What We Can Do to Improve LGBTQ+ Healthcare for Seniors

Public health should be for everyone. Unfortunately in the United States, many healthcare providers are not given the necessary information or other tools they need to properly address the healthcare needs of the LGBTQ population, especially those who are older. Fortunately, by learning a bit more about LGBTQ people and the healthcare disparities they face, we can all help improve their healthcare outcomes.

Who is the LGBTQ Community?

We’re happy you’re taking the time to learn more about this community. You may be a little confused by the terminology, and that’s okay. Let’s discuss a few key terms that may help you better understand who the LGBTQ+ community is, so you can in turn better understand LGBTQ health needs.

What Does LGBTQ+ Stand For?

Also known as the LGBTQ+ community or LGBT community, the LGBTQIA community includes people of all races, ethnicities, and ages.

LGBTQIA+ stands for:

• Lesbian – Women who are attracted to other women.
• Gay – Men who are attracted to other men.
• Bisexual – People who are attracted to the same and different genders.
• Transgender/Trans – People whose current gender identity does not match the gender they were assigned at birth; the outdated term is “transsexual.” For example, a transgender woman is an individual who doctors said was male at birth, but who now identifies as a woman. Often included under the trans umbrella are nonbinary people, who identify as neither male nor female, or who otherwise identify in ways besides male or female.
• Queer/Questioning – While historically an insult, “queer” is a word that many people in the LGBT community use as a neutral umbrella term to mean “not cisgender and/or heterosexual.” “Questioning” refers to people who may be questioning whether or not they are heterosexual or cisgender.
• Intersex – People who are born with multiple sex characteristics; the outdated term is “hermaphrodite.”
• Asexual – People who are not interested in physical intimacy.
• Plus – An umbrella term to encapsulate anything that does not fall under “LGBTQIA.”

People oftentimes use LGBT, LGBTQ, LGBTQIA, queer, and other related terms interchangeably.

Other LGBTQ+ Terms to Know

The following terms are also important to keep in mind:

• Gender identity – The gender that people identify as, which may be different than their biological sex.
• Cisgender – The opposite of transgender; cisgender people are individuals whose gender identity matches their biological sex.
• Gender minority – Individuals who are not cisgender. Transgender people and nonbinary people are gender minorities, for instance.
• Transphobia – A deep dislike or bias against transgender individuals.
• Gender-affirming care – Surgery and other types of care that help trans people look and feel closer to their gender identity. This type of care may include hormone therapy, which can include taking testosterone blockers or receiving injections of estrogen or testosterone.
• Sexual orientation – Who people are attracted to. Heterosexuality (straight) and homosexuality (gay/lesbian) are sexual orientations.
• Homophobia – A deep dislike or bias against LGB individuals (cisgender individuals who are gay, bisexual, or lesbian).

Now that you know some basic terms, let’s dive into how the U.S. healthcare system currently treats the LGBTQ population… and what we all can do to help change the current healthcare landscape.

LGBTQ Healthcare Disparities

Physical and mental health outcomes and access to resources for LGBTQ patients are worse than their non-LGBTQ peers in the United States. Some of the specific disparities facing this community include the following:

• LGBTQ people are more likely to experience suicidal thoughts and attempt suicide.
• LGB adults are more than twice as likely as heterosexual adults to have a mental illness.
• Women in same-sex relationships are less likely to have healthcare insurance, routine medical checkups, and cancer screenings compared to women in different-sex relationships.
• Gay and bisexual men are more likely than heterosexual men to report having a lifetime diabetes diagnosis.
• Gay men are almost twice as likely as straight men to have high blood pressure.
• LGB adults are less likely than heterosexual adults to take cholesterol-lowering medications, which can increase their risk of cardiovascular disease.
• LGB adults are more likely to misuse illicit substances than heterosexual adults.

Why do these disparities exist? There are many reasons, although some contributing factors include the following:

• Homophobia from healthcare facilities that leads to clinicians providing substandard care.
• A lack of access to healthcare services, especially those specifically for and from LGBTQ people.
• Women in same-sex marriages experience poverty at higher rates (5%) than either people in different-sex marriages or men in same-sex marriages, which could mean fewer financial resources available for medical needs.
• Stigma, harassment, and discrimination due to being a minority can be a significant factor in LGBTQIA people experiencing higher rates of mental illness and substance misuse.

Transgender Health Disparities

Disparities even within this community exist; transgender patients face greater healthcare barriers than other LGB people. Some of the unique health disparities trans people in the United States experience include the following:

• Trans individuals are roughly four times as likely as cisgender people to experience a mental illness.
• Trans adults are more likely to attempt suicide (40%) than the general population (less than 5%).
• While data is limited on the issue, trans men may face greater risks of ovarian cancer compared to cisgender women.

