Aging poses challenges to everyone, but for the older LGBT population, particularly those who lived through the AIDS crisis of the 1980s and who did not expect to reach old age, issues remain. In 1996, the life expectancy for a 20-year-old with HIV was 39 years; with the advent of antiretroviral therapy, life expectancy by 2011 estimates was 70 years.
This was the backdrop for a May 21 panel discussion among health care professionals and other experts in the field of aging and palliative care about end-of-life concerns of LGBT patients, partners, and caregivers. The forum was sponsored by the John A. Hartford Foundation and presented by Kaiser Health News.
According to SAGE, an advocacy group for LGBT elders, about 7 million LGBT people in the United States will be older than 50 by 2030, up from 3 million today. During the panel discussion, Sean Squires, a nurse and team director for Seasons Hospice and Palliative Care of Maryland, highlighted the need for nurses and other providers to understand their own underlying assumptions and biases and to be sensitive to LGBT relationships in the language they use. For example, rather than calling a person accompanying a patient a “friend,” which may denigrate their relationship, ask, “How can I refer to your significant other?” (For more on implicit bias in health care, see “Addressing Implicit Bias in Nursing: A Review,” in the July AJN.)
Kimberly D. Acquaviva, a professor at the George Washington University School of Nursing in Washington, DC, has spoken with nurses about such biases and how their religious beliefs, for example, may affect the care they give to LGBT patients. After one such presentation, a nurse told Acquaviva she would change her practice, saying, “I still think you're going to hell, but I'm going to stop telling patients that.” Acquaviva also addressed the lack of LGBT content in nursing curricula and the absence of relevant questions on state board RN licensure exams.
A 2018 survey of LGBT adults 45 years and older, conducted by AARP, found that roughly 60% expressed concerns about neglect, physical abuse, and verbal harassment in long-term care facilities, according to Nii-Quartelai Quartey, senior advisor and national LGBT liaison at AARP, and spokesperson for the report (see www.aarp.org/research/topics/life/info-2018/maintaining-dignity-lgbt.html). The report recommends that long-term care facilities hire LGBT staff, advertise LGBT friendliness, and display welcoming signs in the facility and online to put some of these concerns to rest.
To view the full panel discussion, visit https://khn.org/news/facebook-live-inclusive-care-at-the-end-of-life-the-lgbtq-experience.—Gail M. Pfeifer, MA, RN, news director