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Jakobsen MD, Bromseth J, Siverskog A, Krane MS. The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review. Scand J Prim Health Care 2023; 41:359-371. [PMID: 37602941 PMCID: PMC11001363 DOI: 10.1080/02813432.2023.2242713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region. DESIGN We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included. RESULTS There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender. CONCLUSIONS Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.
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Affiliation(s)
| | | | - Anna Siverskog
- Department of Culture and Education, Södertörn University, Huddinge, Sweden
| | - Martin Sollund Krane
- Centre for Care Research North, UiT The Arctic University of Norway, Tromsø, Norway
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Bratt AS, Hjelm ACP, Wurm M, Huntley R, Hirakawa Y, Muraya T. A Systematic Review of Qualitative Research Literature and a Thematic Synthesis of Older LGBTQ People's Experiences of Quality of Life, Minority Joy, Resilience, Minority Stress, Discrimination, and Stigmatization in Japan and Sweden. Int J Environ Res Public Health 2023; 20:6281. [PMID: 37444128 PMCID: PMC10341585 DOI: 10.3390/ijerph20136281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/08/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023]
Abstract
There is a lack of research on older lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adults. This systematic review aimed to synthesize Japanese and Swedish qualitative research on LGBTQ adults aged 60 years or older following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Japanese and Swedish articles, published in English, were searched across ASSIA, CINAHL, Medline, PsychINFO, PubMed, Scopus, and Sociological Abstracts databases. Additional searches were conducted to include studies in Japanese or Swedish. There were no papers from Japan, whereas five from Sweden were reviewed. One article was excluded due to the wrong phenomenon. Four articles were included, involving 48 participants aged 60-94 years. We summarized the findings using a deductive thematic synthesis. Two major themes emerged: (a) quality of life, minority joy, and resilience (positive aspects), and (b) discrimination, stigmatization, and minority stress (negative aspects). The participants wished to be acknowledged for their own assets and unique life histories, and to be treated as everyone else. They emphasized the importance of knowledge of LGBTQ issues among nursing staff, so that older LGBTQ people are treated in a competent and affirmative way. The study revealed several important topics for understanding older LGBTQ adults' life circumstances and the severe lack of qualitative studies in Japan and Sweden.
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Affiliation(s)
- Anna Sofia Bratt
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, 35195 Växjö, Sweden;
| | | | - Matilda Wurm
- School of Law, Psychology and Social Work, Örebro University, 70281 Örebro, Sweden;
| | - Richard Huntley
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, 35195 Växjö, Sweden;
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Nagoya University, Nagoya 466-8550, Japan;
| | - Tsukasa Muraya
- Faculty of Design, Kyushu University, Fukuoka 815-8540, Japan;
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Buczak-Stec E, König HH, Feddern L, Hajek A. Long-Term Care Preferences and Sexual Orientation-A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2023; 24:331-342.e1. [PMID: 36586720 DOI: 10.1016/j.jamda.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 10/28/2022] [Accepted: 11/26/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The number of sexual and gender minority older adults who require long-term care is steadily increasing. The purpose of this systematic review and meta-analysis was to synthesize the evidence related to preference for long-term care with regard to sexual orientation and gender identity. DESIGN Systematic review and meta-analysis. SETTING AND PARTICIPANTS We searched PubMed/MEDLINE, Ovid/PsycINFO, and Web of Science from inception to July 2020 (updated in July 2021). Search terms embraced 3 themes (1) sexual and gender minorities, (2) long-term care, and (3) preferences. Quantitative studies of the adult population were included. METHODS Screening, data extraction, and quality assessment followed the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The proportions were pooled using meta-analysis and random effects models. RESULTS A total of 17 articles were included out of 5944 studies of potential relevance. The perception of nursing homes (NHs) that emerges from these studies is predominantly negative for heterosexuals and lesbian, gay, bisexual and trans (LGBT) individuals (n = 11). Across 6 studies (10 outcomes), the pooled estimate for the proportion of individuals with a preference to move into a NH was 10.6% [95% confidence interval (CI) 7.88%‒13.22%, I2 = 97.4%]; 13.7% (95% CI 8.6%‒18.7%) for LGBT individuals and 7.3% (95% CI 3.14%‒11.50%) for heterosexuals. LGBT-friendly NHs were preferred by between 55% and 98% of LGBT respondents. Informal care provided by partner or family was one of the preferred options (n = 6). It was preferred by 33% to 70% of various groups of LGBT respondents. CONCLUSIONS AND IMPLICATIONS The preference to move into a NH is relatively low among both heterosexuals and sexual and gender minority adults. Findings showed negligible differences in preferences to move into a NH between heterosexuals and sexual and gender minorities. LGBT-friendly long-term care facilities where every member feels welcomed and not discriminated against seem to be one of the favorable long-term care choices among LGBT individuals. This knowledge is important to inform nursing services and policy makers about the preferred long-term care options. Providing LGBT-friendly facilities is usually less expensive than providing care in newly created LGBT-only facilities.
