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How healthcare professionals can support older LGBTQ+ people living with dementia
Abstract
Older lesbian, gay, bisexual, trans, queer and others (LGBTQ+) people living with dementia have specific needs related to their sexual orientation and identity that should be addressed to maintain their personhood. They may face challenges in health and social care settings, such as heteronormativity and lack of awareness of older LGBTQ+ needs. Service provision for older LGBTQ+ people with dementia is lacking. Healthcare professionals' attitudes towards older LGBTQ+ people with dementia are often poor and there is a clear need for better training, while increased knowledge and awareness would help to challenge the concept of heteronormativity. This article explores some of the needs of older LGBTQ+ people with dementia, the role of legislation and regulation and how healthcare professionals can provide support.
... LGBT past experiences profoundly affected help-seeking behaviour. Some LGBT caregivers experienced legal discrimination and homophobia earlier in life, leading them to adopt and maintain a closeted existence and resist accessing support services (Harper, 2019). Other LGBT caregivers benefitted from the effects of transformational events like the Stonewall riots, Gay Rights movement, and legalisation of same-sex marriage (McGovern, 2014). ...
... Often, LGBT relationships are not identified because questions about sexuality are not asked during assessments (National Dementia Action Alliance, 2017). Because of the limited visibility in services, despite being the experts in the person's wishes, LGBT caregivers may be excluded from important life-making legal decisions such as Advance Care Planning (ACP), Advanced Decision to Refuse Treatment (ADRT) and Do Not Attempt Resuscitation (DNAR) (Adelman, 2016;Cousins et al., 2021;Fredriksen-Goldsen et al., 2018;Harper, 2019). even when the LGBT relationship is legally recognised, through marriage or civil union, some caregivers are challenged by original family members on the grounds of their same-sex relationship (Barrett et al., 2015). ...
... Concerted effort in delivering training for statutory, non-statutory and voluntary support services would increase opportunities for LGBT caregivers to access services and receive prompt support (Harper, 2019;McGovern, 2014). Therefore, friendliness (i.e. ...
Objectives
More than 60% of people with dementia live at home, where assistance is usually provided by informal caregivers. Research on the experiences of the Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers is limited. This scoping review of the literature synthesizes international evidence on support provision for the population of LGBT caregivers.
Methods
Eight electronic databases and Google Scholar were searched using terms including ‘Dementia’, ‘LGBT’ and ‘Caregiver’ for all types of articles, including empirical studies, grey literature and sources from charity/third sector/lobbying organisations. Article selection was performed by two raters. Data were analysed through deductive thematic analysis, and three themes were established a priori: Distinct experiences of LGBT caregivers; current barriers to support; strategies to overcome the current challenges.
Results
Twenty articles were included. Distinct experiences of LGBT caregivers included a loss of LGBT identity, the impact of historical events, families of choice, and disclosing LGBT identities. Current barriers to support included poor representation of LGBT caregivers in support services, negative attitudes of staff and reluctance of caregivers to seek support. Strategies to overcome the current challenges included staff awareness training and kite-marking inclusion.
Conclusion
Limited cultural competency of staff and a subsequent reluctance to seek help have an impact on use of support services among LGBT caregivers. Implications for practice include the development of cost-effective, feasible, and acceptable inclusiveness training for services. Implications for policy include implementation in organisations of top-down agendas supporting staff to understand sexuality and non-heteronormative relationships in older age.
... It is relevant to pay special attention to people with dementia that are younger or come from the LGBTQIA + community or have a migration background or belong to an ethnic minority group. These are populations that not only face the dementia-specific challenges but also encounter other differences, such as aggravated access to healthcare for people from ethnic minorities, heteronormative healthcare services that are not suitable for people from the LGBTQIA + community, lack of healthcare services for younger people with dementia, and therefore have additional needs [13,37,38]. A further important aspect is the role of governments in the care of people with dementia and family carers. ...
Background
Dementia is a disease that impacts people with dementia, their families, and the healthcare system. In 2018, the number of people with dementia in the EU, the European Free Trade Association (EFTA), and the UK was estimated to be 9.1 million. National dementia strategies and publications by organisations such as Alzheimer Europe outline how dementia-specific care should be designed. This study aims to provide insights into existing formal care structures, models of good practise, and gaps in dementia-specific care for people with dementia in 17 European countries.
