Enjeux: santé

Purpose of Review The purpose of this review was to identify health disparities and culturally competent strategies for improving function and independence in a historically disadvantaged group. Recent Findings There are significant health disparities among LGBT older adults including increased disability rates, chronic conditions, and mental distress. There is a shift in the theoretical framework for addressing health disparities in LGBT older adults from an emphasis on minority stress theory, towards factors that facilitate resilience such as identity affirmation and social support networks. Summary Advocacy for cultural competency training and LGBT aging research is needed in multiple clinical domains including rehabilitation and geriatric care centers. There are very few studies that have identified effective intervention approaches for reducing mental health or mobility-related disparities in LGBT aging populations.

Informal care-givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care-giver is known to be associated with poorer health and well-being, and lesbian and gay care-givers re- port experiences of stigma and discrimination in the care-giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care-givers. We compared care-givers to non- caregivers on a range of health and well-being measures, including psychological dis- tress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care-givers who were caring for an LGBTI person to those who were caring for a non-LGBTI person. Among the lesbian women, care-givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indica- tors. Among the gay men, care-givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well-being compared to those caring for a non-LGBTI person. Overall, results from this study suggest that older lesbian and gay care-givers may be facing some challenges related to their well-being and feeling supported, especially if they are caring for another LGBTI person.

This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support.

Loneliness is a phenomenon which affects people globally and constitutes a key social issue of our time. Yet few studies have considered the nature of loneliness and social support for older lesbian, gay and bisexual (LGB) people; this is of particular concern as they are among the social groups said to be at greater risk. The paper aims to discuss this issue.,Peer-reviewed literature was identified through a search of Scopus, PsycINFO and PubMed. A total of 2,277 papers were retrieved including qualitative and quantitative studies which were quality assessed using the Critical Appraisal Skills Programme.,In total, 11 papers were included in the review and findings were synthesised using thematic analysis. The studies were conducted in five countries worldwide with a combined sample size of 53,332 participants, of whom 4,288 were drawn from among LGB communities. The characteristics and circumstances associated with loneliness including living arrangements, housing tenure, minority stress and geographical proximity.,The review suggests that among older LGB people, living alone, not being partnered and being childfree may increase the risk of loneliness. This cohort of older people may experience greater difficulties in building relationships of trust and openness. They may also have relied on sources of identity-based social support that are in steep decline. Future research should include implementation studies to evaluate effective strategies in reducing loneliness among older LGB people.,Reaching older LGB people who are vulnerable due to physical mobility or rural isolation and loneliness because of bereavement or being a carer is a concern. A range of interventions including individual (befriending), group-based (for social contact) in addition to potential benefits from the Internet of Things should be evaluated. Discussions with the VCS suggest that take up of existing provision is 85:15 GB men vs LB women.,Formal social support structures which were provided by voluntary sector agencies have been disproportionately affected by recent austerity measures.,The authors sought to interrogate the tension between findings of lower levels of social support and discourses of resilient care offered by families of choice.

Despite greater recognition of rights and responsibilities around the care of cancer patients who identify as lesbian, gay or bisexual (LGB) within healthcare systems in the United Kingdom, recent qu…

Objectives. We investigated health disparities among lesbian, gay, and bi- sexual (LGB) adults aged 50 years and older. Methods. We analyzed data from the 2003{–}2010 Washington State Behav- ioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions. Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Conclusions. Tailored interventions are needed to address the health dispar- ities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities

This study examined mental and physical health, per- ceived social support, and experiences with HIV/AIDS of 416 lesbian, gay, and bisexual adults aged 60 to 91. Most participants reported fairly high levels of self-esteem; however, many experienced loneliness. Most also reported low levels of internalized homophobia, but men reported significantly higher levels than women did. Ten percent of respondents sometimes or often considered suicide, with men reporting significantly more suicidal thoughts related to their sexual orientation. Men also had significantly higher drinking scores than women, and more men could be classified as problem drinkers. Only 11% of the respondents said that their health status interfered with the things they wanted to do. Although 93% of the participants knew people diagnosed with HIV/AIDS, 90% said that they were unlikely to be HIV-infected. Participants averaged six people in their support networks, most of whom were close friends. Most support network members knew about the participants{’} sexual ori- entation, and the respondents were more satisfied with support from those who knew. Those living with domestic partners were less lonely and rated their physical and mental health more positively than those living alone

