1
|
Ceolin C, Papa MV, Scala A, Sergi G, Garolla A. Getting old in the desired gender: a systematic review on aging diseases in transgender people. J Endocrinol Invest 2024; 47:1851-1862. [PMID: 38904914 PMCID: PMC11266207 DOI: 10.1007/s40618-024-02353-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/28/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION The growing demographic presence of the transgender (TGD) population has sparked an increase in clinical investigations focusing on the impacts of gender-affirming hormone therapy (GAHT) in adults with gender dysphoria. Despite this surge in studies, there remains a significant gap in the literature regarding the health status of older TGD individuals. This review aims to assess prevalent pathological conditions within the TGD population, specifically concentrating on aging-related diseases investigated to date. METHODS A systematic search across Embase Ovid, Scopus, PubMed, Cochrane Library, and Web of Science databases was conducted to identify articles reporting on the aging process in TGD individuals. Methodological quality was evaluated using Newcastle-Ottawa Scale (NOS) scores. RESULTS Initial database searches yielded 12,688 studies, which were refined to 18 through elimination of duplicates and title/abstract review. Following a comprehensive appraisal, nine studies were included in the systematic review. These articles, published between 2017 and 2023, involved a total of 5403 participants. The evidence indicates a noteworthy percentage of the TGD population being at risk for cardiovascular diseases, experiencing depression or disability, and demonstrating hesitancy toward major recommended screening programs. CONCLUSIONS Limited studies on older TGD individuals highlight not only an organic risk of chronic diseases but also a cognitive/psychiatric risk that should not be underestimated. Further research is imperative to deepen our understanding of the pathophysiological mechanisms involved in the health challenges faced by older TGD individuals.
Collapse
Affiliation(s)
- C Ceolin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy.
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden.
| | - M V Papa
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
| | - A Scala
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - G Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, via Giustiniani 2, 35128, Padua, Italy
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
| | - A Garolla
- Regional Reference Center for Gender Incongruence (CRRIG), Padua, Veneto, Italy
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| |
Collapse
|
2
|
Perone AK. An Historical Case Study of Trans Exclusion and Empowerment: Implications for Transgender Older Adults and Aging. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024; 67:660-686. [PMID: 38652754 DOI: 10.1080/01634372.2024.2339987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
Transgender older adults have a long history of exclusion that shapes current experiences with social services. However, scant gerontological research uses archival data, which can provide critical context for service providers. Moreover, sparse research examines how exclusion can be a catalyst for change that social workers could leverage. Empowerment theory provides a theoretical tool to explain how this is possible. This multidisciplinary case study blends community member interviews and archival data to answer this question: How did exclusion shape empowerment and social change for transgender Americans? This study focuses on the events before and after the Compton's Cafeteria Riot, one of the first acts of LGBTQIA+ collective resistance that led to new services for and by transgender Americans. Data reveal how exclusion facilitated the emergence of collective empowerment among transgender women and queer youth in San Francisco. Archival data shows how exclusion preceded self-efficacy, critical consciousness, involvement with similar others, acquisition of new skills, and ultimately action to eliminate social, economic, and political barriers and power imbalances. This study provides both empirical and theoretical tools to contribute new data and perspectives on trans exclusion and empowerment and its implications for social workers serving transgender older adults.
Collapse
Affiliation(s)
- Angela K Perone
- Berkeley School of Social Welfare, Center for the Advanced Study of Aging Services, University of California, Haviland Hall, Berkeley, California, USA
| |
Collapse
|
3
|
Hurd L, Li LYK. "I Want to Grow Older With Dignity": Older LGBTQ+ Canadian Adults' Perceptions and Experiences of Aging. J Appl Gerontol 2024; 43:536-549. [PMID: 38105632 PMCID: PMC10981199 DOI: 10.1177/07334648231219414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
The number of older LGBTQ+ adults is growing worldwide. Yet few studies outside of the United States have examined their experiences of aging. Drawing on the Health Equity Promotion Model and contextualized in Canada's unique socio-political history, our study used multiple, in-depth, qualitative interviews to examine 30 older Canadian LGBTQ+ adults' (aged 65-83) perceptions and experiences of growing older. Our descriptive thematic analysis identified three overarching categories: "Losses," "gains," and "needs." Losses referred to the changes in the participants' health, autonomy, and relationships that had occurred with age. Gains entailed positive later life changes, including increased wisdom, flexibility, and social connections. Finally, needs referred to those things that the participants deemed essential for aging well, namely, inclusive health care, meaningful activities, and supportive networks. We discuss the policy and practice implications of our findings for the fostering of health, well-being, and social inclusion amongst this often-marginalized population.
