In the UK there are no accurate statistics on LGBTQ+ people living with dementia. However, it is estimated that there are approximately 1.2 million older gay and lesbian people in the UK. This approximation demonstrates that there is a need for services such as care settings to recognise the needs of a gay or lesbian person living with dementia. This number, however, does not include transgender or other non-binary people living with dementia, the number of LGBTQ+ people with dementia could, therefore, be a larger number.
How a diagnosis with dementia impacts a person who may be LGBTQ+
When we think about supporting a person from the LGBTQ+ community with dementia, we have to first explore what are the needs of a LGBTQ+ person generally. Then we can apply what we know about supporting a person living with dementia.
If we take the L, G and B letters first, this stands for Lesbian, Gay and Bisexual. A common need for this group of people is feeling safe in an inclusive environment. This is definitely the case for a person living with dementia, especially in care settings.
Care staff should be aware of the language and interactions they have. A concept called heteronormativity is very prevalent in today’s society. This is the view that heterosexuality is the norm, this view is then put onto society as whole and everyone who is not heterosexual is seen and made to feel abnormal. Heteronormativity is often not intentional but can have a negative impact on an individual. An example of this heteronormativity in care would be, when a member of staff assumes heterosexuality and asks if a new male resident has a wife, this can make a non heterosexual person feel excluded, especially in the older generation when they might not feel comfortable to correct the member of staff.
Internalised homophobia is also an important consideration and a barrier to an older person expressing their sexuality if not heterosexual. Foucault famously uses an example of a panopticon to explain internalised homophobia, this is where a guard watches people in cells around them from a central position. Due to the guard being able to observe anybody at any one time the people around them starts to self monitor their behaviour. As already discussed, society commonly sees non heterosexual sexualities as abnormal, therefore, a person might not want society or the weather to se them expressing their sexuality. This is especially prevalent in older people with dementia. It was only in 1967 that homosexuality was decriminalised, therefore, where previous memories might resurface due to the dementia there may be fear about prosecution and others identifying a persons sexuality.
Care setting also hold their own unique challenges, especially, due to outdated views on homosexuality from other residents. This can cause a non inclusive environment where a non heterosexual would not feel comfortable to express themselves.
Tom Kitwood a famous dementia theorist states that love and relationships are important needs to meet when respecting a person as an individual and maintaining their personhood.
Talking about relationships, same sex partners are often not recognised by healthcare professionals, they are often only seen as friends and not partners. There are many cases that a person living with dementia in care settings are taken into hospital or discharged back from hospital and a same sex partner has not been contacted. Much of this stems from the concept of heteronormativity, people should not presume that that male friend who visits frank in hospital three times a day would be his partner, however, if that was a female friend of a similar age staff commonly would assume it was a partner.
People from the LGBTQ+ community commonly find it harder to find a partner, therefore, they might not be in relationship. This is commonly not an issue due to family acting as a persons NOK, however, if a person has become estranged from their family due to their coming out, this could be an issue. Who do healthcare professionals contact? And who acts as an official advocate for an individual especially if they lack capacity? People in the LGBTQ+ community often have a chosen family of close friends, therefore, these people are often the people who know the best about an individual and have their best interests at heart.
The T in LGBT stands for Transgender. This group of people has some very specific needs.
Healthcare professionals often disregard the needs of a person who is transgender, this is by not respecting the assistance a person might need to present as the gender they identify as or by taking a person off their hormone medication. Another consideration, especially with a transgender person who may have dementia would be the effect of memory loss on their gender identity. Previous memories of a person living with dementia often get confused with current memories, therefore, for a person who is transgender and transitioned, they might not recognise the gender they now are. This means that assisting a person with personal care, for example, would need a sensitive and inclusive approach.
Language is also important, especially, in the case of a transgender person living with dementia, identifying and using the right pronouns is essential to build trust and support a persons identity and personhood.
Considerations and ways healthcare professionals can appropriately support a LGBTQ+ person living with dementia
As stated creating inclusive environments is essential in supporting a LGBTQ+ person, especially, living with dementia. The physical environment can be made more inclusive by possibly having LGBTQ+ insignia visibility, such as, the rainbow flag. You can also make the environment more inclusive by thinking about how you communicate to the residents/ clients. Healthcare professionals should challenge heteronormativity. This can be by using Moore inclusive language, for example when a new resident is admitted to your care home, you might just ask partner instead of a gender specific option.
Creating a safe environment would also help reduce a person’s internalised homophobia. Openly discussing sexuality and positive attitudes towards non heterosexuals, on top of the physical insignia as stated, would communicate to a person that the central watcher, in this case the care setting, does not discriminate. This hopefully would encourage a person to feel comfortable to come out and/or express their sexuality.
Reminiscence is useful and commonly used tool in engaging and supporting a person living with dementia. It is important to recognise that for an LGBTQ+ person living with dementia this may resurface negative emotions and feelings. This is especially prevalent for a LGB person living with dementia, as these feelings could be based on prosecution or previous experiences of discrimination, as it was only in 1967 that homosexuality was decriminalised.
For a person who is transgender, living with dementia reminiscence could bring up painful memories of living as the wrong gender or a difficult transition. This does not mean that reminisce should not be attempted with a LGBTQ+ person living with dementia, just that the facilitator should be prepared to validate and support the person with painful emotions.
As well as making LGBTQ+ residents or clients comfortable, their partners and/or friends should be made to feel comfortable also. This can be achieved through recognising them as who they are and as a persons NOK. Due to the recent legal changes and same sex marriage Beijing legalised, things will change. However, due to this only being recent and ageist views around marriage only being for younger people, there might still be a barrier here.
Ask questions, be inclusive in ways stated, this might make the partner feel comfortable to come to you and inform you of their relationship, in turn, this will build trust and improve communication which is essential especially around gaining more information about the resident/ client and discharge if in hospital.
In regards to a person who is transgender, respecting a persons identity is essential.there are many ways you can do this in a healthcare setting. You need to be sensitive when referring to a persons gender, especially, as stated when a person has memory problems and may not remember that they have transitioned. Using gender neutral pronouns and language can help. Also dementia might impact the ability for a person to remember how to provide personal care for themselves, especially, for a person who transitioned later on in life. Therefore, more support from care staff might be needed, bearing in mind that due to the effect on their memory and that learning new information is difficult for a person living with dementia, support and education on these needs might be needed on a very regular basis.
Please note: The image used to illustrate this story does not represent an actual person or events. Image: iStock.
