Improving Health Outcomes and Quality of Care for LGBT Older Adults Heshie Zinman, MBA

LGBT Older Adults Approximately 2.4 million LGBT Americans over 50 years of age. By 2030 that number will grow to almost 5 million Cultural shift towards greater acceptance for LGBT identities

Cultural Shifts Lesbian, gay, bisexual, transgender (LGBT) people have made significant progress in securing long-awaited civil rights HHS continues to ensure that across the lifespan, all LGBT individuals, including people living with HIV and AIDS, have the best possible hope to age healthfully

Landmark HHS accomplishments in 2016 In May, the Affordable Care Act protects against discrimination on the basis of sex, including gender identity and sex stereotyping In June, new position for a Senior Advisor for LGBT Health within the office of the Assistant Secretary of Health (OASH) In October NIH officially designates sexual and gender minorities (SGM) as a health disparity population for research

Causes of Health Disparities for LGBT people Low rates of health insurance Social stigma High rates of stress due to systematic harassment and discrimination Lack of cultural competency in the health care system Multiple identities, e.g. race, ethnicity magnify the disparity

Unique Circumstances 75% live alone (v 35%) 90% are childless (v 20%) 80% have no partner (v 40%) 20% cannot identify an emergency contact (v 2%)

Physical Health Disproportionate rates for: High blood pressure Cholesterol Diabetes Heart disease HIV/AIDS Certain types of cancer

Mental Health Elevated rates of anxiety, loneliness, hopelessness 31% report depression 39% have seriously thought about suicide Higher rates of smoking, alcohol use, and drug use

Social Connectedness 27% LGBT older people feel that work or volunteer activities will not be open to him/her if others know about his/her sexual orientation. Faith-based support networks often not affirming to LGBT identities Struggle to fit in LGBT spaces because of age and in aging spaces because of LGBT

Healthcare environments are often hostile and discriminatory 80% of LGBT older adults fears nursing homes and similar care providers because of the expectation of discrimination 39% of LGBT people have had at least one of a series of lifetime discriminatory experiences at a healthcare provider 40% of LGB older people in their 60s and 70s say their healthcare providers don’t know about their sexual orientations Older LGBT adults in long-term care facilities may face discrimination from staff and other residents

HIV/AIDS By 2015, 1.2 million Americans will be living with HIV, and half of them will be age 50+ Tremendous advances in treatment regimens for HIV/AIDS 17% of new HIV infections are occurring in people over 50 yet few prevention programs target this demographic Increased rates of cardiovascular disease, hypertension, diabetes, and osteoporosis among older adults with HIV More likely to experience depression, social isolation

Moving Forward: Data Collection Surveys typically do not collect data on sexual orientation or gender identity Major obstacle to studying the realities of LGBT older people and health disparities Collecting this data at an organizational/ institutional level will also improve the ability to track the needs of LGBT people Hinders the development of public policies and programs that seek to improve LGBT population’s health and well-being

Improving Quality of Care: LGBT Cultural Competence LGBT older adults deserve to access medical and social services that are culturally-sensitive and affirming of LGBT identities Agencies need policies, protocols and programs that account for the unique needs of LGBT older people LGBT older adults need to be recognize by the OAA as a “greatest social need” group, opening funding avenues & service opportunities Only one-third of senior service agencies have offered staff trainings on LGBT cultural competence

Asking the Right Questions Questions regarding sexual orientation and gender identity should be integrated into clinical settings so that medical professionals capture demographic data during an intake Limits the chances that an LGBT person might withhold this information for fear of being judged Expand definitions of “families” and “next of kin” to include friends, caregivers and alternative kinship structures

Creating Safe Spaces Create an environment where an LGBT individual can feel most comfortable asking candid questions about their health needs Use language that affirms LGBT identities The physical space of a medical office or service agency can communicate a commitment (or lack thereof) to LGBT patients/clients

The LGBT Elder Initiative The LGBT Elder Initiative (LGBTEI) is committed to assuring that lesbian, gay, bisexual and transgender older adults have rights and opportunities to live vibrant, creative and mutually supportive lives. To achieve this vision, the mission of the LGBTEI is to foster and advocate for services and resources that are competent, culturally sensitive, inclusive and responsive to the needs of LGBT elders in the Delaware Valley and beyond.

References Krehely, J. (2009) How to Close the LGBT Health Disparities Gap, Center for American Progress U.S. Department of Health & Human Services (2016) Advancing LGBT Health and Well-Being: 2016 Report: HHS.gov