Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 135

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people have become more visible in recent years, and recent estimates suggest that there are over 3 million LGBTQ adults over the age of 65 in the United States. Older adults in same‐sex relationships have generally reported being highly sexually satisfied, with a high correlation between relationship satisfaction and sexual satisfaction.⁵⁸ For some people who may have grown up with intolerant and discriminatory families or had gender reassignment surgery, being an older adult can feel sexually liberating.⁷ In many ways, the sexual needs of LGBTQ older adults are similar to those of heterosexual people; however, their experiences of bias, prejudice, and insensitivity may impact how they interact with the healthcare community.

This is a population historically underserved and underrepresented in research for many reasons. Compared with heterosexual people, LGBTQ people face increased chronic societal stress due to potential bias, stigmatization, and discrimination, and studies have shown that they do not always disclose their sexual orientation to healthcare providers. Factors that may increase someone’s willingness to disclose include having a gender and race congruent provider (e.g. a white gay man may feel more comfortable disclosing to a provider who is also white and male), having a provider who is also LGBTQ, and having a perception that the provider will respond positively.⁵⁹ Healthcare providers should remember that LGBTQ older adults may have experienced significant discrimination over the course of their lives, which may cause them to feel uncomfortable disclosing their sexual orientation.⁴⁵ This may improve over time, as a younger generation of LGBTQ people age in a society that is more accepting of sexual diversity.

Healthcare providers should try to avoid heteronormative assumptions and include all patient‐designated partners and loved ones in important medical decision‐making. LGBTQ older adults may have significant anxiety about potential late‐life events, end‐of‐life needs, and legal issues. For LGBTQ people, there may be differences between one’s ‘families of origin’ and their ‘families of choice’.⁴⁵ Especially in couples who are not legally married, having a designated surrogate decision‐maker and clear advance directives may be vitally important to ensure the patient’s wishes are honoured.