Methods
The research is based on guided interviews with country-specific care experts. A mixed-methods approach with a combination of open and closed questions was used. All interviews were recorded and transcribed verbatim based on the transcription rules of Kuckarts (2010). For data evaluation, the qualitative content analysis model of Mayring (2014) was used.
Results
In all 17 countries, efforts for dementia-friendly care and models of good care practise exist. However, there are large differences between European countries regarding the spread of dementia-specific services. In nine countries (Bulgaria, Finland, Italy, Liechtenstein, Luxembourg, the Netherlands, Norway, Sweden, the UK), there are already nationwide structures, while in five countries (Belgium, Greece, Ireland, Portugal, Romania), services are only available in certain regions. In three countries (Austria, Denmark, Germany) dementia-specific outpatient services are widespread nationwide, whereas inpatient services are not. Simultaneously, in all countries, areas with major care gaps exist. Several European states have an urgent need for action concerning the expansion of the provision of dementia-specific services, the reduction of regional differences regarding the provision of care, the elimination of barriers to access to care, the dementia-friendliness of services, and the participation of people with dementia and their relatives in care and research.
Conclusions
To reduce the existing structural inequalities in care between and within European countries, and to establish quality-related minimum standards in the care of people with dementia, transnational concepts are needed. The EU, in cooperation with care planners, research institutions, care providers, and patient organisations, should develop European care guidelines or dementia plans that contain concrete measures, schedules, and budgets.
... Having lived through decades in which their sexuality and/or gender identities were viewed as unnatural, deviant or criminal, LGBT+ people with dementia may avoid seeking out health and social care when they need it (McPhail and Fulop, 2016). When they do use health services, some LGBT+ people may choose to hide their sexuality and/or gender identity to protect themselves (Birch, 2009;Peel and McDaid, 2015;Harper, 2019). They may also experience deep-seated concern about whether they will accidentally disclose their LGBT+ identity as their cognitive ability declines (Birch, 2009;Barrett et al., 2015aBarrett et al., , 2015bCousins et al., 2020). ...
Dementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about their experiences, the ways in which their lives have been investigated, to inform future research, policy and practice. Using an established scoping review methodology, we identified seven papers that reported empirical research on the lived experience of LGBT+ people with dementia and their care partners. Only a single study reported on in two of the papers included people who were trans. This in itself reveals how rarely LGBT+ people are asked to speak about how dementia has shaped their lives in academic research. Our reflexive thematic analysis indicates that LGBT+ people with dementia and their care partners endure overlapping forms of disadvantage. This results in heightened experiences of fear and discrimination, lack of services and compounded social isolation. Importantly, while dementia was embodied as interference and loss by LGBT+ people, it was their gender and sexuality differences that provided solace, even in the face of disadvantage. Importantly, people's relationships with LGBT+ identities were framed as fundamental for safety, resilience and wellbeing, rather than a complicating or confounding factor in living with dementia.
This article reports on empirical findings from a Canadian study examining the experiences of carers who support a trans or non-binary person with dementia. Using a trans-affirmative, critical disability, anti-ageist, and intersectional approach, these findings fill an important gap in the literature. The narrative interviews with four participants reveal that there are unique features to caring for a trans or non-binary person with dementia, namely, becoming a carer due to marginalized status, performing care tasks linked to gender identity and expression, and managing multiple and specific forms of discrimination. Three of the four carers were themselves trans or non-binary, pointing to pathways into care that are linked to a shared marginalized identity. In addition to the traditional tasks of dementia care, the participants engaged in gender-related tasks such as gendered body care, sustaining the gendered self, and advocacy and future planning linked to gender identity and expression. The carers also had to manage numerous forms of cisgenderist, ageist, and cogniticist discrimination and violence directed at both the trans or non-binary person with dementia and themselves. This discrimination dramatically reduced care options, placing more responsibility on the shoulders of carers. The article ends with practical recommendations.
Introduction:
Although dementia risk factors are elevated in lesbian, gay, bisexual, and transgender (LGBT) older adults and are perpetuated by a lack of cultural competency, no known studies have quantified LGBT cultural competency among dementia care providers.
Methods:
Dementia care providers (N = 105) across the United States completed a survey consisting of the 7-point Likert LGBT-Development of Clinical Skills Scale.
Results:
Dementia care providers reported very high affirming attitudes (M = 6.67, standard deviation [SD] = 0.71), moderate knowledge (M = 5.32, SD = 1.25), and moderate clinical preparedness (M = 4.93, SD = 1.23). Compared to previously published data, they reported significantly lower knowledge than medical students. There were no differences compared to psychiatry residents.
