Championing LGBTI+ Older People

In November 2019, then Minister for Justice and Equality, Charlie Flanagan TD, launched Ireland’s National LGBTI+ Inclusion Strategy. The Strategy contained over 100 actions that are aimed at promoting inclusion, protecting rights, and improving the quality of life and wellbeing of LGBTI+ people. This Strategy contained a specific objective relating to healthcare, ensuring that healthcare providers and practitioners are trained to understand the identities and needs of their LGBTI+ patients, and highlighted the need to provide health and social care services that meet the needs of older LGBTI+ people.

About LGBT Ireland

LGBT Ireland is a national support service for Lesbian, Gay, Bisexual, and Transgender people (LGBT) and their families and friends. We offer a comprehensive range of services which provide support and information on issues relating to sexuality and gender identity, including front line services such as Peer Support Groups and managing the national LGBT Helpline (1890 929 539) and Transgender Family Support Line (01 907 3707).

In the area of healthcare, LGBT Ireland uses the Healthy Ireland ‘whole-of-society’ approach, delivering LGBTI+ awareness training to services and community groups with a focus on reducing health inequalities and eliminating barriers that may currently prevent LGBTI+ people from accessing health and social services.

This LGBTI+ awareness training includes the LGBT Champions programme, a training programme for health and social care professionals, which aims to create change in the healthcare system, making LGBTI+ older people visible, safe, and assured that they will be accepted even at their most vulnerable time.

An invisible population

According to the CSO, by 2031, the number of people aged 65 years plus is expected to grow to over 1 million. It is estimated that up to 8% of persons in Ireland aged 65 years and over may be LGBT. All ageing populations share common lifestyle, health, and social concerns as they plan for old age, however many older LGBTI+ people face significant additional challenges.

While there have been huge advances in LGBTI+ rights and recognition in Ireland in recent years, it is apparent that the older LGBTI+ population are benefiting least from these positive changes. What LGBT Ireland has heard from older LGBTI+ people contacting the national LGBT helpline mirrors findings from research into the experiences of older LGBTI+ people. Many are forced back into the closet due to concerns that older age health and social care services are not welcoming of them or will discriminate against them.

As the most readily accessed healthcare professional in Ireland, it is crucial that community pharmacists are welcoming, supportive, and understanding of this population group, so that older LGBTI+ people can enjoy equality of access to care as they need it.

The situation for older LGBTI+ people

Homosexuality was listed as a mental disorder in the World Health Organisation (WHO) until 1990 and was criminalised in Ireland until 1993. Transgender health issues were classified as mental and behavioural disorders until as recently as 2019. These issues and the prevailing social, religious, and cultural attitudes which existed in Ireland until relatively recently, mean older LGBTI+ people grew up in society where being a member of the LGBTI+ community led to exclusion and isolation. Coming out often meant the loss of relationships with parents, siblings, spouses, children, and friends and could lead to exclusion, marginalisation, and loss of employment.

The Lesbian, Gay & Bisexual People in later life report published by Stonewall found that “older LGB people are nearly twice as likely as their heterosexual peers to expect to rely on a range of external services, including GPs, health and social care services and paid help”. While this is UK-based research, Irish research has suggested that the experience of older LGBTI+ people living here is similar. The reasons for this greater reliance include:

Diminished support networks in comparison to heterosexual peers:

• More likely to be single;
• More likely to live alone;
• Less likely to have children; and
• Less likely to see biological family members regularly.

Exhibit ‘notable differences’ in health risk factors and lifestyle choices:

• Drink alcohol more often;
• More likely to take drugs; and
• More likely to have a history of mental ill health.

The Visible Lives study, which was commissioned by GLEN (Gay and Lesbian Equality Network) and conducted by a team of researchers from the School of Nursing and Midwifery at Trinity College Dublin, showed that 40% of older LGBTI+ people in Ireland were not comfortable being open with their health and social care providers about their sexual orientation, sexual identity or sexual expression for fear of rejection or discrimination. Many of those surveyed feared that healthcare staff would not understand or would discriminate against them because they were LGBTI+.

These factors and the lack of meaningful community and social support means that older LGBTI+ people are at a much higher risk of being lonely and isolated compared to older people in general, having a huge negative impact on their mental and physical health and well-being over time. This is why it is so important that services “come out as LGBTI+-friendly” and not leave it to the vulnerable older person.

First-hand account

Sean is in his mid-60’s and lives in Skibbereen, Co. Cork — here he shares his thoughts on the impact that inclusive healthcare can have.

Have you ever felt anxious standing in line at your local pharmacy? Making calculations of all the scenarios that could possibly playout in reaction to your questions? Side-stepping important details or making up fictitious stories to gain crucial information that you need to make informed decisions about your healthcare? Being an older gay man living in a rural area, I have.

This used to be an all too familiar situation for me. I would walk away from the pharmacy, my mind aflutter with unasked questions. To me, these were important questions, ones I felt would have an impact on my wellbeing — but the fear of potential discrimination held me back.

One of the most positive experiences I have had was in the UK. I was interested in the new drug used as PreP and thought a pharmacist would have the best answers for me. I went to a pharmacy and on the front glass door was a discrete but noticeable rainbow sticker. On seeing this, I was much more relaxed and confident to go and speak to them about my query. The pharmacist proved to be most helpful and non-judgemental, giving me pamphlets on PreP and other useful information and encouraging me to return if I needed more advice. They earnestly embraced diversity and inclusivity. I continued to use this pharmacy as I felt valued and could speak to them about my personal needs as an older gay man.

Luckily, I overcame my fear of asking questions, but I know that many other LGBTI+ people still live with that same fear I felt. I see a need for all healthcare providers in the chain to understand the needs and health concerns of the many groups in society today. No one should feel they are marginalised because of their gender or sexual identity especially when it comes to a person’s health.

What is most important for me is that my pharmacist can communicate in comfortable terminology, and respond to me in a kind and compassionate manner. I want a safe and welcoming environment with a positive attitude.

What you can do to make your practise inclusive

There are several simple and practical strategies for becoming more inclusive.

• Make your pharmacy visibly LGBTI+ inclusive: LGBTI+ people feel safer and more confident in accessing services if it is clear they are welcome. Posters signposting LGBTI+ organisations, leaflets relevant to LGBTI+ specific issues or even a discrete but noticeable rainbow sticker, will contribute to a safe and welcoming environment;
• Avoid assumptions: When speaking with a patient, avoid making assumptions about their gender and/or sexual orientation. Ask open questions and use gender neutral language;
• Ensure that staff receive LGBTI+ awareness training: Making yourself LGBTI+ aware will make your practice LGBTI+ inclusive. Training creates confidence to be proactive in addressing LGBTI+ issues and promotes person-centred care. Contact training@lgbt.ie to discuss awareness training options; and
• Become familiar with national and local LGBTI+ organisations: There are a network of national and local organisations working throughout Ireland providing support and training, some of which are listed here:

• • LGBT Ireland: www.lgbt.ie;
  • TENI (Transgender Equality Network Ireland): www.teni.ie;
  • BeLonG To, the national organisation for LGBT young people: www.belongto.org; and
  • HIV Ireland: www.hivireland.ie.

Any of these organisations will be able to provide LGBTI+ leaflets, posters, or stickers to display in your pharmacy.

Making small changes can have an enormous impact for a very vulnerable group; embracing LGBTI+ people for who they are and providing the best care and support possible will ensure they can go on to live happier, healthier lives as part of their communities.