A

pproximately 2 million older adults identify as lesbian,

gay, or bisexual (Fredriksen-Goldsen et al., 2011); how-
ever, this may be an underestimation given the reticence
many have about disclosing their status. This estimation is fur-
ther complicated by some who practice same-sex behaviors, but
by and large, identify themselves as heterosexual. Likewise, the
numbers of individuals who identify as transgender are some-
what more difcult to measure also due to ambivalence about
disclosing; regardless, such estimates range from 0.3% to 0.5%
(Fredriksen-Goldsen, Cook-Daniels, et al., 2013).
Rita A. Jablonski, PhD, CRNP; David E. Vance, PhD, MGS; and Elizabeth Beattie, PhD, RN, FGSA
ABSTRACT
More than 2 million older adults identify as lesbian, gay, bisexual, or transgender
(LGBT). The purpose of this article is to present an overview of the physical and
mental health needs of LGBT older adults to sensitize nurses to the specifc needs
of this group. Nurses are in a prominent position to create health care environ-
ments that will meet the needs of this invisible, and often misunderstood, group of
people. [Journal of Gerontological Nursing, 39(11), 46-52.]
Lesbian, Gay, Bisexual, and
Transgender Older Adults

2
0
1
3

S
h
u
t
t
e
r
s
t
o
c
k
.
c
o
m
/
e
l
l
e
g
a
n
t
46 Copyright SLACK Incorporated
When asked if they provided services
tailored to the needs of lesbian, gay, bi-
sexual, or transgender (LGBT) older
adults, only 15% of the Area Agencies
on Aging replied in the afrmative (Kno-
chel, Croghan, Moone, & Quam, 2012).
The remaining agencies did not offer
tailored services to LGBT individuals
because they never received a request for
such services; in fact, some respondents
believed that all older adults require the
same services, regardless of sexual ori-
entation. LGBT older adults may also
contribute to their invisibility by decid-
ing not to disclose to health professionals
and agencies. Many LGBT older adults
have lived lives lled with discrimi-
nation and, as a result of negative
experiences with health care agencies
and personnel, are at greater risk for
poorer health than their straight
counterparts (Fredriksen-Goldsen et
al., 2011, Fredriksen-Goldsen, Cook-
Daniels, et al. 2013; Fredriksen-Gold-
sen, Emlet, et al., 2013).
In the rst federally funded na-
tional survey of LGBT older adults
and their caregivers, researchers
found that the majority of respon-
dents identify as gay men (61%),
followed by lesbians (33%), trans-
gender (7%), bisexual men (3%), bi-
sexual women (2%), and queer (a
term used with few but a pejorative
comment to many [Haber, 2009]) or
other (1%) (Fredriksen-Goldsen et
al., 2011). The majority of individuals
who identied as transgender were
male-to-female (60%). Twenty-six
percent of individuals identied as
female-to-male, whereas the remain-
ing either chose other or declined
to answer (Fredriksen-Goldsen et al.,
2011). The numbers of transgender
individuals may be higher because of
how these older adults classify them-
selves. After completing the transition
process, which includes sexual reas-
signment surgery, some older adults
no longer identify as transgender;
they instead identify as either male or
female (Fredriksen-Goldsen, Cook-
Daniels, et al., 2013). For the sake of
simplicity and clarity, the abbrevia-
tion LGBT will be used in this article
to denote the lesbian, gay, bisexual,
and transgender community.
The purpose of this article is to
present an overview of the physical
and mental health needs of LGBT
older adults to sensitize nurses to the
specic needs of this group. We con-
clude with specic suggestions as to
how nurses can create health care en-
vironments that will meet the needs
of this invisible, and often misunder-
stood, group of people within our
care.
HEALTH DISPARITIES OF LGBT
OLDER ADULTS
The LGBT community is as het-
erogeneous as any other group of
older adults who come from differ-
ent racial/ethnic, religious/spiritual,
educational, and socioeconomic
backgrounds. For most of these older
adults, it is fair to say they grew up
in a family and a society that was un-
aware or misinformed about what be-
ing LGBT was or how people became
that way. Sadly, the current cohort
of LGBT older adults may have ex-
perienced a lifetime of discrimination:
being shunned by family, friends, re-
ligious organizations, and the medi-
cal community; ridiculed or physi-
cally attacked; or labeled as criminals,
perverts, or sinners (Haber, 2009). In
fact, it was not until 1973 that homo-
sexuality was removed as a mental
disorder from the Diagnostic and Sta-
tistical Manual of Mental Disorders
of the American Psychiatric Asso-
ciation (Institute of Medicine, 2011).
Yet, despite this unprecedented and
bold stand, the lack of information
and misrepresentation in the media
of what it meant to be LGBT un-
doubtedly contributed to continued
discrimination and prejudice, which
was often expressed in victimization
such as threats or attacks to ones
body, job, or property. In fact, in one
survey, 82% of LGBT older adults re-
ported having been victimized at least
once, whereas 64% reported having
been victimized three or more times
in their lifetime (Fredriksen-Goldsen
et al., 2011). Approximately 25%
have experienced discrimination at
work, either through denial of a po-
sition or a promotion, or simply be-
ing red once their sexual orientation
or gender identity become known
(Fredriksen-Goldsen et al., 2011).
