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

2. 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

3. 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

4. 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

5. 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

6. 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%)

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.

17. 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