Discussion:
The current state of dementia care providers' LGBT cultural competency has significant, yet modifiable, gaps. Better education, including more LGBT patient exposure, is necessary to improve the care being provided to members of the LGBT community impacted by dementia illness.
Speaking with a female patient and her same-sex partner about their experiences of colorectal cancer and ileostomy surgery led to reflection on how specialist nursing care could be made more inclusive of the needs of lesbian, gay, bisexual and transgender (LGBT) people. The LGBT community includes people who are attracted to the same sex and/or identify as a different gender to the one they were assigned at birth. LGBT people in the UK have experienced a long history of discrimination and only begun to win legal protections over the past two decades, an experience that still affects the older generation especially. Compared with the general population, LGBT people are more likely to report poor health status, experience mental health issues and engage in risky behaviours; however, many are reluctant to attend healthcare services due to fear of discrimination. UK LGBT rights charity charity Stonewall surveys have revealed some discriminatory attitudes and widespread unconscious bias among health and social care staff. For health professionals, it can be a challenge to use the correct terminology to avoid causing offen ce, and there is a largely unmet need for inclusion training to improve their understanding and confidence to speak with patients about sexual preference and gender identity. However, confident LGBT inclusivity can be achieved with simple communication skills, such as equal treatment for same-sex partners, acknowledgement of post-transition names and pronouns and discretion in documentation, as well as awareness of verbal and non-verbal cues. Clinic environments can be made more LGBT-friendly with gender-neutral toilets, as well as wearable LGBT symbols, inclusive imagery and posters and literature that promotes LGBT rights, inclusion and support groups. Specialist nurses can act as role models and advocates for LGBT patients and colleagues in their area through small but impactful actions.
John’s Campaign argues that carers should have the right to stay overnight in hospital if their loved ones have dementia. Phil Harper explains how it was implemented in Hampshire.
Long-term participation in creative activities has benefits for middle-aged and older people that may improve their adaptation to later life. We first investigated the factor structure of the Creative Benefits Scale and then used it to construct a model to help explain the connection between generativity and life satisfaction in adults who participated in creative hobbies. Participants included 546 adults between the ages of 40 and 88 (Mean?=?58.30 years) who completed measures of life satisfaction, generativity, and the Creative Benefits Scale with its factors of Identity, Calming, Spirituality, and Recognition. Structural equation modeling was used to examine the connection of age with life satisfaction in older adults and to explore the effects of creativity on this relation. The proposed model of life satisfaction, incorporating age, creativity, and generativity, fit the data well, indicating that creativity may help explain the link between the generativity and life satisfaction.
Sexuality and intimacy in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy.When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with howto continue sexual activitywithreduced capacity.We reviewthe (Anglophone) academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents (though much of this applies to older people generally).We highlight how ageism (or ageist erotophobia), which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing that recognises constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption. Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically informed practitioner-led work.
The face recognition of medically altered faces under gender transformation is performed. Medical alteration is the gender transformation performed by undergoing hormone replacement therapy (HRT). Face images that are undergoing HRT based gender transformation over a period of several months to three years are taken. By altering the balance of sex hormones HRT achieves gender transformation. HRT causes changes in the physical appearance of the body and face. Changes in the face due to HRT affect the face recognition system. Existing system uses a face recognition system and the studies reveal that the Periocular region is invariant to the changes due to HRT. So a Periocular based face recognition system is developed. Initially perform face and eye detection then alignment and cropping is performed. Face images are represented using patch based local binary patterns. Face recognition is performed by using the binary classifier SVM Classifier.
Purpose:
We examined associations between family rejection and risk of suicide attempts and substance misuse among a national sample of transgender and gender nonconforming adults.
Methods:
Data were drawn from the National Transgender Discrimination Survey (N = 6456). This secondary analysis was restricted to 3458 individuals who self-identified as transgender or gender nonconforming and provided complete data on study variables. We used multivariable logistic regression to examine health risks by level of reported family rejection (low/moderate/high), controlling for relevant sociodemographic characteristics.
Results:
Overall, 42.3% of the sample reported a suicide attempt and 26.3% reported misusing drugs or alcohol to cope with transgender-related discrimination. After controlling for age, race/ethnicity, income, education, and employment status, family rejection was associated with increased odds of both behaviors. Odds increased significantly with increasing levels of family rejection.
