Are Services Inclusive? A Review of the Experiences of Older GSD Women in Accessing Health, Social and Aged Care Services

Abstract

The review aimed to examine the views and experiences of ageing gender and sexually diverse (GSD) women—a triple minority in relation to their age, gender and sexual orientation—in accessing health, social and aged care services. Eighteen peer reviewed articles identified from seven electronic databases in health and social sciences were evaluated according to predefined criteria and a thematic review methodology drawing upon socio-ecological theory was used to analyse and interpret the findings. Four major themes were identified from the analysis: “The Dilemma of Disclosure”, “Belonging/Connection”, “Inclusiveness of Aged Care” and “Other Barriers to Access Care”. In the dilemma of disclosure, older GSD women consider factors such as previous experiences, relationship with the provider and anticipated duration of stay with the provider before disclosing their sexual identifies. The review also revealed that aged care services lack inclusiveness in their policies, advertising materials, aged care spaces and provider knowledge and attitude to provide sensitive and appropriate care to GSD women. Overall, older GSD women experience multiple and multilevel challenges when accessing health, aged and social services and interventions are needed at all levels of the socio-ecological arena to improve their access and quality of care.

Primary Healthcare Nurse’s Barriers and Facilitators to Providing Sexual and Reproductive Healthcare Services of LGBTQI Individuals: A Qualitative Study

“…The significance of public awareness and transparency about LGBTQI SRHS was indicated as one of the vital approaches to improving SRHS at primary healthcare facilities. This is verified by the studies which detail that the provision of LGBTQI-inclusive care and services should be available [ 39 , 40 ]. The importance of interprofessional communication as a starting point to raise awareness about LGBTQI health matters was also highlighted [ 41 ].…”

Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

“…The assumed heterosexual identity of older people is one example of an issue that might occur in the implementation of the treatment plan. For example, when implementing the treatment plan, an assumed heterosexuality might lead to false assumptions about the support system of the patient (Lottmann 2020 ; Heusinger and Dummert 2016 ; Dune et al 2020 ). Today’s older non-heterosexual generation grew up in a time when their non-heteronormativity was met with prejudice, medicalization, and criminalization, which has influenced the way they disclose their sexual orientation and also the way in which they organise their social lives (Tolley and Ranzijn 2006 ; Löf and Olaison 2020 ; Mahieu et al 2019 ).…”

“…Today’s older non-heterosexual generation grew up in a time when their non-heteronormativity was met with prejudice, medicalization, and criminalization, which has influenced the way they disclose their sexual orientation and also the way in which they organise their social lives (Tolley and Ranzijn 2006 ; Löf and Olaison 2020 ; Mahieu et al 2019 ). Yet, regarding the aging LGBT community, studies have shown that in gerontology and care, heteronormative perceptions of older people are predominant and influence the way older people and their living environment are assumed to be (Dune et al 2020 ; Harrison 2006 ; Tolley and Ranzijn 2006 ; Phillips and Marks 2006 ). Additionally, it has been observed that on the topic of sexuality and sexual orientation, a ‘don’t ask, don’t tell’-policy is still common (Dune et al 2020 ; Phillips and Marks 2006 ).…”

“…Yet, regarding the aging LGBT community, studies have shown that in gerontology and care, heteronormative perceptions of older people are predominant and influence the way older people and their living environment are assumed to be (Dune et al 2020 ; Harrison 2006 ; Tolley and Ranzijn 2006 ; Phillips and Marks 2006 ). Additionally, it has been observed that on the topic of sexuality and sexual orientation, a ‘don’t ask, don’t tell’-policy is still common (Dune et al 2020 ; Phillips and Marks 2006 ).…”

“…In this way, the questions are open to any answer and do not presume a particular lifestyle. The patient can feel comfortable to disclose these intimate parts of their life story, which are often connected to feelings of shame or previous experience of discrimination, so that the implementation of the treatment plan fits their needs and results in positive outcomes (Lottmann 2020 ; Dune et al 2020 ). In this way, possible pitfalls based on heteronormative structures are paid attention to and structural discrimination based on these assumptions are avoided.…”