Collapse
Affiliation(s)
- Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Lynda Y. K. Li
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Aggarwal RA, Fields CD, van Zuilen MH. Mental Health for LGBTQIA+ Older Adults. Clin Geriatr Med 2024; 40:299-308. [PMID: 38521600 DOI: 10.1016/j.cger.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
LGBTQIA+ older adults share a unique set of risk factors that impact mental health. This article provides an overview of the minority stress and allostatic load models and how they can lead to worse physical and mental health outcomes. The article also describes unique epidemiologic and psychosocial context for various aspects of mental health among LGBTQIA+ older adults. Within each section are suggestions for health care providers when addressing these mental health issues and caring for LGBTQIA+ older adults in all settings.
Collapse
Affiliation(s)
- Rohin A Aggarwal
- Department of Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
| | - Cynthia D Fields
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 235, Baltimore, MD 21287, USA
| | - Maria H van Zuilen
- Department of Medical Education, University of Miami Miller School of Medicine (R53), 1600 NW 19th Avenue, Miami, FL 33136, USA
| |
Collapse
|
5
|
Catlett L. Healthcare needs and assets of gender diverse older adults: A systematic integrative review. J Nurs Scholarsh 2024; 56:119-141. [PMID: 36111650 DOI: 10.1111/jnu.12810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Gender diverse older adults often endure health disparities, encounter discrimination in healthcare settings, and experience lack of access to healthcare. However, members of this population also have assets that help to mitigate these healthcare challenges. A systematic integrative review was performed to synthesize recent studies of the healthcare needs and assets of gender diverse older adults living in the United States. METHODS A search of PubMed, CINAHL, Web of Science, PsycINFO, and Google Scholar was conducted. Findings from selected studies were organized by theme and subtheme. RESULTS Thirty-five articles met inclusion criteria. Seven themes were identified: (1) Inclusivity and acceptance, (2) Antidiscrimination protections, (3) Community, (4) Care of mind, body, and spirit, (5) End of life preparations, (6) Financial security, and (7) Intersectionality. These themes were further divided into 20 healthcare needs and 9 healthcare assets. CONCLUSION The findings call for increased training for healthcare providers to provide safe, gender-inclusive care environments; policy to combat discrimination across all healthcare settings; supportive community resources and healthcare advocacy; empowerment of gender diverse older adults through acknowledgment of their healthcare assets; and more research to discern the role of intersectionality in the applicability of the identified themes to gender diverse older adults of various sociodemographic backgrounds. CLINICAL RELEVANCE This review benefits clinicians by suggesting practice changes to address healthcare needs of gender diverse older adults while describing healthcare assets of this population for integration into health promotion initiatives.
Collapse
Affiliation(s)
- Lauren Catlett
- School of Nursing, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
6
|
Cheung AS, Nolan BJ, Zwickl S. Transgender health and the impact of aging and menopause. Climacteric 2023; 26:256-262. [PMID: 37011669 DOI: 10.1080/13697137.2023.2176217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Gender affirming hormone therapy (GAHT) is used by many transgender people to reduce gender incongruence and improve psychological functioning. As GAHT shares many similarities with menopausal hormone therapy, clinicians supporting people through menopause are ideally placed to manage GAHT. This narrative review provides an overview of transgender health and discusses long-term effects of GAHT to consider when managing transgender individuals across the lifespan. Menopause is less relevant for transgender individuals who take GAHT (often given lifelong) to achieve sex steroid concentrations generally in the range of the affirmed gender. For people using feminizing hormone therapy, there is an elevated risk of venous thromboembolism, myocardial infarction, stroke and osteoporosis relative to cisgender individuals. For trans people using masculinizing hormone therapy, there is an increased risk of polycythemia, probable higher risk of myocardial infarction and pelvic pain which is poorly understood. Proactive mitigation of cardiovascular risk factors is important for all transgender people and optimization of bone health is important for those using feminizing hormones. With a lack of research to guide GAHT in older age, a shared decision-making approach is recommended for the provision of GAHT to achieve individual goals whilst minimizing potential adverse effects.