Conclusions:
Family rejection related to gender identity is an understudied interpersonal stressor that may negatively affect health outcomes for transgender and gender nonconforming individuals. A better understanding of the role of close relationships in both risk and resilience for transgender individuals is critical in the development of effective public health interventions for this community.
Introduction: Cognitive and functional compromise, as frequently observed in Alzheimer’s disease (AD), hinders communication and social interactions. One consequence of this hindrance may be a feeling of loneliness. Moreover, emptiness and boredom, as observed in social isolation and loneliness, may thus be
compensated for by creating imagined stimuli. Conditions of loneliness may be viewed as potentially generating hallucinatory experiences. To assess this assumption, the present study explored the relationship between social isolation, loneliness, and hallucinations in a sample of 22 mild AD participants and 24
elderly, healthy controls.
Methods: Participants were assessed using the Launay–Slade Hallucination Scale, the UCLA Loneliness Scale, and a scale exploring contact with others and social participation.
Results: More hallucinatory experiences, social isolation, and loneliness were found in the AD group than in the healthy control group. Moreover, significant correlations were observed between hallucinations and loneliness and between hallucinations and social isolation in both groups. Finally, hallucinations were predicted by social isolation.
Discussion: Hallucinations may constitute a compensatory mechanism that aims to fulfil communication needs in lonely, elderly participants. Hallucinations may also be regarded as experiences that allow certain participants to escape the cycle of boredom, emptiness, and affective deprivation caused by social isolation.
Objective:
To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals' recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care.
Review methods:
The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health-care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible.
Results:
A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies - seven quantitative, eight qualitative and three opinion papers - met the inclusion criteria and were appraised. The importance of sexuality to well-being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health-care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings.
Conclusions:
Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health-care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment.
Sexuality and intimacy needs in care homes for older people are overshadowed by concern with prolonging physical and/or psychological autonomy (Bauer et al 2014). When sexuality and intimacy have been addressed in scholarship, this can reflect a sexological focus concerned with how to continue sexual activity with reduced capacity (Hodson and Skeen 1994; Gott 2005). We review the Anglophone academic and practitioner literatures bearing on sexuality and intimacy in relation to older care home residents, often applicable to older people generally. We highlight how ageism or ageist erotophobia, which defines older people as post-sexual, restricts opportunities for the expression of sexuality and intimacy. In doing so, we draw attention to more critical writing (Bauer et al 2012; Hafford-Letchfield 2008) that recognizes constraints on sexuality and intimacy and indicates solutions to some of the problems identified. We also highlight problems faced by lesbian, gay, bisexual and trans (LGB&T) residents who are doubly excluded from sexual/intimate citizenship because of ageism combined with the heterosexual assumption (Willis et al 2013). Older LGB&T residents/individuals can feel obliged to deny or disguise their identity. We conclude by outlining an agenda for research based on more sociologically-informed practitioner-led work, for example Hafford-Letchfield (2008).
This study is the first to examine the experiences and needs of an international sample of current, English-speaking, lesbian, transgender-identified (trans-lesbian) adults around a number of later life and end-of-life perceptions, preparations, and concerns. I analyzed a subset (n = 276) of the cross-sectional data collected from the online Trans MetLife Survey on Later-Life Preparedness and Perceptions in Transgender-Identified Individuals (N = 1,963). I assessed perceptions and fears around aging, preparation for later life, and end-of-life as well as numerous demographic and psycho-social variables. Despite the overall feeling that they have aged successfully, the respondent trans-lesbian population harbors significant fears about later life. I found that this population, while better-prepared than the overall respondent trans-identified population, is still ill-prepared for the major legalities and events that occur in the later to end-of-life time periods.
This article brings together two case studies that examine how nontransgender people, “gender normals,” interact with transgender people to highlight the connections between doing gender and heteronormativity. By contrasting public and private interactions that range from nonsexual to sexualized to sexual, the authors show how gender and sexuality are inextricably tied together. The authors demonstrate that the criteria for membership in a gender category are significantly different in social versus (hetero)sexual circumstances. While gender is presumed to reflect biological sex in all social interactions, the importance of doing gender in a way that represents the shape of one's genitals is heightened in sexual and sexualized situations. Responses to perceived failures to fulfill gender criteria in sexual and sexualized relationships are themselves gendered; men and women select different targets for and utilize gendered tactics to accomplish the policing of supposedly natural gender boundaries and to repair breaches to heteronormativity.