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Affiliation(s)
- Elżbieta Buczak-Stec
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany.
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
| | - Lukas Feddern
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
| | - André Hajek
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research; Hamburg Center for Health Economics; Hamburg, Germany
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Abstract
OBJECTIVES To synthesize literature about lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults in long-term care (LTC) facilities and provide recommendations for best practice guideline development to inform practice, research, and policy. METHODS Four electronic databases were searched in June 2019 for studies conducted between 2000- 2019 related to caring for LGBTQ older adults in LTC settings. An integrative literature review was conducted on the twenty eligible studies. RESULTS LGBTQ participants fear discrimination in LTC settings leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. LTC staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. LTC staff experience training deficits and require more expansive modalities. CONCLUSIONS LGBTQ participants and LTC staff both advise that LTC facilities revise forms and policies to ensure all sexual orientations and gender identities are affirmed and protected in addition to providing widespread training. CLINICAL IMPLICATIONS This review calls to attention the need for LTC settings to uniformly follow best-practices. Clinical recommendations to promote equitable healthcare include: staff training at all levels and communication that does not assume heterosexuality or cisgender identity.
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Affiliation(s)
| | - Erik McIntosh
- College of Nursing, Rush University, Chicago, Illinois, USA
| | - Susan W Buchholz
- College of Nursing, Michigan State University, East Lansing, Michigan, USA
| | - Todd Ruppar
- College of Nursing, Rush University, Chicago, Illinois, USA
| | - Sarah Ailey
- College of Nursing, Rush University, Chicago, Illinois, USA
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Flatt JD, Cicero EC, Kittle KR, Brennan-Ing M, Anderson JG, Wharton W, Hughes TL. Advancing Gerontological Health Research With Sexual and Gender Minorities Across the Globe. J Gerontol Nurs 2022; 48:13-20. [PMID: 35343840 PMCID: PMC9949509 DOI: 10.3928/00989134-20220304-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current article presents results of a scoping review of international research on the health and health care needs of sexual and gender minority (SGM) older adults. Electronic databases and related resources were used to identify empirical and review studies published during the past 10 years. We reviewed 33 peer-reviewed articles from 19 countries. Findings were organized using the SGM Health Disparities Research Framework, which highlights factors at individual, interpersonal, community, and societal levels that impact health. Overall, historic and current environmental factors, including stigma, discrimination, and social exclusion, played an important role in SGM older adults' health, health care access, and use of related aging and social services. There is a critical need for training and future research, and health professionals are needed to advance gerontological health and health care research and improve the health and care of SGM older adults globally. [Journal of Gerontological Nursing, 48(4), 13-20.].
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Affiliation(s)
- Jason D. Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Ethan C. Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Krystal R. Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, New York
| | - Joel G. Anderson
- College of Nursing, University of Tennessee, Knoxville, Tennessee
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, New York
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Putney JM, Hebert N, Snyder M, Linscott RO, Cahill S. The Housing Needs of Sexual and Gender Minority Older Adults: Implications for Policy and Practice. J Homosex 2021; 68:2375-2392. [PMID: 32776865 DOI: 10.1080/00918369.2020.1804261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support. Data were gathered through seven groups with a sample of SGM-identified adults age 55 and over (N = 50) and analyzed using thematic analysis. The participants seek affordable and inclusive housing options. They identified that access to transportation is paramount in maintaining social support and accessing healthcare. Findings underscore the need for strategies to serve the housing needs of low-income SGM-identified older adults in a nondiscriminatory way, train housing providers in culturally responsive care, meet transportation needs, and provide SGM-inclusive community-based services that reduce isolation.
