1 / 24

Health Disparities in the LGBT Elderly

Health Disparities in the LGBT Elderly. Ethnogeriatrics Course Feb 2011 Katherine Breitenbach, APN Charles Rhee, MD Erika Sullivan, MS4 Megan Huisingh-Scheetz, MD, MPH. Case. 71 yo F presented to clinic to establish care. PMH - Type 2 DM, HTN, HL, OA Soc Hx –

chinue
Download Presentation

Health Disparities in the LGBT Elderly

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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-in’s • 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 pt’s 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. 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 Decreased Access/Utilization of Health Care services in the GLBT population

  7. Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental quality Immunizations Access to Care 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

  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/temp/CMIIndex2011.pdf

  12. LGBT Communities In US Cities

  13. 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

  14. Support and Resources for the Patient and Provider Healthcare provider Social Patient Religious/spiritual Legal

  15. 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.howardbrown.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

  16. 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

  17. 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.html 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

  18. 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

  19. LGBT Religious Resources Gaychurch.org - http://www.gaychurch.org/Find_a_Church/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/LGBT/list/ National listing of gay friendly synagogues

  20. 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

  21. 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_guide.pdf

More Related