will help them
   Try your own experiments
Discrimination against
LGBTQ People

 Homophobia – negative attitudes toward
  lesbians and gay men
 Discrimination crosses cultural boundaries
 Rhode Island and Northeast are more
  accepting of LGBQ people
 Assumption of heterosexuality
 Homosexuality listed as a disease in DSM II
  until 1974
Others Areas of Discrimination
   Discrimination/ internalized homophobia
     Against older gay men

     Against transgender

     Against bisexuals
Halloween experiment…
     Discrimination… (cont‟d) www.hrc.org
   17 states and DC have laws banning discrimination
    based on sexual orientation; for others,
    discrimination is legal
   About half of the states ban workplace discrimination
   Defense of Marriage Act in 1996 – prohibited the
    federal government from recognizing same-sex
    unions
   43 states have laws/ amendments that ban same-sex
    marriage
   39 states ban same sex couples from adopting
    children
   31 states have hate crime legislation that includes G
    or L, only 11 (not RI) include gender identity
    (transgender)
            The last socially- acceptable
            prejudice…
   “Treating gay and lesbian people like
    second class citizens -- people who may be
    worthy of „tolerance‟, but not of equality --
    was and still is the last socially-acceptable
    prejudice.”
    Anthony Romero, ACLU Executive Director
    October, 2008
LGBTQ Elder Issues
   Dual-minority status – ageism and homophobia
      Lesbians have triple – add sexism
      All LGBT plus all aging issues

   As vulnerability increases, so does fear of
    discrimination
   Profound Invisibility (Brotman et al,. 2003)
      Passing
   Options:
      Stay out (or come out) and risk discrimination
      Go back in closet and “pass”
      If never out, continue to be in closet
Who are our Gay and Lesbian
Older Adults?

 1.75 – 3.5 million in US
 Diverse
 Difficult to study
    Sampling issues

 Born in or before 1933
 “Pre-liberation” , internalized homophobia
   Older Gays and Lesbians
                   Gays         Lesbians
Formerly Married    33%           42%
College Graduates 53%-73%        68-80%
    Have children   25%          16-35%
          Income 27% less      same as straight
      Live alone   65–75 % of older G & L
Both Gays & Lesbians
   12.3 - 27% lack health insurance
      22 – 52% of transgender no insurance
   Up to 2/3 could not identify someone who would
    provide care for them if disabled
   Domestic violence - about same rate as among
    heterosexuals
      22 - 46% of lesbians have been in a physically
       violent same-sex relationship
      17 - 46% % of gay men

   Disability and homosexuality increases risk of
    abuse & neglect by caregivers
Transgender Elders

 Gender is not congruent with biological sex
 Estimates 1 in 30,000 M to F,
  1 in 100,000 F to M
 Being transgender does not go away with
  aging
 74 year old M to F surgery after wife died
Bisexual Elders

 Sexual attraction towards or sexual behavior
  with persons of both genders
 Little research
 4% report attraction to both sexes
 .8% of men & .5% of women identify as
  bisexual
Older Lesbians: Health Issues

  Heart disease
  Cancers
  Arthritis
  Higher rates of smoking
  Higher BMI
  Fewer preventive health exams
Older Gay Men:
Health Issues

 Heart disease/ stroke
 Cancers
 STDs
    HIV/AIDS

 Higher rates of smoking
Transgender Older Adults:
Health Issues
 Hormones
 Surgical changes
 Organs & organ size
 Lab values
 Sexually transmitted diseases
Older Bisexuals:
Health Issues

 Lack of research on bisexuals
 Same issues as gays and lesbians
    Risk Factors

    HIV/AIDS
    Mental Health/ Spiritual Issues of
    Older LGBT Adults
 Discrimination/ internalized homophobia
 Self image
 Depression
 Grief and loss
    Disenfranchised grief

 Substance abuse
 Exclusion from religious
  support
Under-utilization of Health Care
 Much commitment to cultural sensitivity –
  little to interests of LGBT community
    Negation as a cultural group

    Paucity of information

    Invisibility

 Coming out to providers is risky
 Lack of rights of partners/ isolation of
  patient and family
    Mental Health Issues:
    LGBTQ Adjustment to Aging
 Most well adjusted to
  aging
 Crisis competence
 Social support network:
    less family - more friends

 Major concerns: loneliness, health, income,
  and discrimination
MEET THE OLDER NEIGHBORS:
 A PORTRAIT OF RHODE ISLAND’S OVER
  FIFTY LESBIAN, GAY, BISEXUAL, AND
      TRANSGENDER COMMUNITY

                        SAGE/RI
                          2005


 Funded by the Equity
     Action Fund:
  A Field of Interest
  Fund at The Rhode
  Island Foundation
Survey Method