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Affiliation(s)
- Jennifer M Putney
- School of Social Work, Simmons University, Boston, Massachusetts, USA
- The Fenway Institute, Boston, Massachusetts, USA
| | - Nicholas Hebert
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | - Matthew Snyder
- School of Social Work, Simmons University, Boston, Massachusetts, USA
| | | | - Sean Cahill
- The Fenway Institute, Boston, Massachusetts, USA
- School of Public Health, Boston University, Boston, Massachusetts, USA
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
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Silva Junior JRD, França LD, Rosa A, Neves VR, Siqueira LD. Health care for LGBTI+ elders living in Nursing Homes. Rev Bras Enferm 2021; 74Suppl 2:e20200403. [PMID: 33759943 DOI: 10.1590/0034-7167-2020-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to describe and analyze the scientific production on health care for Lesbians, Gays, Bisexuals, Transvestites, Transsexuals, Transgenders, Intersex (LGBTI+) and other variations of gender or sexual orientation living in Nursing Homes (NHs). METHODS a scoping review, in which PubMed, Web of Science, Scopus and Virtual Health Library databases were analyzed and studies from other sources were added. After assessment by two independent reviewers, 19 publications were selected to compose the sample. RESULTS the studies were grouped into two categories. FINAL CONSIDERATIONS NHs are configured as spaces that are not very inclusive, where LGBTI+ elders' demands are not considered due to the cis-heteronormativity in force in these places. Training and awareness of health professionals on the LGBTI+ theme is a tool that can make such spaces more inclusive for this population.
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Affiliation(s)
| | | | - Anderson Rosa
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
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Abstract
Online dating is continually on the rise and nowadays a widely used and accepted way to find different kinds of companionship. This relatively new interpersonal phenomenon has provided an especially important virtual space for non-heterosexuals. Previous research on behaviors and trends on dating communities online for sexual minorities has focused primarily on sites for gay men in Anglo-Saxon countries. The purpose of the present study is to examine self-presentations on the Nordic LGBTQ online dating scene and possible gender-dependent differences in self-presentation. The Nordic countries are commonly perceived as progressive in issues regarding gender equality and LGBTQ rights. The countries on average also have low population density with large rural areas and consequently limited scenes for non-heterosexuals. A testimony of this is the study's selected dating site, which is based in Sweden but encompasses the neighboring countries and markets itself as a Nordic meeting venue. The present study embarks on new territory within psychology-, gender-, and queer research by examining self-presentations on a mixed-gender LGBTQ dating site, situated in the supposedly liberal Nordic countries. Based on qualitative and quantitative data from a stratified sample of 716 cis-gendered, predominantly Swedish online dating profiles, on a well-established Nordic online dating site for non-heterosexual men and women, statistical calculations and a thematic analysis (TA) were executed. The findings show that central self-presentations concern mind versus body, lust and longings, and boundaries, where gender frequently functions as the dividing line. Women self-present more through personality and romantic longings compared to men, who to a higher degree emphasizes body, and lust. Self-presentation is also expressed through resistance against boundary-breaking contact on the site. The boundaries that are guarded regard age, anti-racism and most pronounced - boundaries against male harassment of non-heterosexual women. The implications of self-presentation, possible discrimination and misrepresentation on the Nordic LGBTQ online dating scene are discussed.
