Research shows older adults who identify as gay or transgender have higher rates of chronic conditions, including cancer, mental health issues, and cardiovascular disease. They are also less likely to disclose their sexual orientation to medical providers, which can limit preventive medical care that is vital to early detection and care.
This challenge, a legacy of stigma and discrimination, has become the focus of a movement among human rights advocates and physicians to make health care settings more welcoming to LGBT people, particularly older adults.
“We have to think of the time when LGBT older adults grew up,” said Amy Whelen, senior staff attorney at the National Center for Lesbian Rights. They “often were thought to have a mental illness.”
They lived through the McCarthy-fueled “Lavender Scare” in the 1950s and ’60s, and the AIDS epidemic, which heightened fear as early scientists referred to AIDS as a “gay-related immune deficiency” or “gay cancer.” This trauma for many led to an avoidance of healthcare altogether.
For those who do seek care, more than a third, or 36%, of LGBT adults aged 45-75, reported that they don’t disclose their sexual orientation to their health care providers due to fear of judgment, in a 2014 survey reported by Sage, a New York-based advocacy group.
For health care providers, knowledge about the sexual orientation of a patient could prompt them to screen for certain conditions or risk factors. For example, LGBT older adults are more likely to have breast, testicular, prostate, and colon cancer.
To better screen for and treat these diseases, providers need to work on being more inclusive, said Liz Margolies, the founder and executive director of the National LGBT Cancer Network.
The first step to better care is to just ask about sexual orientation, she said. A study from the Patient-Centered Outcomes Research Institute found that 90% of patients said would be comfortable with disclosing their sexual orientation while only 60% of physicians said they would be comfortable asking for that information.
Medical schools can also improve their training about the needs of LGBT patients. A study from JAMA showed the average amount of time medical schools devote to LGBT health issues is 5 hours. This can lead healthcare providers to feel uncomfortable in their ability to provide care for LGBT Patients
Another way for healthcare providers to provide a more inclusive environment for all patients is to have a non-discrimination policy and display it openly, Margolies said. She suggested that healthcare settings provide intake forms that are more inclusive with more options for gender and sexual orientation. Websites can also include LGBT-friendly pictures and terminology as it is often the first point of contact for many, she said.
Acceptance for the LGBT community has increased among younger generations which is a meaningful step forward. Still, healthcare providers can go a long way toward building a more inclusive environment.
“If people can bring their whole self, they are more likely to take part in health care. If they feel like they have to hide, they are more likely to avoid health care,” Margolies said.