How Can You Optimise Your LGBTQIA Patient’s Care?

In Australia, 3.6% and 3.4% of men and women respectively identify as a minority sexual identity (Wilson et al, 2020). In the US, it’s a similar story with an average of 3.5% of US adults identifying as homosexual or bisexual, and 0.5% of US adults identifying as transgender (Gates, 2011). We see these statistics repeated all over the world with an average of 11% of people between 16 and 74 in over 26 countries describe their sexual orientation as something other than heterosexual (Boyon, 2021).

Given those percentages, over 651,700 people in Australia identify as members of the LGBTQIA community (Wilson et al, 2020). While many LGBTQIA Australians live healthy lives, there are still healthcare inequities present between the general populace and the LGBTQIA community.

What specialised healthcare do they require? And how does it differ from their cisgender and heterosexual counterparts?

Below is a discussion of some of the main healthcare conditions and issues the LGBTQIA community encounter, as well as references for you to find out more.

What does LGBTQIA stand for?

LGBTQI+ stands for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex and Asexual or Ally. In some cases people use + to refer to any other sexual or non-conforming gender-based minority.

When caring for someone from this community, it’s integral that you gauge how they prefer to identify. For example, young people are increasingly preferring non-binary terms such as ‘queer’ instead of using terms like ‘lesbian’ and ‘gay’. Older adults can often be the opposite, choosing binary identifiers and refuting the previously offensive term ‘queer’.

If you’re unsure how to start this sort of conversation, introduce yourself using your name and pronouns and then ask your patients for theirs. This not only shows that you’re an open-minded and compassionate carer but also destigmatises the process of explaining anything regarding gender or sexual identity. If you need to know anything else about their sexuality or gender for the purposes of their care, it’s essential you explain why you need that information. If you don’t need that information, there’s no reason to ask unless they offer the information first.

A brief history of Australia’s LGBTQIA Community

To understand your patients' needs – especially older adults entering the aged care demographic – you should understand some general LGBTQIA history of Australia.

There is little publicly known about the presence of same-sex attraction and gender non-conformity in Indigenous Australian cultures historically. However, nowadays 1.4% of Aboriginal and Torres Strait Islander couples are same-sex while only 0.9% of non-Indigenous couples are same-sex (Wilson et al, 2020).

Settler-colonial Australia is historically a conservative nation and has only seen pro-gay rights emerge in legislation over the past 50 years. For example, same-sex sexual activity was first legalised in Australia by the South Australian Government in 1975 (Price, 2019). This by no means indicates that all rights were accrued 50 years ago: Queensland only decommissioned the ‘Gay Panic’ defence in 2017 and legalised same-sex couples adopting children in 2016 (Burke, 2017; Winsor, 2016).

Though the number of instances is decreasing, Australia has a strong history of homophobic and transphobic violence perpetrated by both the general population as well as figures of authority, such as state police forces (Callaghan, 2021). This is important to know and understand as your LGBTQIA patients may not feel comfortable engaging with figures of authority, such as in the event of a critical incident in which they must make a report from a clinical unit. Your support – in the form of being present in the room, for example – and guidance through these periods of stress is essential and very much appreciated by your LGBTQIA patients.

For a deeper look into the history of Australia’s LGBTQIA history, read these in-depth discussions and summaries:

A Definitive Timeline of LGBT+ Rights in Australia - SBS

Australian LGBTIQ history timeline: the 20th century - QNews

Protestors at the Marriage Equality Rally, 2017

Caring for older LGBTQIA adults

The BBC’s Aidan Lewis highlighted the fact that many older LGBTQIA people have less family support than their heterosexual counterparts, have little to no spousal benefits, less help from children and are more likely to be cut out from inheritance (Lewis, 2014). Older adults experiencing this kind of alienation may not know how to explain it to someone who doesn’t have a framework to understand the gravity of the isolation, such as straight or cisgender friends.

As a solution to this, many countries around the world are building LGBTQIA retirement homes and care packages. These are largely government funded or subsidised and house communities of older LGBTQIA people from various backgrounds and areas, and often use means-tested rental pricing systems so less affluent people can also find inclusive housing.

You may be wondering: why do LGBTQIA people need to access specific LGBTQI+ retirement housing? Why can’t they just live in a regular retirement home and ask for specific assistance? Here’s what these homes offer:

• Protection from harassment: people of the retirement age group are more dichotomised on the ‘issue’ of gay rights, as they experienced the fight for – and against – gay rights in the 1960s as well as the stigmatised AIDS pandemic in the 1980s (Schuessler, 2016).

• Specific health concerns: LGBTQIA people require different health care, especially amongst people who contracted HIV during the AIDS pandemic as well as amongst older trans and non-binary people.

• Comfort: being able to personally engage with people around you is essential for a comfortable ageing experience. Where LGBTQIA people experience alienation in regular retirement homes, they are encouraged to share their past and bond with their neighbours in open-minded retirement homes.

There is still a long way to go for aged care in terms of specific LGBTQIA care, however countries such as Australia, the UK, the US and Sweden are setting a great standard for the years to come.

If you’d like to learn more about healthcare for older LGBTQIA people, visit the links below:

LGBTQI Awareness in Aged Care - Ausmed

Older Australians who identify as lesbian, gay, bisexual, transgender or intersex - Australian Institute of Health and Welfare

The Double Closet: LGBTI People and Dementia - Dementia Training Australia

Mental health in the LGBTQIA community

LGBTQIA people are two and a half times more likely than the general population to have been diagnosed or treated for a mental health condition in the past 12 months. Additionally, LGBTQIA Australians have the highest suicide rate of any other group; as reported by LGBTQIA Health in April 2021, LGBTI young people aged 16 to 27 are five times more likely to attempt suicide than the general population (LGBTIQ+ Health Australia, 2021). Transgender people aged 14-25 are fifteen times more likely than the general population (LGBTIQ+ Health Australia, 2021).

The best thing you can do for your LGBTQIA patients is understand the urgency of addressing their mental health condition, and have a clear idea of who can help them. What government schemes are there for subsidised mental health support? Does that extend to acute support, or just long-term therapy? Are there any not-for-profit organisations that can provide specialised education and support to this LGBTQIA person, regardless of age and gender identity?

If you’re not sure you can confidently answer these questions, visit the links below to learn more about the support available. Additionally, use these resources to learn more about mental health trends amongst LGBTQIA people:

Geoffrey Ahern on LGBTI Mental Health - Ausmed

Mental Health 2021 Update - LGBTIQ+ Health

To better understand the huge difference between the mental health of trans youth and their non-trans counterparts (both LGBTQIA and not), read the following resources:

Understanding Mental Health in the Transgender Community - HealthPartners

Is there more to learn?

The healthcare community is constantly learning about the LGBTQI+ community, as the latter is always developing. Additionally, the LGBTQI+ community is ageing into an aged care demographic that is finally interested in catering to the very specific needs of older gay people.

So, if you’re wondering if there’s more to learn, yes! There always is. However, don’t become overwhelmed: as long as you have an open mind and are using a portion of your professional learning time (and plan) to learn about any areas you’re not clear on, you’re on the right track.

Here are a few more Ausmed resources relating to the LGBTQIA community. Add them to your learning plan and complete them as you go:

4 Key Actions to Advocate for LGBTQI+ Patients - Ausmed

Advocates and Language Services - Ausmed

References: