Impact of Anticipated Bias from Healthcare Professionals on Perceived Successful Aging Among Transgender and Gender Nonconforming Older Adults

Abstract

With high rates of discrimination and prejudice toward TGNC persons in various contexts (e.g., healthcare, education, and housing), it is imperative that practitioners, researchers, policymakers, and institutions work together to eradicate healthcare disparities, promote social change, and support an environment that encourages successful aging. This calls for a coordinated, proactive outreach effort to put trust back into a system that has historically let down an entire subset of the population.

A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

“…Concerns/fears about discrimination are a recurrent theme (Ferron et al, 2010;Latham and Barrett, 2015a;Witten, 2017) and are linked to inadequate health care and possibly with behaviours that might be regarded as risky (Bachmann and Mussman, 2015;Walker et al, 2017). The context for older adults is that of lifetime experience of violence, abuse and hate crimes (Fredriksen-Goldsen et al, 2014;Porter et al, 2016).…”

“…Experiences of discrimination and disrespect within care settings range across a spectrum of experiences from insensitivity (Page et al, 2016) through 'subtle Othering' (Pang et al, 2019) to frank refusals of care (Redman, 2011) (maybe linked with denial of insurance cover; Finkenauer et al, 2012), and across a range of care settings, including gender identity services (Latham and Barrett, 2015a). Trans individuals' concerns link with previous negative experiences in health and/or social care and lead to anticipation of bias which acts as a barrier (Fabbre, 2015;Baril and Silverman, 2019), influencing trans persons both in terms of reluctance to access services (Walker et al, 2017) and in whether they are able to be open and 'come out' to health and social care practitioners (Fredriksen-Goldsen et al, 2014). Service barriers include denial of agency and gate-keeping (Fabbre, 2015;Johnson et al, 2018;Baril and Silverman, 2019).…”

“…Set against this, for some people later life may bring new beginnings (Pang et al, 2019). Other writers flag up the need to acknowledge intersectionality: in addition to transphobia and ageism some older trans adults will be subject to other forms of oppression, including those related to ethnicity and/or sexuality (Siverskog, 2014;Witten, 2014;Porter et al, 2016;Walker et al, 2017).…”

“…This has been identified as a concern for trans individuals as they grow older: people may fear increasing dependency and a need for assistance with personal care and other activities of daily living either in their own home or in a long-term care setting. These concerns might also encompass communal housing options for older adults (Walker et al, 2017), some of which due to their faith-based foundations may introduce even greater complexity into an already challenging situation. Witten (2014) comments on the fear of potential abuse by care-givers and some of her interviewees considered de-transitioning for reasons of safety.…”

“…Positive practice in health and social care Taking a lifecourse perspective involves aiming to understand individuals in terms of their family and personal history, prior life experiences, psycho-social context, broad socio-historical context and relational context, all of which affect physical and mental health, and wellbeing in later life (Siverskog, 2014;Witten, 2014;Latham and Barrett, 2015b;Porter et al, 2016;Walker et al, 2016Walker et al, , 2017. Health and social care systems are often perceived as inflexible by those who use them, and a lifecourse perspective to some extent mitigates inflexibility.…”