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Health Disparities in the LGBT Elderly

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Health Disparities in the LGBT Elderly Ethnogeriatrics Course Feb 2011 Katherine Breitenbach, APN Charles Rhee, MD Erika Sullivan, MS4 Megan Huisingh-Scheetz, MD, MPH – PowerPoint PPT presentation

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Title: Health Disparities in the LGBT Elderly


1
Health Disparities in the LGBT Elderly
  • Ethnogeriatrics Course Feb 2011
  • Katherine Breitenbach, APN
  • Charles Rhee, MD
  • Erika Sullivan, MS4
  • Megan Huisingh-Scheetz, MD, MPH

2
Case
  • 71 yo F presented to clinic to establish care.
  • PMH - Type 2 DM, HTN, HL, OA
  • Soc Hx
  • 40 pyh tobacco, Remote etoh abuse?, No illicits
  • Lives alone in 3 flat bldg, paranoid about
    break-ins
  • She is a big spender and has a poor credit
    score,
  • No children
  • Fxnl Hx
  • Missed paying bills,
  • Completed HS,
  • Transfers and mobility limited by knee and
    shoulder OA
  • GDS 3/15, MMSE 29/30

3
Case
  • MD referred to SW for counseling for anxiety
    symptoms
  • Pt revealed to SW that she had female sexual
    partners, denied being lesbian.
  • Led to significant stress b/c of the lack of
    community acceptance.
  • To date, MD and pt have never discussed pts
    sexuality.

4
How might this issue affect her health?
  • Risk factors
  • Lack of social support networks
  • POA and Living Will
  • State variation
  • Social Isolation and loneliness
  • Psychological consequences
  • Depression, Anxiety,
  • Mistrust/Confidentiality/Fear of Judgment
  • Government recognition of partner
  • Medicare benefit

5
Defining Gender and Sexual Orientation
  • What is Gender A construct of biological
    psychosocial, and cultural factors generaly used
    to classify individuals as male or female.
  • What is Transgender An inclusive term to
    describe people who have gender identities,
    expressions, or behaviors not traditionally
    associated with their birth sex.
  • What is sexual orientation Sexual orientation
    encompasses more than sexual behavior, because
    individuals may identify with a specific sexual
    minority group without expressing those
    behaviors. In contrast, they may practice sexual
    behaviors consistent with definitions of
    homosexuality but not define themselves within
    the terms gay, lesbian, or bisexual.

Mayer et al. (2008). Sexual identity and gender
minority health what we know and what needs to
be done. American Journal of Public Health 98(6).
6
Decreased Access/Utilization of Health Care
services in the GLBT population
  • Lack of utilization of services out of fear of
    judgement or discrimination
  • Uninsured
  • Heterosexism
  • Less preventative measures, decreased risk
    reduction for illness
  • Decreased screening
  • Lack of population based research

7
Leading Health Indicators among Sex and Gender
Minorities Healthy People 2010
Leading Health Indicators in the
Areas of Increased Concern for General US
Population Sexual and Gender Minorities
  • Physical Activity
  • Overweight and Obesity
  • Tobacco Use
  • Substance Abuse
  • Responsible Sexual Behavior
  • Mental Health
  • Injury and Violence
  • Environmental quality
  • Immunizations
  • Access to Care

8
Caring for Lesbian and Bisexual Women
Considerations for Clinicians
  • Tobacco Abuse
  • Only demographic whose smoking increases with age
  • LBT women smoke 200 more than other women
  • Overweight and Obesity
  • Lower rates of Childbirth
  • Increased rates of Breast Cancer
  • Screening for other CA is imperative, pap,
    mammogram, colonoscopy all at appropriate
    intervals

Bye, L., Gruskin, E., Greenwood, G., Albright,
V., and Krotki, K. The 2003 California Lesbian,
Gays, Bisexuals, and Transgender (LGBT) Tobacco
Survey, Field Research Corporation, San
Francisco, CA. 2004
9
Caring for Gay and Bisexual Men Considerations
for Clinicians
  • HIV/AIDS
  • 42 of new HIV infections/year
  • s/e of drugs ? HART therapy increases lipids
  • AIDS Dementia
  • STD/STI
  • Increased rates and recurrence of Syphilis
  • CDC reccomends annual screening
  • Hepatitis immunization
  • HPV ? increased risk for anal CA
  • Substance Abuse
  • Increased risk for unsafe sex behaviors
  • Eating and body image disorders

