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Baril A, Silverman M. "We're still alive, much to everyone's surprise": The experience of trans older adults living with dementia in an ageist, cisgenderist, and cogniticist society. J Aging Stud 2024; 68:101208. [PMID: 38458727 DOI: 10.1016/j.jaging.2024.101208] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 12/23/2023] [Accepted: 01/02/2024] [Indexed: 03/10/2024]
Abstract
Trans and non-binary older adults living with dementia experience forms of marginalization, pathologization, and discrimination embedded in epistemic violence that leads them to be mistreated and dismissed as knowledgeable subjects. Based on empirical findings from a Canadian study examining the experiences of trans and non-binary people living with dementia and their carers, we combat this epistemic violence by focusing on the first-hand narratives of this population and their carers. Narrative interviews were conducted with six participants (N = 6): four carers of trans and non-binary adults living with dementia and two trans (binary) people living with dementia. Through a thematic analysis, we examine the unique aspects of living with dementia as a trans or non-binary person. First, the findings show how cogniticism impacts the experience of gender identity and cisgenderism, for example through blocked surgeries, excessive gatekeeping, and not being taken seriously by practitioners. Second, the findings discuss how dementia impacts gender identity and cisgenderism, for example, by increasing the need for formal care that can in turn increase vulnerability to structural violence. Third, the findings illustrate how cisgenderism and gender identity impact the experience of dementia and cogniticism, for example by limiting care options and the ability to advocate for oneself. Fourth, the findings highlight the silo mentality among practitioners, since most of them do not work with an intersectional lens. The article concludes by offering recommendations.
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Affiliation(s)
- Alexandre Baril
- School of Social Work, University of Ottawa, 120 University, Room 12025, Ottawa, Ontario K1N 6N5, Canada.
| | - Marjorie Silverman
- School of Social Work, University of Ottawa, 120 University, Room 12044, Ottawa, Ontario K1N 6N5, Canada.
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Kcomt L, Gorey KM, Barrett BJ, McCabe SE. Healthcare avoidance due to anticipated discrimination among transgender people: A call to create trans-affirmative environments. SSM Popul Health 2020; 11:100608. [PMID: 32529022 PMCID: PMC7276492 DOI: 10.1016/j.ssmph.2020.100608] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/01/2022] Open
Abstract
Transgender people encounter interpersonal and structural barriers to healthcare access that contribute to their postponement or avoidance of healthcare, which can lead to poor physical and mental health outcomes. Using the 2015 U.S. Transgender Survey, this study examined avoidance of healthcare due to anticipated discrimination among transgender adults aged 25 to 64 (N = 19,157). Multivariable logistic regression analysis was conducted to test whether gender identity/expression, socio-demographic, and transgender-specific factors were associated with healthcare avoidance. Almost one-quarter of the sample (22.8%) avoided healthcare due to anticipated discrimination. Transgender men had increased odds of healthcare avoidance (AOR = 1.32, 95% CI = 1.21–1.45) relative to transgender women. Living in poverty (AOR = 1.52, 95% CI = 1.40–1.65) and visual non-conformity (AOR = 1.48, 95% CI = 1.33–1.66) were significant risk factors. Having health insurance (AOR = 0.87, 95% CI = 0.79–0.96) and disclosure of transgender identity (AOR = 0.77, 95% CI = 0.68–0.87) were protective against healthcare avoidance. A significant interaction of gender identity/expression with health insurance was found; having health insurance moderated the association between gender identity/expression and healthcare avoidance. Providers should consider gender differences, socio-demographic, and transgender-specific factors to improve accessibility of services to transgender communities. A multi-level and multi-faceted approach should be used to create safe, trans-affirmative environments in health systems. Transgender people encounter barriers to healthcare access. Providers should consider transgender-specific factors to improve healthcare access. A multi-faceted approach should be used to create trans-affirmative health settings.
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Affiliation(s)
- Luisa Kcomt
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA
| | - Kevin M Gorey
- School of Social Work, University of Windsor, 167 Ferry Street, Windsor, ON, N9A 0C5, Canada
| | - Betty Jo Barrett
- Women's and Gender Studies, University of Windsor, 401 Sunset Avenue, Windsor, ON, N9B 3P4, Canada
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109-5482, USA.,Institute for Research on Women and Gender, University of Michigan, 1136 Lane Hall, 204 S. State Street, Ann Arbor, MI, 48109-1290, USA.,Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, USA
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Kcomt L. Profound health-care discrimination experienced by transgender people: rapid systematic review. Soc Work Health Care 2019; 58:201-219. [PMID: 30321122 DOI: 10.1080/00981389.2018.1532941] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 07/29/2018] [Revised: 09/24/2018] [Accepted: 10/03/2018] [Indexed: 05/28/2023]
Abstract
Transgender people experience interpersonal and structural barriers which prevent them from accessing culturally and medically competent health care. This rapid systematic review examined the prevalence of health-care discrimination among transgender people in the U.S. and drew comparisons with sexual minority samples and the general U.S. population. Eight primary studies with 35 prevalence estimates were analyzed. Transgender populations experience profound rates of discrimination within the U.S. health-care system. Compared to sexual minorities, transgender participants appear to be more compromised in their access to health care. Service providers must change structural inequities which contribute to transgender people's invisibility.
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Affiliation(s)
- Luisa Kcomt
- a School of Social Work , University of Windsor , Windsor , Ontario , Canada
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