A surgeon who spots a wedding ring and asks if the patient’s wife can take care of him after surgery, not realizing the man’s spouse is actually a husband.
Staff in long-term care facilities who express puzzlement or
even disgust about same-sex sexuality.
Emergency room personnel who convey alarm when they
discover the woman the hospital just admitted was once a man.
Such situations are more than just awkward. They can keep
lesbian, gay, bisexual and transgender (LGBT) older adults from
getting the care they need. The result is disparities, with LGBT
older adults at higher risk of many negative health outcomes,
including worse mental health and unhealthy behaviors.
Psychologists are working to change that by investigating the
special challenges — and resiliencies — of LGBT people and
calling for health-care providers who work with older people to
create a welcoming environment for LGBT patients.
“A lot of general practitioners in the field of gerontology
Diversity within difference
assume that everyone who walks into their office is
heterosexual,” says Douglas C. Kimmel, PhD, co-chair of
the Committee on Aging of APA’s Div. 44 (Society for the
Psychological Study of LGBT Issues). “But instead of making
assumptions about someone’s sexual history or practices,
their relationship status or their gender identity, they need
to be aware that they can’t assume anything but need to ask
Of course, it’s difficult to generalize about a group as large as
LGBT older adults, says Kimmel. According to Services and
Advocacy for Gay, Lesbian, Bisexual and Transgender Elders
(SAGE), about 1. 5 million people age 65 and older in the
United States are lesbian, gay or bisexual, and that population
may double by 2030.
As a 2011 Institute of Medicine report called “The Health
of Lesbian, Gay, Bisexual and Transgender People: Building a
Foundation for Better Understanding” points out, while LGBT
people are often lumped together for advocacy and research
purposes, each letter of the acronym represents a distinct
population with its own characteristics and health needs.
Knowing that an older person is LGBT doesn’t tell you
much, agrees Kimmel. “You have to grasp all the dimensions of
diversity,” he says.
Consider the life experiences of different age groups within
the broad category of “older,” says Kimmel. The oldest may have
spent a lifetime in the closet, he points out, while older baby
boomers may have had much more open lives.
Health-care providers’ biases and misunderstandings are
keeping some older LGBT patients from getting the care they
need. Psychologists are working to change that.
BY REBECCA A. CLAY