Collapse
Affiliation(s)
- A S Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - B J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - S Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
| |
Collapse
|
7
|
Catlett L, Acquaviva KD, Campbell L, Ducar D, Page EH, Patton J, Campbell C. End-of-Life Care for Transgender Older Adults. Glob Qual Nurs Res 2023; 10:23333936231161128. [PMID: 36992796 PMCID: PMC10041615 DOI: 10.1177/23333936231161128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/30/2023] [Accepted: 02/08/2023] [Indexed: 03/31/2023] Open
Abstract
As the number of transgender older adults increases, the need for respectful and inclusive end-of-life (EOL) care for this population is becoming more apparent. Aging transgender adults often face discrimination, inadequate access to care, and poor quality of care. In response, we organized a think tank that invited participation from 19 transgender older adults, scholars in EOL care, and palliative care providers in the United States to generate recommendations for EOL care for transgender older adults. Subsequently, we conducted a qualitative descriptive exploration of the written record of think tank discussions for the purpose of identifying key EOL care considerations for transgender older adults. We identified four themes that highlight the importance of understanding the experiences of transgender older adults for the advancement of future research, policy, and education initiatives aiming to ensure inclusive and equitable provision of EOL care by nurses and other clinicians for this population.
Collapse
Affiliation(s)
- Lauren Catlett
- University of Virginia School of Nursing, Charlottesville, USA
- Lauren Catlett, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA 22903-1738, USA.
| | | | - Lisa Campbell
- East Carolina University, Greenville, North Carolina, USA
| | | | | | | | - Cathy Campbell
- University of Virginia School of Nursing, Charlottesville, USA
| |
Collapse
|
8
|
Velasco RAF, Blakeley A, Rostovsky J, Skeete KJ, Copeland D. Conceptualizing transgender and gender-diverse older adults as a vulnerable population: A systematic review. Geriatr Nurs 2023; 49:139-147. [PMID: 36525871 DOI: 10.1016/j.gerinurse.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND While extant literature clearly illustrates the negative experiences of transgender and gender-diverse (TGD) people, the intersection between TGD identity and older age in producing vulnerability is poorly understood. The Vulnerable Populations Conceptual Model (VPCM) provides a framework for identifying vulnerable communities. Understanding access to resources, relative risks, and health status experienced by TGD older adults is critical in developing person-centered interventions. METHODS A systematic review using PRISMA guidelines was used. CINAHL, Medline, PubMed, and PsycINFO were searched for studies published from 2017 to 2022. RESULTS Of the seventeen articles included, no articles were based from a nursing journal. Synthesis of findings described TGD older adults as a vulnerable population with limited access to resources and several risks leading to poor health status. CONCLUSION Identifying TGD older adults as a vulnerable population is critical to understand their unique needs. The findings underline implications in nursing education, practice, and research.
Collapse
Affiliation(s)
- Roque Anthony F Velasco
- College of Nursing, University of Colorado Denver, 13120 East 19(th) Avenue, Aurora, Colorado, United States; DAP Health, 1695 N. Sunrise Way, Palm Springs, California, United States.
| | - Anne Blakeley
- DAP Health, 1695 N. Sunrise Way, Palm Springs, California, United States
| | - Jacob Rostovsky
- Queer Works, 1775 E. Palm Canyon Drive, Suite 110-1032, Palm Springs, California, United States
| | - Kimberly June Skeete
- BIOS Clinical Research, 1401 N. Palm Canyon Drive, Suite 201, Palm Springs, California, United States
| | - Darcy Copeland
- School of Nursing, University of Northern Colorado, Gunter Hall 3080, Greeley, Colorado, United States
| |
Collapse
|