This paper reports the findings of a literature review of the health, social care and housing needs of older lesbian, gay, bisexual and transgender (LGBT) adults undertaken in 2006 for the Welsh Assembly Government. Peer-reviewed literature was identified through database searches of BNI, PubMed, CINAHL, DARE, ASSIA and PsychInfo. Follow-up searches were conducted using references to key papers and journals as well as specific authors who had published key papers. A total of 187 papers or chapters were retrieved, of which 66 were included in the study; major themes were identified and the findings synthesised using a meta-narrative approach. The main themes that emerged from the review were isolation, health behaviours, mental health and sexual health behaviours. The literature indicates that the health, social care and housing needs of LGBT older people is influenced by a number of forms of discrimination which may impact upon the provision of, access to and take up of health, social care and housing services. Understanding of the health, social care and housing needs of older LGBT people is limited and research in this area is scarce. The research which exists has been criticised for using small samples and for tending to exclude participants from less affluent backgrounds. The focus of research tends to be on gay men and lesbians; consequently, the needs of bisexual and transgender people remain largely unknown. Additionally, research which does exist tends to focus on a narrow range of health issues, often related to the health needs of younger LGBT people. Discrimination in various forms has a major impact on needs and experiences, leading to marginalisation of LGBT people both in the provision of health and social care services and neglect of these groups in public health research.
This study investigated what it means for mature gay men to be voluntary single from the perspective of both assessment and subjective experience. A convenience sample of 94 self-identified single gay men from a large midwestern city, ages 35 and over, completed a structured questionnaire that included the 15-item Adaptation to Single Status Measure. Twenty of these men also participated in semi-structured life-history interviews. Descriptive, item, and scale analyses indicated a discrepancy between the perception of oneself as "single by choice" and acceptance of and satisfaction with single status. Qualitative data indicated that voluntary singlehood is neither a salient identity nor an expression of primary control; rather, it is an idiosyncratic "narrative strategy" and a form of secondary control that preserves ego integrity. These findings are discussed with respect to their implications for the creation and maintenance of healthy, happy, single lifestyles and communities.
This paper investigates the concept of internalized homophobia in both theory and research relating to lesbian and gay health. It offers a contemporary and critical review of research in this area, and discusses a range of recent findings relating to a range of health issues including HIV and AIDS. Whilst the concept has a resonance for gay men and lesbians, and is widely used in 'lesbian and gay-affirmative' interventions, the paper demonstrates that research findings have been equivocal and the term is often used without full consideration of its sociopolitical consequences. The paper concludes that the concept does have a valuable role to play in health promotion work with lesbians and gay men but invites further discussion and examination of the construct.
Stereotypes of an asexual old age remain pervasive, shaping not only popular images of older people, but also research and policy agendas. However, older people's own attitudes towards the role and value of sex in later life remain relatively unexplored. This paper draws on both quantitative and qualitative data to examine how sex is prioritised in middle age and later life. Data collection methods involved completion of two quality of life measures (WHOQOL-100 and WHOQOL Importance Scale), followed by semi-structured interviews. In total the sample comprised 69 individuals recruited from the age/sex register of a general practice in Sheffield in the UK. This paper will focus upon the accounts of 21 men and 23 women aged 50-92 years. Ratings of the importance of sex to participants were gathered from the WHOQOL Importance Scale; the in-depth interviews enabled the basis for this prioritisation to be explored. Analysis identified the following key themes. Participants who did not consider sex to be of any importance to them neither had a current sexual partner, nor felt that they would have another sexual partner in their lifetime. Indeed, all participants who had a current sexual partner attributed at least some importance to sex, with many rating sex as 'very' or 'extremely' important. However, experiencing barriers to being sexually active led them to place less importance on sex; this was particularly apparent when health problems and widowhood were experienced. Age was seen as facilitating coping when sex became less frequent, or stopped altogether. This was explained in terms of sexual desire decreasing with age (for some male participants), the cessation of sex being easier to cope with in a relationship of long duration and the expectation that sex will become less possible with 'normal ageing'. The discussion considers the implications of these findings for this developing field.