Thirteen percent reported either re-
ceiving inferior care or being denied
care because of their sexual orienta-
tion or gender identity (Fredriksen-
Goldsen et al., 2011). Given the
cumulative effect of such negative ex-
periences, it is surprising that as many
as 80% disclose their sexual or gen-
der identity to a health care provider
(Fredriksen-Goldsen et al., 2011;
Fredriksen-Goldsen, Cook-Daniels,
et al., 2013); however, those who were
treated worse may not identify as gay
at all anymore out of fear of such vic-
timization.
Fortunately, given the slowly
changing political climate for social
justice for LGBT issues over the past
few decades since the Stonewall Riots
when the LGBT civil rights move-
ment began in New York City, some
age-related differences among the
current LGBT cohort must be con-
sidered. Older adults ages 50 to 64 are
more likely to disclose their sexual ori-
entation or gender identity than those
65 or older (Fredriksen-Goldsen et
al., 2011). To understand this inclina-
tion between these two groups, it is
important to consider whether such
individuals realized they were LGBT;
for those who came out to them-
selves before the Stonewall Riots,
they did not have any political clout;
these individuals would be 65 and
older now. For those who came out
after the Stonewall Riots, they were in
47 Journal of GerontoloGical nursinG Vol. 39, no. 11, 2013
the midst of growing self-identity as
a proud community in a changing
political landscape; these older adults
would be ages 50 to 64 now.
In addition to such historical dif-
ferences that inuence perceptions
among LGBT older adults, differ-
ences among lesbians, gay men, bisex-
ual men and women, and transgender
older adults themselves obviously
exist. Lesbians, for example, report a
triple threat of insignicance due to
combined marginalization from het-
erosexism, sexism, and ageism (Av-
erett, Yoon, & Jenkins, 2011, p. 216);
and this could be a quadruple threat
of social insignicance if one is a per-
son of color or has other unfavor-
able societal attributes (e.g., mental
illness, physically disabled, poor).
LGBT older adults face signicant
health disparities, even after control-
ling for income, educational level,
and age. Almost half of LGBT older
adults have a disability, dened as the
need for specialized equipment or
physical activity limitations. Nearly
two thirds of transgender older adults
experience disability compared to
half of lesbians and bisexual men and
women (Fredriksen-Goldsen et al.,
2011). Gay men had the lowest rates
of disability at 41% (Fredriksen-
Goldsen et al., 2011). Obesity is a
signicant problem for many LGBT
older adults as well. Forty percent
of transgender older adults are obese
(Fredriksen-Goldsen, Cook-Daniels,
et al., 2013). Lesbians and bisexual
women have the same rates of obe-
sity, 34%. The obesity rates for gay
men and bisexual men are also similar,
19% and 18%, respectively (Fredrik-
sen-Goldsen et al., 2011).
Living arrangements are another
distinction to be considered among
LGBT older adults. In the heterosex-
ual population, older women are more
likely to live alone than men. In the
LGBT population, this is reversed: Gay
and bisexual men are more likely to
live alone compared to lesbians and bi-
sexual women (Fredriksen-Goldsen et
al., 2011). Thus, gay and bisexual older
adults may require more social support
to age in place. Also, it is important to
consider that not all families are accept-
ing of ones partners. Families may be
uncomfortable including their uncles
roommate in family events; and as
such, couples may not be integrated
into other families of orientation. Thus,
this may be an important area for spe-
cial attention at senior centers and other
venues so that the roommate is not
left home isolated from the rest of the
community.
Mental health problems are an-
other health disparity that should be
considered in LGBT older adults. In
particular, transgender individuals
experience more mental health prob-
lems than lesbian, gay, and bisexual
older adults. Forty-eight percent of
transgender older adults report de-
pression, compared to the overall de-
pression rates for LGB older adults
at 31% (Fredriksen-Goldsen, Cook-
Daniels, et al., 2013). When examined
individually, lesbians and gay men
have lower depression rates (27% and
29%, respectively) whereas bisexual
men and women have similar depres-
sion rates (35% and 36%, respective-
ly) (Fredriksen-Goldsen, Emlet et al.,
2013). In regard to anxiety, 39% of
transgender older adults have this di-
agnosis, compared to 22% of gay and
lesbian older adults. Bisexual older
men and women fare differently: Bi-
sexual older men have similar anxiety
rates as gay men (24%), whereas 34%
of bisexual older women experience
anxiety (Fredriksen-Goldsen et al.,
2011). Serious thoughts of suicide fol-
lowed similar patterns: 71% of trans-
gender older adults considered suicide
at some point in their lives compared
to 35% of lesbians, 37% of gay men,
39% of bisexual men, and 40% of bi-
sexual women (Fredriksen-Goldsen
et al., 2011). Fortunately, not all of the
news is bad. The majority of LGBT
older adults (89%) feel positive about
belonging to the LGBT community
(Fredriksen-Goldsen et al., 2011).