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Affiliation(s)
- Emelie Louise Miller
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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Abstract
OBJECTIVES To investigate what empirical studies report on the perceptions of community-dwelling LGBT adults regarding sexuality and sexual expression in residential aged care (RAC), and how their sexuality should be addressed in RAC. METHODS Relevant papers were identified through electronic searches in databases; and by reference tracking and citation tracking. Data were extracted using a standardized data extraction form and were compared, related, and synthesized using thematic analyses. We evaluated the methodological quality of the studies. RESULTS Eighteen articles were identified. Three major topics emerged regarding sexuality in RAC: (1) factors affecting LGBT people's perceptions, subdivided into (a) discrimination, (b) loss of sexual identity, (c) failure to acknowledge the same-sex partner, and (d) lack of privacy; (2) LGBT-specific RAC facilities; and (3) characteristics of LGBT friendly RAC facilities and caregivers. CONCLUSIONS LGBT people have clear perceptions about how sexuality and sexual expression is or should be managed in RAC. Despite the general increase in acceptance of sexual minorities, many community-dwelling LGBT people believe older LGBT residents are discriminated against because of their sexual orientation or gender identity. Taking into account these opinions is crucial for increasing accessibility of RAC to LGBT people and to ensure the quality of the provided care.
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Affiliation(s)
- Lieslot Mahieu
- a Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven - University of Leuven , Leuven , Belgium
| | - Alice Cavolo
- a Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven - University of Leuven , Leuven , Belgium
| | - Chris Gastmans
- a Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven - University of Leuven , Leuven , Belgium
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Abstract
BACKGROUND Sexual health is an important issue in daily life, but little is known about occupational therapy (OT) students' views on these matters. AIM To explore occupational therapy students' views on addressing sexual health in their future professional role. MATERIAL AND METHODS A descriptive qualitative study involving 37 OT students in 5 focus groups was performed and analyzed using content analysis. RESULTS Three categories: 'Sexual health is part of occupational therapy and but not of the OT educational program'; 'Need for knowledge to identify and intervene related to sexual health problems'; and finally, 'Communication about sexual health-unknown, untried, but necessary', formed the theme, 'Willing to try, wanting to know more, and recognizing not only the difficulties and challenges but also the importance of sexual health in OT practice'. CONCLUSIONS OT-students consider sexual health as part of OT-practice, but experience lack of knowledge of sexual health related to disease/disability, cultural diversity, and age and sexual orientation. Educational programs need to cover these matters, including how to address sexual health in OT-practice, to enhance OT's future competence related to promotion of sexual health for clients. SIGNIFICANCE Knowledge on students' views are vital to guide education on this important, rather neglected, area.
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Affiliation(s)
- Kristina Areskoug-Josefsson
- a School of Health and Welfare , Jönköping Academy for Improvement of Health and Welfare, Jönköping University , Jönköping , Sweden
| | - Sofi Fristedt
- b School of Health and Welfare , Jönköping University , Jönköping , Sweden
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Rosenberg L, Kottorp A, Johansson K. LGBQ-Specific Elderly Housing as a "Sparkling Sanctuary": Boundary Work on LGBQ Identity and Community in Relationship to Potential LGBQ-Specific Elderly Housing in Sweden. J Homosex 2017; 65:1484-1506. [PMID: 28885103 DOI: 10.1080/00918369.2017.1377487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study explored how boundaries in relationship to community and identity were created and negotiated among lesbian, gay, bisexual, and queer (LGBQ) people within the framework of picturing LGBQ-specific elderly housing as a housing alternative in older age, by applying focus group methodology. "An island as a sparkling sanctuary" was identified as a metaphor for how symbolic resources defining the LGBQ community can be manifested in LGBQ-specific qualities of elderly housing. The boundary work underlying this manifestation included elaborations on the dilemma between exclusiveness and normality. The findings illustrate further how symbolic resources and collective identities were developed through dialectic interplay between internal and external definitions. Further, the findings show how boundary work generated shared feelings of similarity and group membership. The associated symbolic and social resources not only served to deal with difficult situations but also to manifest LGBQ identity and sense of community as a "gold medal."
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Affiliation(s)
- Lena Rosenberg
- a Department NVS, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden
| | - Anders Kottorp
- a Department NVS, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden
| | - Karin Johansson
- a Department NVS, Division of Occupational Therapy , Karolinska Institutet , Huddinge , Sweden
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