Healthcare and Aging Network
HAN - An ASA Constituent Group

When David called the hospital to find out how his partner of 32 years was doing after an operation, the staff refused to tell him. His partner was not legally related to him, nor could he be under current law in the United States, the United Kingdom and most other jurisdictions: David, 58, and his partner, Henry, 60, are a gay couple. They were understandably angry and distressed by the hospital's complete disregard for their relationship, but it's a familiar tale for many same-sex couples.

When you are not regarded as next of kin, obtaining information about a patient -- let alone being involved in any medical decisions -- can be a complicated task. A spouse is automatically entitled to such access; same-sex partners are not, unless the couple has prepared specific written instructions and powers of attorney -- a fact only fully understood by many lesbian, gay and bisexual elders when it is too late.

In a worst-case scenario, some can be denied access to a partner's bedside by family members if the couple's relationship is not understood or recognized. This position is all too familiar for lesbian, gay and bisexual elders, who are much more likely than their younger counterparts to have lived their personal lives discreetly, even secretly. Imagine the trauma of not being able to be with the person you love when he or she is ill, because of a healthcare provider's rules or a family's misunderstanding or ignorance.

The problems faced by same-sex partners in relation to healthcare represent only the tip of the iceberg for lesbian, gay and bisexual elders. Many older adults from these communities also fear discrimination in treatment and provision of services. This fear is one of the key reasons why lesbian, gay and bisexual elders are less likely to seek medical help than other older adults -- especially if the condition is related to their sexuality.

A difficulty lesbian, gay and bisexual elders often face when they reveal their sexual orientation to service providers is the assumption that their orientation itself is a problem. As a result, lesbian, gay and bisexual elders with a mental health problem often feel unable to disclose their sexual orientation, either for fear of it being regarded as the problem or because of concerns about confidentiality, discrimination or even abuse. This pressure to conceal one's sexuality can cause these clients further conflict and difficulty at an already vulnerable time.

The Harmful Effects of Social Marginalization

Of course, hostile and negative social attitudes can and do have a serious debilitating effect on the psychological well-being of some lesbian, gay and bisexual people. Depression and fear of rejection can affect those grappling with the coming-out process -- especially in the case of older people, who have more likely suffered condemnation for much of their lives. The marginalization experienced by lesbian, gay and bisexual people can result, for example, in higher levels of drug and alcohol abuse.

It is important not to equate sexual orientation only with sexual activity, yet at the same time to be aware that many older people have active sex lives. Lesbian, gay and bisexual elders are no different from heterosexual elders in this regard. As a result, healthcare providers should be alert to the possibility that older adults -- including lesbian, gay and bisexual elders -- may encounter sexually transmitted diseases.

Given this fact, older people are as much in need of safer sex information as younger people -- yet the overwhelming majority of such materials are aimed exclusively at the young. The language these materials use can be alienating or even embarrassing to an older person, and combined with youthful visual images, can make the issue seem irrelevant to them. Lesbian, gay and bisexual elders can feel further excluded if materials targeted at older adults reflect a presumption that all elders are heterosexual.

Another serious deterrent to elders seeking medical help for sexually transmitted diseases is fear of age discrimination in what is perceived as a youth-focused area of healthcare. In addition, older people can have very specific needs in relation to treatment, care and support. HIV-positive elders, for example, tend to progress from infection to developing AIDS symptoms more rapidly than do younger people.

Discrimination and lack of understanding also present challenges for lesbian, gay and bisexual elders whose partners are in long-term care facilities. These elders often face the uncomfortable choice of lying or repeatedly having to explain -- even justify -- their relationships.

The elder acting as caregiver not only has to deal with personal anxieties about coming out, but also must think about the consequences for the sick partner: Will being open have a negative effect on the partner's quality of care? Will staff and other residents and the family react badly?

For many lesbian, gay and bisexual elders, keeping quiet or coming out have equally unsettling effects. Denial can cause grave feelings of betrayal and guilt at what is already a distressing time; coming out, possibly for the flrst time to strangers, is likely to be similarly traumatic.

In what they often perceive as the heterosexual setting of long-term care facilities, many older lesbian, gay and bisexual caregivers still choose to conceal their relationships. Their fear of negative reactions might be unfounded, yet many elders see openness as a risk not worth taking when a loved one's care is at stake.

Creating an Atmosphere of Respect

Lesbian, gay and bisexual elders don't necessarily need special services or programs; what they do need, above all, is to feel acknowledged, included and understood. Healthcare providers can make sure that their services are truly accessible to all elders by working to create this atmosphere of respect.

Antony Smith is a freelance consultant, writer and trainer on aging; equality issues; and lesbian, gay, bisexual and transgender issues. He is coauthor of Opening Doors: Working With Older Lesbians and Gay Men (London: Age Concern, 2001). He lives in London.