Equity , diversity and belonging
Equity , diversity and belonging
Feature
Learning to improve support for LGBTQ + people in later life
Dr Trish Hafford-Letchfield explores what the new Skills for Care learning framework to improve support for the LGBTQ + community in later life looks like for occupational therapists .
A s we celebrate the history of lesbian , gay , bisexual , trans , queer and people with less known gender and sexual identities ( LGBTQ +) there is an opportunity to focus and reflect upon the experiences and support needs of people in later life .
I often hear health and social care professionals say how they ‘ treat everyone the same ,’ regardless of their sexual or gender identity , or that they don ’ t have many LGBTQ + people in their service .
While people with sexual and gender diversity experience the same challenges or express similar needs as they get older to those in their peer group , a distinct body of research evidence suggests that there are significant barriers and gaps in health and care services . These are known to have an adverse effect on their wellbeing and quality of life .
Professionals tend not to have training to raise their awareness , knowledge and skills in this area . Providers of care to older people don ’ t know where to start and find it hard to prioritise training on gender and sexual diversity .
Knowing how to promote inclusivity in assessment , provision and support and how to be active in enabling and supporting LGBTQ + people requires sensitivity , familiarity , awareness , capability and not least compassion .
This is where the Skills for Care learning framework for affirmative care in later life is helpful .
LGBTQ + people in later life
Historically , a lack of large-scale data in the UK on its older LGBT + population and LGBTQ older people means that they remain invisible within official statistics , epidemiological research and in the media .
The 2021 UK Census was the first time that questions were included on sexual orientation and gender identity , reflecting the lack of collection of information or monitoring in routine screening of patients in health and social care .
It is difficult to paint a more precise picture of LGBTQ + older people ’ s needs and their diversity .
Practitioners and providers can be reluctant to ask about identities or fail to see its relevance .
Older people ’ s histories will include consequences for ‘ coming out ’. Examples include older gay men who were criminalised before 1967 for engaging in consensual same sex relationships . The age of consent was only equalised to the age of 16 in 2001 .
Older lesbians may have lost custody of their children and many will have experienced rejection by their families .
‘ Homosexuality ’ was completely removed from the DSM in 1987 and from the international classification of diseases in 1992 . The association of gender and sexual identities with psychological and behaviour problems resulted in being subjected to the so-called ‘ conversion therapies ,’ some of which were conducted by the NHS .
These cumulative experiences of discrimination contribute to health inequalities and disadvantages in later life , such as poverty , poor mental health , stigma and violence . These barriers to accessing services must be acknowledged and addressed .
Research studies show that LGBTQ + older people may have worse experiences of dementia and end of life care and do not have the family networks of support as they become older , are more likely to be living alone and less likely to have children to look out for them .
They are extremely fearful of losing control of their privacy and feel unsafe if their independence is compromised . Within care , their relationships have been misunderstood , not valued , or insensitively questioned .
However , outside of LGBTQ + own communitybased provision , there are few services tailored for older LGBTQ + patients and their carers . In-depth studies have captured older LGBT + people ’ s stories about being invisible , overlooked and undervalued when they interact with care .
Older trans people ’ s access to gender-affirming treatments can be excessively delayed , or even denied , and they are pressured to educate care professionals unconfident in trans care .
14 OTnews February 2024