Enjeux: santé cognitive

Literature on the topic of trans older adults has documented a few anecdotal cases in which some trans people living with dementia forgot they transitioned and reidentified with their sex assigned at birth ({\textquotedblleft}detransition{\textquotedblright}). Trans commu- nities and their allies have encouraged trans people to engage in end-of-life planning, including the preparation of legal documents that state their wishes regarding gender identity and expression in the event of {\textquotedblleft}incapacity{\textquotedblright} caused by dementia. While useful, we contend that end-of-life planning is often implicitly based on cisnormative and cognonormative (normative system based on cog- nitive abilities) assumptions. Such planning is founded on a stable notion of gender identity throughout the life course ({\textquotedblleft}post-transition{\textquotedblright}) and assumes that the pre-dementia self is better equipped to make decisions than the {\textquotedblleft}demented{\textquotedblright} self. We conclude by encouraging, based on an intersectional, trans-affirmative, crip-positive, and age-positive approach, respect for the agency of trans people with dementia.

There is little research at the international level to help us understand the experiences and needs of trans people living with dementia, despite population aging and the grow- ing numbers of trans people including the first cohort of trans older adults. There is a need to understand the widespread barriers, discrimination and mistreatment faced by trans people in the health and social service system, and the fears trans people express about aging and dementia. Anecdotal evidence from the scarce literature on the topic of LGBTQ populations and dementia suggest that cognitive changes can impact on gender identity. For example, trans older adults with dementia may forget they transitioned and reidentify with their sex/gender assigned at birth or may experience {‘}gender confusion.{’} This raises crucial questions, for example regarding practices related to pronouns, care to the body (shaving, hair, clothes, etc.), social gendered interactions, health care (con- tinuing or not hormonal therapy) and so on. This article fills a gap in current literature by offering a first typology of responses offered by academics who analyzed the topic of dementia and gender identity, to trans older adults with dementia who may be experi- encing {‘}gender confusion,{’} namely: (1) a gender neutralization approach; (2) a transaf- firmative stable approach; and (3) a trans-affirmative fluid approach. After providing critical reflections regarding each approach, we articulate the foundations of a fourth paradigm, rooted in an interdisciplinary dialogue regarding the interlocking systems of oppression faced by trans older adults with dementia, namely ageism, ableism/sanism, and cisgenderism.

The needs of LGBT people living with dementia are poorly recognised due, in part, to assumptions that all older people are heterosexual, together with persistent ageist stereotypes that older people are asexual. LGBT older adults are more likely to reside in care homes as a quarter of gay and bisexual men and half of lesbian and bisexual women have children, compared to 90% of heterosexual women and men. Older LGBT people may be unwilling to express their identity within care settings and this can have an impact on their ongoing care. Recognition of the members of an older person{’}s informal care network is crucial for their ongoing involvement in the life of a person resident in a care setting. However, healthcare professionals may not always appreciate that LGBT people may rely more on their family of choice, or their wider social network, than their family of origin. This article explores socio-legal issues that may be encountered when caring for older LGBT people living with dementia, including enabling autonomy, capacity and applying the legal frameworks in ways which support the identities and relationships of these older people in care.