The following factors (and more not listed here) contribute to these poor outcomes:

• Overt transphobia and mistreatment from healthcare providers, which leads to substandard care.
• A lack of understanding of transgender health and anatomy from medical care providers, which may lead to providers not providing patients with the right information they need to keep themselves healthy. It may also mean that providers do not recommend appropriate screenings or provide other kinds of preventative care.
• Lack of financial support to receive expensive gender-affirming care; not receiving this care can increase likelihood of mental distress.

Health Disparities for LGBT People of Color

Individuals who identify as both LGBTQ and people of color (POC), or people who are not White, face worse mental and physical health outcomes than their White LGBTQ peers or non-LGBTQ people. That means that health disparities for LGBTQ POC include the following:

• LGBTQ POC in high school are more likely to attempt suicide (27%) than their White LGBTQ peers (22%) and non-LGBTQ peers (5%).
• Compared to non-Hispanic White women, Black lesbian and bisexual women are more likely to be overweight and have conditions like diabetes and hypertension.

The intersection of racial minority and sexual orientation/gender minority status means that LGBTQ POC face unique obstacles to facing healthcare access and quality medical care, including:

• A combination of racism and homophobia/transphobia from others, including healthcare professionals (which can be even worse when aging).
• The emotional and physical toll that being a minority (minority stress) can have on the body, which is worsened by the dual minority status of being LGBT+ and non-White.
• A higher likelihood of being homeless than their White peers, which can mean a greater likelihood of mental distress and fewer financial resources needed to obtain quality medical care.

Senior LGBT Health Disparities

Aging is rarely easy; this fact is especially true for older adults who do not identify as heterosexual and/or cisgender. And there are a lot of older adults who identify as part of this community, with some experts estimating that there are over 2.4 million LGBTQIA older adults in the United States.

Unfortunately, little research exists about elder LGBT health disparities, although experts believe that plenty of factors, like the ones below, contribute to hardships accessing proper care and housing for this demographic:

• A combination of ageism and homophobia/transphobia in senior living and healthcare settings.
• Reduced access to informal care services, such as family caregiving from adult children.
• Fewer financial resources for retirement and healthcare needs, resulting from a lifetime of reduced financial and employment opportunities due to discrimination.
• Greater difficulty finding affordable senior housing due to discrimination, as the “federal Fair Housing Act does not specifically prohibit discrimination based on sexual orientation or gender identity.” Even in locations where nondiscrimination housing policies are in place, LGBTQIA older adults may lack the resources they need to fight violations of these policies in court.
• Increased social isolation compared to their cisgender, heterosexual peers; social isolation is a significant risk factor for conditions like dementia.
• Well-meaning medical providers may assume that all LGBTQIA people have the same experiences—usually a youthful, cisgender, White, middle-class experience—which can impact the quality of care that aging, trans, non-White, and/or low-income LGBTQIA patients receive.

How to Improve LGBTQ Healthcare for Older Adults

As we’ve seen, LGBTQ people in the United States experience not just reduced access to healthcare services, but also often worse-quality patient care compared to their non-LGBTQ peers.

We think that needs to change.

While the following list is by no means exhaustive, the following steps can help the United States move toward healthcare equality for LGBTQIA folks, including those who are older:

• Improving training programs to ensure cultural competence for medical providers.
• Improving health insurance coverage for and overall access to gender-affirming surgery, which can improve mental and behavioral health outcomes for trans people.
• Making patient intake forms more inclusive of gender identity and sexual orientation, so that healthcare providers know vital information about their patients.
• Closing loopholes in nondiscrimination policies to ensure that LGBTQIA+ folks receive the same employment, health, housing, and other opportunities as the general population.
• Introducing legislative initiatives to improve mental/behavioral health coverage for everyone, which can reduce rates of mental illness and substance misuse.
• Increasing the size and scope of outreach programs for this community, improving access to quality care and vital information to make informed medical decisions.

Healthcare Resources for LGBTQ+ Seniors

We aren’t the only organization that’s here to advocate for the medical rights of aging LGBTQ adults. The following are just a few resources that LGBTQ elders, their loved ones, and their primary care providers may find useful:

• Centers for Disease Control and Prevention (CDC)
• Gay and Lesbian Medical Association (GLMA)
• Human Rights Campaign
• Long-Term Care Equality Index (LEI)
• Movement Advancement Project (MAP)
• National Center for Transgender Equality (NCTE)
• National Council on Aging (NCOA)
• Services & Advocacy for GLBT Elders (SAGE)
• U.S. Department of Health and Human Services (HHS.gov)

Disclaimer – This article is for informational purposes only.