Nurses hold key to providing quality care to older LGBT adults

"Nurses are in a prominent position to create health care environments that will meet the needs of this often misunderstood group of people," said Rita Jablonski, Ph.D., associate professor of nursing at the University of Alabama at Birmingham School of Nursing and lead author of the paper. "Nurses are the front line for care, and they can directly impact the quality of care older LGBT adults experience."

Very little content on specific care needs of LGBT individuals exists in nursing literature, especially for older adults, which brings challenges to providing culturally competent care.

Even though LGBT populations are often grouped together, each is a distinct group with its own specific health care needs and concerns, Jablonski says. This is especially true with older LGBT persons and involves issues ranging from housing and long-term care placement to home-health and the selection of health promotion practices.

Jablonski and co-authors recommend some practices that nurses can take to improve the quality of care they give to LGBT patients, as well as help them feel more at ease.

Realize that they already have LGBT patients or residents.

"Given lifetime experiences of negativity at best and violence at worst, older LGBT adults may not openly share their identity with health care providers," Jablonski said. "Older LGBT adults may have prior life experiences, including having been married or having children, that cause nurses to assume heterosexuality. Don't make that mistake."

Change the way information is gathered from the patient.

Questions about sexual orientation and gender identity should be routinely asked of all patients or residents. Given the discrimination faced by older LGBT adults, the nurse must preface this information with why the questions are being asked, Jablonski says. The best way to do this is for the nurse to state, "To provide the best and most sensitive care for all of our patients, we ask questions that may seem different."

Ask questions about sexual orientation and gender identity separately.

"On forms, a blank line can be included after the 'male' and 'female' choices to allow older adults to label their own gender," Jablonski said. "Another option is to ask, 'What is your gender?' and leave a blank line to allow for an individual to complete the question as he or she believes appropriate."

Questions such as marital status may need to be amended.

One possibility is to offer the choice "married/partnered."

If an adult identifies as transgender, the nurse must ask how the client wishes to be addressed.

Also, the nurse must inquire as to how the older adult prefers his or her information recorded on permanent medical records.

Ask what surgeries have been completed, as it may directly affect the care needed.

Male-to-female reassignment surgery patients often need specific tests and examinations. Nurses should also ask about medications, especially hormones like estrogen and testosterone.

Only 15 percent of the National Association of Area Agencies on Aging -- a leading voice on aging issues -- provide services tailored to the needs of older LGBT adults. The remaining agencies did not offer tailored services because they never received a request for such services.

Some agencies believed all older adults require the same services, regardless of sexual orientation; but studies have shown that is not the case, and that older LGBT adults face significant health disparities, with almost half reporting a disability that included a need for specialized equipment or physical activity limitations. Obesity and mental health issues, particularly for transgender individuals, also are common among older LGBT adults.

"Older LGBT adults have encountered a lifetime of discrimination, violence and even persecution, and these experiences have left many suspicious of health care providers and systems," Jablonski said. "By adopting inclusive language and practices, nurses are in the best position to provide thoughtful and culturally appropriate care to these older adults."