Objectives: Until now little research has been done to answer the question of whether people with dementia experience stigma. No previous studies investigated possible differences between countries and cultures. Therefore, the aims of this study were to compare the experience of stigma (with social isolation, social rejection and internalised shame as components) among people with dementia and mild cognitive impairment (MCI) (n = 180) in Italy (n = 79), Poland (n = 47) and the United Kingdom (UK) (n = 54); and to investigate possible relationships with demographical and clinical outcomes.
Methods: A one group multinational cross-sectional design was used. Stigma was measured with the Stigma Impact Scale (SIS), quality of life aspects with Dementia Quality of Life scale (DQOL) and Quality of Life Alzheimer’s Disease scale (QOL-AD), social support with Duke Social Support Index (DSSI), cognitive functioning with Global Deterioration Scale (GDS).
Results: The level of stigmatisation (SIS) among study participants varied from 2 to 65 (median = 33.5; Q1 = 27; Q3 = 41). People with dementia in the UK experienced a higher level of stigmatisation than people in Italy and Poland. The experienced stigmatisation negatively correlated with social support (DSSI; rho = −0.42, p = 0.000) and quality of life (QOL-AD; rho = −0.39, p = 0.000). People who experienced a higher level of stigmatisation scored higher in negative mood DQOL subscale (rho = 0.28, p = 0.0002).
Conclusion: There is a strong need for research into the individual experience of people with dementia across the world. This could help in providing support and care services that match their experience, needs, preferences; and in designing well informed awareness campaigns based on their voice.
Background and purpose:
This article provides foundational information about 1) the significant health disparities LGBT individuals face, which are associated with persistent discrimination, oppression, and stigmatization in both societal and healthcare settings; and 2) how cultural humility can help nurses to create safe spaces and provide optimal care for all patients.
Methods:
CINAHL, Medline, PsychInfo, and GoogleScholar databases were searched to identify theoretical and empirical literature regarding LGBT health, health disparities, barriers to accessing care, unconscious bias, cultural humility, and creating safe spaces to better meet the healthcare needs of the LGBT population.
Conclusions:
LGBT patients' health needs are not being adequately met in many healthcare settings due to inadequate education and preparation of healthcare providers, including nurses. Lack of access to safe, appropriate, and affirming healthcare services increases the risk of poor health and persistent health disparities.
Implications for practice:
As the largest professional healthcare workforce, nurses can have a significant role in reducing the health disparities LGBT patients face. When armed with the tools to care for LGBT patients with cultural humility, nurses can lead clinical change within their institutions to create safe, accepting, affirming, inclusive, and welcoming environments for all patients.
The experiences of transgender individuals within health-care, social services, and aging systems are unique throughout the lifespan. Traditional aging services such as long-term care facilities and aging in place resources can offer opportunity and unexpected pitfalls in older age. This chapter details systems of support available to transgender older adults and explains how to leverage these systems to improve the aging experience.
This article is concerned with the relationship between gender performativity and organizational place, taking the City of London as the focus for the empirical research, and extending a Lefebvrian understanding of space through the practice of flânerie. The article explores how the City is imagined, constructed and experienced in and through gender performativity. This is explored with reference to fieldwork including photographic and interview data, as well as through an embodied, immersive methodology based on the observational tradition of flânerie, showing how this can help to both sense and make sense of organizational place, particularly in terms of how such places can compel feelings of belonging or non‐belonging. The research looks beyond the spatial configuration of a single organization to encompass the wider geographical location of multiple organizations, in this case the City. The analysis highlights the interplay between two dominant forms of masculinity, emphasizing how the setting both reflects and affects this interplay. In this way the article contributes to scholarship on organizational place and the placing of gender performativity, and extends Lefebvre's theories of space as socially produced by (re)producing the City through peripatetic practice based on the tradition of the flậneur.
Aim:
To review current research on lesbian, gay, and bisexual (LGB) individuals' experience of nursing services from an emancipatory nursing practice framework.
Background:
As LGB issues are marginalized in health care, it is important to understand LGB individuals' experiences of nursing.
Design:
An integrative literature review using critical analysis based on an emancipatory nursing practice framework was conducted.
Data sources:
A search of all English nursing journals in the World of Science database was conducted.
Review methods:
Established methods were used to search, identify, and appraise articles meeting the criteria of examining LGB individuals' experiences of nursing services, published in the years 2009 to 2015. Sixteen articles that met the inclusion criteria were identified independently by the two authors. Data were analysed using descriptive and critical phases of enquiry.