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indi- cated that elders 55{–}64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utiliza- tion was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Objectives: Modeling the health and care trajectories of lesbian, gay, and bisexual (LGB) is essential to identify inequalities and support needs, yet because of the small sample of LGB people in any one survey, current evidence relies on studies that have poor generalizability and low power. This study assesses the magnitude of health inequalities among older LGB people across 10 outcomes, informed by evidence on the health trajectories and distinct LGB history of the United Kingdom. Method: A systematic review was conducted of representative data sources on older LGB and heterosexual people{’}s health and care status in the United Kingdom. Individual Participant Data (IPD) meta-analysis was employed to synthesize data from up to 25 different sources. To account for the intricacies of individual data sets, the analysis employed a two-stage approach where an odds ratio and standard error was calculated for each data set individually, before being meta-analyzed through DerSimonian and Laird random effects models. Results: Among men aged 50+, being gay, bisexual, or having another nonheterosexual orientation is associated with an increased risk of reporting long-term illness and health-related limitations. Indicators of mental health also suggest that gay and bisexual men are more likely to report low life satisfaction and to have attempted suicide over their life time. Among women, differences are apparent with regards to self-rated health as well as with engagement with risky health behaviors. Discussion: The findings corroborate the minority stress theory, but they also generate new questions for researchers around when and how these inequalities emerge.

The hostile environment that older lesbian, gay, bisexual and transgender (LGBT) people faced at younger ages in the United Kingdom (UK) may have a lasting negative impact on their health. This systematic scoping review adds to the current knowledge base through comprehensively synthesising evidence on what is known about the extent and nature of health and care inequalities, as well as highlighting gaps in the evidence which point the way towards future research priorities. We searched four databases, undertook manual searching, and included studies which presented empirical findings on LGBT people aged 50+ in the UK and their physical and mental health or social care status. From a total of 5,738 records, 48 papers from 42 studies were eligible and included for data extrac- tion. The synthesis finds that inequities exist across physical and mental health, as well as in social care, exposure to violence and loneliness. Social care environments appeared as a focal point for inequities and formal care environments severely compromised the identity and relationships that older LGBT people developed over their lifecourse. Conversely, the literature demonstrated how some older LGBT people successfully negotiated age-related transitions, e.g. emphasising the important role of LGBT-focused social groups in offset- ting social isolation and loneliness. While there exist clear policy implications around the requirement for formal care environments to change to accommodate an increasingly diverse older population, there is also a need to explore how to support older LGBT people to maintain their independence for longer, reducing the need for formal care.

This study examines the potential health-related impact of recent versus lifetime experi- ences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimin- ation uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological dis- tress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distin- guishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.

Purpose This study explores perceptions and experiences related to healthcare utilization in a group of Italian sexual minority older adults, to understand the unique challenges faced by this population when accessing healthcare services. Older adults represent one of the subgroups exposed to the highest risk within sexual minorities with regard to physical and mental health. Method Data collection occurred between October 2018 and April 2019. Semi-structured interviews were carried out with 23 participants over 60 years, including questions about participants{’}: experiences when dealing with physical/mental healthcare services; tendency to disclose sexual orientation in clinical contexts; preferences and desires when seeking care. Data were analyzed using Interpretative Phenomenological Analysis (IPA), in order to provide qualitative information on participants{’} experiences. Results Three interconnected themes were identified: the relevance of clinician and patient{’}s identities in determining confidence and satisfaction; expectations and experiences of discrimination; the need for specific competencies on sexual minority concerns. Conclusion Access and utilization of healthcare services can be considered as a multi-faceted phenomenon which involves people{’}s past and current experiences, perceptions, expectations and desires. Participants{’} perception of having to deal with heterosexist healthcare settings influences health behaviors and outcomes. Policy Implications Interventions directed to healthcare providers are needed, to increase specific competencies and ensure safe and affirming environments.

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospi- talizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services net- work. This article provides exemplars from empirical data on older les- bians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.