 Survey design – modeled after Meet the
  Neighbors
 Snowball sampling – not generalizable;
  some refused in fear of being “outed”
 Self-identified as LGBT
 Surveys completed anonymously
Who Answered the Surveys?
   Sample size = 148
   Age
      50-59 – 55%

      60-69 – 30%

      70+ - 15%

   White - 97%
   Female – 52%; male – 45%; transgender – 3%
   Sexual orientation: gay – 45%; lesbian, 45%;
    bisexual – 6%; other – 3%
               Education, Income, and Employment
                                                      Education
                Income by age group                      22% college grads

          40                                             49% postgraduate
          30                               50-59
                                                          education
Percent




          20                               60-69
          10                               70 +       Employment > age 60
          0
               0 - $10 $25 $40 $55 $70                   21% full time
               $10 - 25 - 40 - 55 - 70 +
                 Incom e in thousands                    18% part time

                                                         56% retired
Topics Surveyed
   Living arrangements/ transportation/ socialization
   Relationships
   Spirituality
   Sexual orientation issues
   Need for services
   Community/ leisure activities
   Health
       Living Arrangements/
       Transportation/ Socialization
             Living Arrangements
                                                         78.4% own homes
        70
        60
        50
                                                         93.9% drove own car
        40
Percent
        30                                    50-59      Most socialized
        20
        10
                                              60-69       mainly in private
         0                                    70+
              Alne Prtnr F/F        Othr                  homes (85%)
             Live alone, with partner, with
                family/friends, or other                 Of those > age 70,
                                                          18% didn‟t often
                                                          socialize
Relationships

 60% currently in a relationship
 55% over age 70 were single
 Average time in current relationship – 16.7
  years (range 1 – 49)
 17% had partner who died
 40% were parents
 42% had been in heterosexual marriage
         Spirituality

             Religion and spirituality
                                                         31% were “out” to
       100
        80                               Childhood
                                                          their clergy
Percent 60
        40
        20
                                         Now             22% felt supported by
                                         Importance
         0                                                their clergy
               50-   60-   70+
               59    69                                  10% had experienced
         Affiliation in childhood, now
         and spirituality importance
                                                          or witnessed
                                                          homophobia at their
                                                          religious institution
Sexual Orientation Issues
   Average age of “coming out” – 26.4 (range 7-74)
   Percentages of respondents “out” to their
      Families (63%)

      LGBT friends (88%)

      Non-LGBT friends (59%)

      Coworkers (40%)

      Health care providers (40%)
Sexual Orientation Issues:
Homophobia
   73% - no homophobia directed toward them
    personally in the past year
   Percent experienced or witnessed homophobia at
    some time in past year at
      Public establishment (35%)

      Work (By firefighter, police etc (11%)
      Religious institution (10%)

      In a medical setting (10%)

      Home (8%)
      In senior housing (5%) (2 people -daily)
Community/
Leisure Activities
 97% registered to vote; 93% always voted
  in regular elections
 66% volunteered in past year
 56% participated in educational seminars at
  least yearly
 62% used a computer daily (31% >70)
 79% each watched TV and read daily
 81% traveled a few times a year
Health
   90% had good or excellent health
   Had no health insurance (2%)
   Exercised regularly (34%)
   Ate 4 or more servings fruits and vegetables
    (33%)
   Overweight by > 30 lbs. (21%)
   Trouble sleeping (46%)
   Smoked cigarettes (14%)
   Had been abused (51%)
   Currently being abused (7%)
Health (cont‟d)
Of those > age 70
    18% have difficulty with household tasks
    4% have trouble with personal care

    14% have difficulty with shopping and meal
     prep

Who Will Care for Me?
   Partner – 60%
   Friend – 35%

   Child – 9%
   Don‟t know – 27%
Summary of Needs/ Issues
   Health Care
      LGBT sensitive health care providers and
       services
      LGBT friendly nursing homes
   Personal Health Issues
      Health behavior change – exercise, weight loss,
       smoking, sleep improvement, HIV testing and
       risk reduction
      Options for provision of personal care

   LGBT Community Services
      Support services specifically for LGBT elders
Summary of Needs/ Issues (cont‟d)
   Housing
      Safe, affordable LGBT friendly housing, assisted
       living, nursing homes
   Spirituality
      LGBT affirming clergy and religious institutions

   Discrimination and civil rights
      Expanding civil rights protections
      Dealing with homophobia and transphobia

      Greater LGBT visibility in the media
      Achieving a greater sense of community cohesiveness

   Coping with loss and personal crisis
      Failing health

      Losing partner, friends and family

      Domestic violence
Strategies to Improve Quality of
Life for the LGBTQ Elders
   Welcoming agencies and health care providers
      Sensitive assessments

   Education for providers
   Appropriate screenings
   Mental health care
   Resources for uninsured
   Support networks
   Local resources
What can be done to improve health
and quality of life for LGBT elders ?

				
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posted:9/4/2011
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