10
Caring for Transgender patients
  • MALE to FEMALE (MTF)
  • FEMALE to MALE (FTM)
  • Prostate/Breast/Cervical CA screenings still
    important aspect of care
  • Long term effects of hormone therapy
  • Increased cardiovascular risk
  • Violence/Stigma

11
LGBT Demographics
http//www.communitymarketinginc.com/documents/tem
p/CMIIndex2011.pdf
12
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13
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14
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15
LGBT Communities In US Cities
16
Heteronormative Behavior
  • Attitude, language and behavior which stipulates
    that heterosexuality is normal and that all
    other gender pairings are abnormal
  • Assumptions about sexual practice and orientation
    can be discriminatory and prevent individuals
    from accessing proper health care
  • Interpersonal interactions
  • Intended or unintended persecution and prejudice
  • Legislated nationally
  • Local, state and federal laws prohibiting same
    sex unions
  • Power of attorney and next of kin
  • Health care
  • Intake questionnaire forms
  • Sexual histories

17
Support and Resources for the Patient and Provider
Healthcare provider
Social
Patient
Religious/spiritual
Legal
18
LGBT Healthcare Resources
  • Gay Lesbian Medical Association (GLMA)
    -http//www.glma.org
  • Comprehensive listing of healthcare resources
    for LGBT patients, as well as for physicians
    seeking additional information on the care of
    LGBT patients
  • Howard Brown Health Center - http//www.howardbrow
    n.org
  • Chicago based LGBT health organization offering
    health care services to the LGBT community as
    well as information regarding services available
    throughout the the Chicago area

19
LGBT Healthcare Resources (cont)
  • The Body - The Complete HIV/AIDS Resources -
  • http//www.thebody.com
  • Extensive database on HIV/AIDS treatment,
    research, and educational material for both
    patients and providers
  • The Ruth M. Rothstein Core Center -
    http//www.corecenter.org
  • Integrated HIV/AIDS center in Chicago (Cook
    County Hospital/Rush Hospital) offering medical
    treatment as well as social services
  • Illinois Dept. of Public Health AIDS Drug
    Assistance Program (ADAP) - http//www.idph.state.
    il.us/health/aids/adap.htm

20
LGBT Social Resources
  • Center on Halsted - http//www.centeronhalsted.org
  • Large Chicago-based LGBT community center
    offering a wide variety of social activities, as
    well as multiple support group meetings.
    Notably, http//www.centeronhalsted.org/cohsage.ht
    ml which focuses on LGBT activities for
    individuals 55 or older.
  • National Resource Center on LGBT Aging -
    http//www.lgbtagingcenter.org/
  • Relatively new website still in progress which
    will address issues specific to geriatric LGBT
    populations

21
LGBT Social Resources (cont)
  • Chicago House - http//www.chicagohouse.org
  • Organization devoted to providing housing and
    support to HIV positive patients who may be also
    impacted by poverty, homelessness, mental
    illness, or substance abuse
  • Parents, Families, and Friends of Lesbians and
    Gays (PFLAG) - http//www.pflagillinois.org/
  • National organization formed by LGBT allies with
    multiple resources regarding issues such as
    coming out or accepting a newly out family member

22
LGBT Religious Resources
  • Gaychurch.org - http//www.gaychurch.org/Find_a_Ch
    urch/united_states/us_illinois.htm
  • Comprehensive listing of gay friendly churches
    (Christian/Catholic) in the Chicago land area,
    organized by location and denomination
  • Hebrew Union College / Institute for Judaism and
    Sexual Orientation - http//huc.edu/ijso/SynOrg/LG
    BT/list/
  • National listing of gay friendly synagogues

23
LGBT Legal Resources
  • Lambda Legal - http//www.lambdalegal.org
  • National organization with numerous resources
    including information regarding LGBT specific
    medical-legal issues such as visitation rights,
    POA, and discrimination
  • AIDS Legal Council of Chicago -
    http//www.aidslegal.com/
  • Provides legal assistance and advocacy for
    people living with HIV/AIDS on issues such as
    access to care

24
Interventions
  • Provider / Staff Education
  • Core competency and exposure during training
  • Get to know local resources
  • Understand the unique risks and challenges
  • Social support, legal support services
  • Clinical Encounter
  • Neutralize discussion and language
  • Routine
  • Confidentiality
  • Use patient preferred pronouns
  • Welcoming Environment
  • Unisex bathrooms
  • Non-discrimination statement
  • http//www.qahc.org.au/files/shared/docs/GLMA_guid
    e.pdf
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