Results:
Results show a nexus of experiences of exclusion and oppressive social norms. Our analytical framework highlighted absences in nursing practice. No research indicates that LGB people experience nurses as advocates or participatory health care processes.
Conclusion:
Standards, training, and systems need to be devised that ensure inclusionary nursing practices, that encourage nurses to act as advocates for LGB health care justice, and that allow LGB individual to participate in the development of health care policies and procedures.
Mobilizing the concept of postfeminism as a sensibility, this article invites organization and gender scholars to examine how postfeminist masculinities are discursively constituted and performed by men within contemporary work contexts. Acknowledging that women are interpellated within postfeminist discourses as empowered and autonomous subjects whose lives are shaped by individual choice, this article explores the implications for men, in particular how men variously perform postfeminist masculinities and the implications for addressing gendered inequalities within the workplace. Developing a research agenda, this article outlines three research trajectories: (1) problematizing a gender binary in which women are depicted as empowered at work and men in a state of crisis; (2) interrogating signs of 'new' postfeminist masculinities coded as inclusive in the workplace; and (3) examining how different types of men perform postfeminist masculinities at work. This article concludes by providing examples of research questions to generate future organizational scholarship in these areas.
Background:
There is limited research on what family members and frontline care home staff consider to be the best responses to the sexual expression of a person with dementia, whilst at the same time respecting relatives' feelings, managing their possible distress and conflict.
Methods:
This exploratory study investigated the views of relatives and care workers of new relationships or sexual intimacy between care home residents with dementia, whilst still married to another person. It reports the themes that emerged in qualitative interviews with eight relatives of people with dementia and with 12 frontline care home staff working in two English care homes. Interviews took place in 2015 using a hypothetical vignette that unfolded in four stages. Thematic analysis was used to analyse the data.
Findings:
The views of care home staff and relatives had similarities in general terms regarding the problems arising around expressions of sexuality in care homes: indicting that a light-hearted or non-physical connection between residents is deemed acceptable, but the moment it becomes a sexual relationship then decision making becomes more complicated. Staff were inclined to turn to managers for advice and to consider separating residents. They expressed familiarity with distracting residents from situations that were of concern. Relatives were considerate of the difficulties and dilemmas faced by care home staff.
Conclusion:
The use of a vignette facilitated discussion of a potentially sensitive topic. Areas for further research are identified.
This volume collects twenty-two published and unpublished chapters on a variety of topics related directly to human rights, justice, and the common good. The first nine date from 1970 through to 2007. They begin with a study — in dialectic with Dworkin's earlier lecture on the same themes — of the bearing of contemporary legal and political theory on the incorporation of a declaration of rights and freedoms in British law. There follow chapters on place of rights, and of duties to oneself, in Kant's moral and legal theory and some contemporary interpreters of Kant; on the application classical conceptions of distributive justice to modern problems; on the emergence of the ideal of government limited by, inter alia, respect for human rights, and contemporary distortions of the ideal that are proposed by Rawls, Dworkin, and followers of theirs (not least in relation to marriage); on the place of civic virtues and respect for diverse persons in constitutional order; and two chapters on the great question of migration rights and the legitimacy of national boundaries preventing free and equal migration. Part Two groups three chapters on the justice of punishment, concluding with the mature statement of retribution's place as punishment's formative justifying aim, in engagement especially with Nietzsche's ‘genealogy of morals’. Part Three surveys just way theory in its historic development and current shape. Parts Four, Five, and Six each group three chapters: on autonomy, justice, and euthanasia; on autonomy, justice, and human reproduction; and on marriage in its relation to justice and the common good.
More women than ever before are participating in a diverse array of sports. However, at the same time, this popularity accentuates the femininity of these sportswomen, protecting the "image" of women's sports. The underlying message is that athleticism and femininity are contradictory, and females have to go out of their way to show that they can be athletic and be socially accepted. Kolnes' (1995) concept of heterosexuality as an organizing principle in women's sport provides the foundation for understanding the social construction of females in sport. Generally, women who appear heterosexually feminine are privileged over women perceived as masculine. Consequences of nonconformity to hegemonic femininity in sport often include sexist and heterosexist discrimination. This leads many sportswomen to emphasize feminine characteristics to avoid prejudice and discrimination. However, females perceived as too feminine are then sexualized and trivialized, leaving women to carefully balance athleticism with hegemonic femininity. However, in less traditional sport settings, females are resisting, challenging, and transforming expectations of hegemonic femininity. © 2001 National Association for Physical Education in Higher Education.
