Cognitive impairment, Alzheimer’s disease, and other dementias in the lives of lesbian, gay, bisexual and transgender (LGBT) older adults and their caregivers: Needs and competencies (2018)

Karen Fredriksen-Goldsen, Sarah Jen, Amanda Bryan, & Jayn Goldsen

Sexual and gender diverse older adults have unique risk factors for cognitive impairment and dementia. We have outlined key competencies for working with sexual and gender diverse older adults living with cognitive impairment, Alzheimers disease, and other dementias, and their families and caregivers.

Unique Risk Factors for Sexual and Gender Diverse Older Adults

10% reported severe or extreme cognitive difficulties
38% reported moderate cognitive difficulties
77% reported mild cognitive difficulties

Data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), a longitudinal study of 2450 sexual and gender diverse older adults.

Key Competencies for Healthcare Providers

1

Attitudes

Regularly assess your personal and professional attitudes toward sexual and gender diverse older adults (including their sexual orientation, gender identity, gender expression, and age) as well as cognitive impairment and dementia. Understand how such attitudes influence the care of LGBT older adults, families, and caregivers.

2

Historical, Social, and Cultural Context

Understand the way in which historical, social, and cultural context negatively impact sexual and gender diverse older adults living with cognitive impairment, Alzheimer’s disease, and other dementias, especially how past experiences may alter needs and behaviors in relation to cognitive impairment and help-seeking behaviors.

3

Intersecting Identities and Subgroups

Distinguish similarities and differences within the subgroups of sexual and gender diverse older adults, as well as among individuals’ intersecting identities (such as age, gender, race, ethnicity, ability status, and socio-economic status), to develop tailored and responsive care strategies for cognitive impairment, Alzheimer’s disease, and other dementias.

4

Application of Theoretical and Practice Perspectives

Understand, apply, and advocate a practice perspective supporting personcentered care, and actively stay abreast of and utilize relevant theoretical, intervention, and research literature to engage in up-to-date culturally competent practice with sexual and gender diverse older adults living with cognitive impairment, Alzheimer’s disease, and other dementias.

5

Assessment and Interviewing

Understand, apply, and advocate a practice perspective supporting personcentered care, and actively stay abreast of and utilize relevant theoretical, intervention, and research literature to engage in up-to-date culturally competent practice with sexual and gender diverse older adults living with cognitive impairment, Alzheimer’s disease, and other dementias.

6

Personal Relationships

Be aware of, and able to address, the needs and changes in sexual and gender diverse older adults’ personal relationships with partners, caregivers, and others. Facilitate communication and be sensitive to the intimate and sexual needs of LGBT older adults living with cognitive impairment, Alzheimer’s disease, and other dementias.

7

Supporting Caregivers

Assist caregivers in providing care and accessing support services to address strain, depression, or other challenges that may arise in the course of the caregiving role.

8

Services, Programs, and Agencies

Understand and articulate the ways in which services, programs, and agencies create welcoming, affirming, and supportive environments for sexual and gender diverse older adults living with dementia.

9

Policies and Laws

Understand and articulate the ways that local, state, and federal policies and laws address the needs of sexual and gender diverse older adults, family members, and caregivers living with dementia, as well as address capacity, decision-making, and consent, to advocate on their behalf.

10

Advocacy and Capacity Building

Enhance the capacity of older adults, family members and caregivers to navigate care systems and advocate for innovative approaches to address the growing dementia-related needs in sexual and gender diverse communities.

Cognitive Impairment is “when a person has trouble remembering, learning new things, concentrating, or making decisions that affect their everyday life” (Center for Disease Control and Prevention). Cognitive Impairment is a risk factor for developing dementia later in life.

Dementia is a severe type of cognitive impairment “characterized by a decline in memory, language, problem-solving and other cognitive skills that affects a person’s ability to perform everyday activities” (Alzheimer’s Association).

It is imperative that health care and service providers be prepared to ensure sensitivity and inclusivity when serving sexual and gender diverse older adults and providing outreach and education in these communities. Additionally, researchers must seek to better understand the intersection between sexual and gender diverse adults’ unique risk factors and cognitive impairment, Alzheimer’s disease, and other dementias.

Recommended citation: Fredriksen-Goldsen, K. I., Jen, S., Bryan, A. E. B., & Goldsen, J. (2018). Cognitive impairment, Alzheimer’s disease, and other dementias in the lives of lesbian, gay, bisexual and transgender (LGBT) older adults and their caregivers: Needs and competencies. Journal of Applied Gerontology, 37(5), 545-569 . doi:10.1177/0733464816672047

© Goldsen Institute 2023

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