There can be several reasons why someone might experience loneliness, but for older people in the lesbian, gay, bisexual, transgender, and non-binary (LGBT) community, there are some specific ones to be aware of.
In older age, people who identify as LGBT are more likely to be single and live on their own compared to heterosexual people. They’re also less likely to have children or regularly see family members, and if they don’t have a partner or family to support them as they get older, they’re more likely to need additional care services.
As health professionals, it’s important to know how loneliness can occur, and what you can do to help.
Some older LGBT people don’t feel that services are able or willing to meet or understand their specific needs
People in the LGBT community, no matter their age, have to overcome barriers when accessing health and social care services.
Some older LGBT people don’t feel that services are able or willing to meet or understand their specific needs, and as a result they may not engage with them. Also, many older people who have moved into care homes might feel uncomfortable with staff knowing their sexual orientation.
In most care settings, people tend to talk freely about their husband, wife, or children, however many people who identify as LGBT fear that others will react with shock, awkwardness or even rudeness if they talk openly about their partner or family.
They may have experienced discrimination in the past, and it is highly likely that without outside engagement, and a sense of community, they might have felt more alone than usual during the pandemic.
Research shows that as dementia progresses, a person’s social circle shrinks, and they tend to become even more isolated.
LGBT people living with dementia, and their partners, friends, and relatives, face many challenges and the lack of common ground between them and the professionals caring for them can result in an increased likelihood of loneliness.
The nature of dementia means that it is not always easy to communicate with people. This has led to the widely held assumption that people with dementia are not capable of expressing their views or making decisions – but research has demonstrated that people with dementia want and should be heard.
Therefore person-centred care is vital, and for this group especially. Professionals must try to understand individual experiences, which in turn, will help them to value and respect their patient.
Staff must take steps to make all services welcoming and inclusive for all and train to be as culturally competent in LGBT rights and lifestyles as they are with race and religion.
Top inclusivity tips
- Vocabulary. Remember that not all people who identify as LGBT feel comfortable with terms such as “lesbian”, “gay” or “bisexual”. For example, they may refer to their friend or companion rather than to a boyfriend/girlfriend or partner. Take the cue from the person as to the kind of language you should use and make sure these preferences are recorded.
- Connection. It might be particularly important for people to have contact with other LGBT people to support them. This can be especially important during a time of loss and change, such as the COVID-19 pandemic. For example, many older gay men will remember the traumas of anti-gay legislation during the 1980s and the AIDs epidemic. Their fears and anxieties may be being re-lived if they are alone during these times when fear, anxiety and intolerance have been raised to heightened levels, so they may need the support of their community.
- Considerations. If staff members are LGBT, they will need to consider whether it is appropriate to “be out” to the resident or their family. Professional boundaries must be kept in place, however, in some situations, and where the staff member is confident and open about their own sexuality in the workplace, it might be entirely appropriate to reassure service users that, as a gay person, they might be able to offer empathy and support. This should always be discussed with the broader care team and with the line managers.
- Education. Staff members must not push their own sexuality onto a resident, their family, or friends – and this applies to heterosexual as well as homosexual staff. If most staff are heterosexual and have had little contact with LGBT people, they must consider the need to equip themselves with more information on LGBT history, culture and experiences.
- Awareness. Most important of all, staff must avoid the excuse that sexuality is a private matter – that it is “nobody’s business” – and they must consider their patient as a whole person. Be aware you will almost certainly have contact with several LGBT residents, patients or service users and other staff members will be looking to you for leadership.
Paul Smith is a consultant in older people's care and a member of the RCN Older People’s Forum committee.
For more information, news and resources on older people’s care, visit the RCN’s Older People’s Forum.
You might also want to read our guidance on how to discuss sex, sexuality and intimate relationships with people in care homes.
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