‘We see it as being heterosexualised, being put into a care home’: gender, sexuality and housing/care preferences among older LGB individuals in the UK
Westwood S (2016b) 'We see it as being
heterosexualised, being put into a care home':
gender, sexuality and housing/care preferences
among older LGB individuals in the UK. Health &
Social Care in the Community. 24, 6, e155-e163.
Doing gender, doing heteronormativity: ‘gender normals,’ transgender people, and the social maintenance of heterosexuality
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Dementia: The One-Stop Guide: Practical Advice for Families, Professionals, and People Living with Dementia and Alzheimer's Disease
- J Andrews
Andrews J (2015) Dementia: The One-Stop Guide:
Practical Advice for Families, Professionals, and
People Living with Dementia and Alzheimer's
Disease. Profile Books, London.
Gender Trouble: Feminism and the Subversion of Identity. Routledge, London. Care Inspectorate Wales (2019) What We Do. careinspectorate.wales/about-us/what-we-do
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Butler J (1999) Gender Trouble: Feminism and the
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The Life Cycle Completed (Extended Version)
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Erikson E, Erikson J (1997) The Life Cycle Completed
(Extended Version). WW Norton and Company,
New York NY.
V/f Validation: The Feil Method, How to Help Disoriented Old-Old
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Feil N, de Klerk-Rubin V (2015) V/f Validation: The
Feil Method, How to Help Disoriented Old-Old. Third
edition. Edward Feil Productions, Cleveland OH.
LGBT* individuals and dementia: an intersectional approach
- W Hulko
Hulko W (2016) LGBT* individuals and dementia:
an intersectional approach. In Westwood S, Price E
(Eds) Lesbian, Gay, Bisexual and Trans* Individuals
Living with Dementia: Concepts, Practice and
Rights. Routledge, Abingdon, 35-50.
Metaphors for teaching about changing memory and cognition in Alzheimer's disease: bookcases in a library
- G Jones
Jones G (2004) Metaphors for teaching about
changing memory and cognition in Alzheimer's
disease: bookcases in a library. In Jones G,
Miesen B (Eds) Care-Giving in Dementia: Research
and Applications. Volume 3. Routledge, Abingdonon-Thames, 37-66.
Dementia Reconsidered: The Person Comes First
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Kitwood T (1997) Dementia Reconsidered:
The Person Comes First. Open University Press,
Buckingham.
Safe to Be Me: Meeting the Needs of Older Lesbian, Gay, Bisexual and Transgender People Using Health and Social Care Services
- S Knocker
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Knocker S, Smith A (2017) Safe to Be Me: Meeting
the Needs of Older Lesbian, Gay, Bisexual and
Transgender People Using Health and Social Care
Services. Age UK, London.
Meeting the needs of LGBT people affected by dementia: the story of the LGBT dementia support group
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Newman R, Price E (2012) Meeting the needs of
LGBT people affected by dementia: the story of the
LGBT dementia support group. In Ward R, Rivers
I, Sutherland M (Eds) Lesbian, Gay, Bisexual and
Transgender Ageing: Biographical Approaches
for Inclusive Care and Support. Jessica Kingsley,
London, 183-195.
Over the Rainbow': Lesbian, Gay, Bisexual and Trans People and Dementia Project: Summary Report
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Peel E, McDaid S (2015) 'Over the Rainbow':
Lesbian, Gay, Bisexual and Trans People and
Dementia Project: Summary Report. University of
Worcester, Worcester.
Health and Social Care Standards My Support, My Life. Scottish Government
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Scottish Government (2017) Health and Social
Care Standards My Support, My Life. Scottish
Government, Edinburgh.
Microaggressions in Everyday Life: Race, Gender, and Sexual Orientation
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Sue D (2010) Microaggressions in Everyday Life:
Race, Gender, and Sexual Orientation. John Wiley
and Sons, Hoboken NJ.
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Traies J, Munt S (2014) Life histories and health
narratives of older British lesbians. In Zeeman L,
Aranda K, Grant A (Eds) Queering Health: Critical
Challenges to Normative Health and Healthcare.
PCCS Books, Monmouth, 23-44.
Gender, sexuality, gender identity and dementia; (in)equality issues
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identity and dementia; (in)equality issues. In
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Older People in Care Homes: Sex, Sexuality and Intimate Relationships: An RCN Discussion And Guidance Document for the Nursing Workforce
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