Intended for healthcare professionals

Opinion

The greying rainbow: We need inclusive care for older LGBTQ+ people

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q3 (Published 03 January 2024) Cite this as: BMJ 2024;384:q3
  1. Aphra Luchesa Smith, junior clinical teaching fellow
  1. Royal Free Hospital, London

To provide more inclusive care we must listen to and respect the needs of older LGBTQ+ people

One morning I was sitting in with a GP in a small practice. An older man came in, followed by another who introduced himself as a friend. The patient was visiting after a recent hospital admission. As he expressed his fear about his deteriorating health, he turned momentarily to his companion. His friend reached out as if to take the patient’s hand but caught himself and moved back in his chair without making contact. After they left, the GP explained that the two men had lived together for decades and had barely been apart since the illness began but had always said that they were just good friends.

This experience led me to consider the issues facing older LGBTQ+ patients today. Some still report direct discrimination and homophobia, encountered at all levels of treatment from health and social care professionals.12 Many more are discouraged from seeking care because of a legacy of discrimination in healthcare settings and wider society, having lived through times where their sexuality was criminalised or considered a mental illness.3

A major concern of many ageing LGBTQ+ people is their lack of access to inclusive social care support. Those without children or who are estranged from their family may have less access to informal support in the community than most people, so they’re more likely to be reliant on formal support services for care as they age. Research among older LGBTQ+ people found that they hoped for dedicated spaces such as LGBTQ+ care homes, where they would feel companionship with other residents and be protected from prejudice.4

Another key issue for these patients is their same sex partners being frequently overlooked or assumed to be next of kin.4 The language used by older LGBTQ+ couples may be less specific, or they may use euphemisms such as “good friend” or “companion” rather than “partner.”

Using words that people are comfortable with is important, and we shouldn’t force people to disclose relationships. But clarifying who a patient wants their medical team to communicate with should always be a priority. This is important to help avoid cases such as those described in an interview with Age UK, where an older gay man told of how he was rarely allowed time alone with his partner by care home staff. When his partner became sick and was rushed to hospital, the care home didn’t contact him. In his words: “The man I love could have died, and I wouldn’t have been there or even known.”3

Policies and input

Asking about anyone’s sexuality can seem intrusive, so it’s common to find that “heterosexual” is taken as the default for older people. A colleague of mine, while completing an equality and diversity monitoring form for a hospice referral, asked a 90 year old how she’d describe her sexual orientation. “I’m normal, dear,” the patient replied, looking slightly bemused.

We need to get to a place where “normal” is no longer synonymous with heterosexual. Small gestures to promote inclusivity are already used, such as rainbow lanyards and badges. But more education is needed for students5 and for practising health and social care professionals,6 specifically including the needs of ageing LGBTQ+ people.

To make the NHS a safer place for these patients we need to empower staff at all levels to challenge homophobia at work and to ensure that concerns are listened to and acted on. Policies should be designed to take homophobic and transphobic discrimination seriously, with input from LGBTQ+ service users, and these should be enforced consistently. Health messaging and materials that include older same sex couples will help to reinforce the message that they’re welcome to access services, as does using open language rather than assuming that people are heterosexual.

Thought should also be given to whether same sex couples get the same private time as heterosexual couples while in hospital, as well as how staff can ensure that wards feel like safe places to show affection and spend quality time with loved ones.7 Most importantly, we need to listen more carefully to what patients are telling us about themselves and their relationships—and we need to find practical ways to ensure that these are valued and respected.

Footnotes

  • This blog was adapted from the winning entry to the 2022 Association of LGBTQ+ Doctors and Dentists’ inaugural essay competition and has not been published elsewhere.

  • All identifiable details have been changed.

  • Competing interests: None.

  • Provenance and peer review: Not commissioned, not externally peer reviewed.

References