Also, there is some literature that
suggests that once someone has dealt
successfully with a difcult life chal-
lenge, such as coming out to oneself
and others, this produces crisis com-
petence (i.e., hardiness, resilience); as
such, this life skill can help one with
successful aging as well (Vance, Struz-
ick, & Masten, 2008).
LONG-TERM CARE AND LGBT
OLDER ADULTS
Although older adults rarely relish
the thought of requiring long-term
care, LGBT older adults have addi-
tional unique concerns. Many older
adults who have come out of the
closet grapple with whether to make
their LGBT status known to nursing
home staff for fear of facing discrimi-
nation during a period of increased
vulnerability (National Resource
Center on LGBT Aging, 2012b; Stein,
Beckerman, & Sherman, 2010). They
also fear being ostracized and mal-
treated by other nursing home resi-
dents, especially roommates (Stein et
al., 2010). LGBT older individuals
may constantly self-censor to appear
straight. Although non-LGBT
nursing home residents are free to
reminisce about their lives and fami-
lies, LGBT older adults worry about
offending others by talking about
their lives as gay individuals (Stein et
al., 2010).
Given lifetime
experiences of
negativity at best and
violence at worst,
LGBT older adults
may not always
openly share their
identity with health
care providers.
48 Copyright SLACK Incorporated
Transgender individuals also ex-
pressed concerns about long-term
care. After experiencing a lifetime of
harassment and violence, the thought
of being vulnerable and frail and re-
quiring care from others is fright-
ening. Although some may have
completely changed their physical
appearance via sexual reassignment
surgery, many older adults have not
(Fredriksen-Goldsen, Cook-Daniels,
et al., 2013; Kaufman, 2010). Individ-
uals who wish to appear female may
use prosthetic breasts, whereas indi-
viduals wishing to appear male may
use compression vests to minimize
existing breasts (Kaufman, 2010).
Nursing home staff and fellow resi-
dents may respond to the discovery
that Paula is biologically Paul
with a range of reactions, including
astonishment, shock, anger, and con-
fusion (Kaufman, 2010). Transgender
older adults may nd themselves be-
ing addressed by the non-preferred
pronoun and the wrong name, while
being assigned to a room based on
their biological gender instead of their
identied gender.
AGING WITH HIV
Another particular area of concern
in the LGBT older adult community
is aging with HIV. Nine percent of
LGBT older adults have HIV. Most of
these infections are in gay or bisexual
men; in fact, 14% of gay or bisexual
men are HIV positive (Fredriksen-
Goldsen et al., 2011). Fortunately, les-
bians experience a lower rate of infec-
tion compared to the larger straight
community; this is probably due to
the type of biological risk associated
with the different modes and amount
of uid exchange during sexual in-
teraction between gay/bisexual men,
heterosexuals, and lesbians. Regard-
less, aging with HIV can affect sev-
eral areas that affect successful aging
including physical, cognitive, social,
and spiritual health in both LGBT
and heterosexual individuals (Vance,
Bayless, Kempf, Keltner, & Fazeli,
2011; Vance, Brennan, Enha, Smith,
& Kaur, 2011).
Fortunately, data are reecting that
those who respond well to combina-
tion antiretroviral therapy (cART) for
HIV and avoid any detrimental health
issues (e.g., intravenous drug use) tend
to have survival rates similar to those
without HIV (Rodger et al., 2013).
This news is encouraging; clearly,
cART has been shown to help protect
and reconstitute the immune system
and prevent AIDS progression. Yet,
despite such encouragement, HIV is
associated with increased systemic
inammation and cART is associated
with increased metabolic syndromes
that can promote hypertension, hy-
percholesterolemia, heart disease, dia-
betes, liver disease, renal disease, and
certain carcinomas (Vance, Mugave-
ro, Willig, Raper, & Saag, 2011). As
such, there is concern that these con-
ditions will accelerate the aging pro-
cess in those living with HIV. There-
TABLE
HELPFUL LESBIAN, GAY, BISEXUAL, AND TRANSGENDER (LGBT) CAREGIVER RESOURCES
Name Site Description
Services and Advocacy for
Gay, Lesbian, Bisexual, and
Transgender Elders (SAGE)
http://www.sageusa.org This group was begun in the late 1970s and started out as
Senior Action in a Gay Environment. The purpose of the
group is to provide LGBT older adults with the unique resourc-
es they need to age successfully. The site is very comprehen-
sive, with information for consumers and clinicians alike.
National Resource Center
on LGBT Aging
http://www.lgbtagingcenter.org This is a project operated by SAGE. The site contains excel-
lent and free information for LGBT older adults, aging
organizations, and clinicians. Content includes webinars,
documents, and links to other resources.
Lavender Health http://www.lavenderhealth.org This site was developed, and is currently maintained, by a
team of nurses who have experience in LGBTQ communi-
ties, both as members of the communities and as providers,
researchers, and educators. Of special interest are the two
PowerPoint presentations free for downloading: Intro-
duction to LGBTQ Healthcare Issues and Culture is More
than Ethnicity: Best Practices for LGBTQI Communities.
The presentations can be accessed directly at http://www.
lavenderhealth.org/educationFiles/mediaEd.html.
National Gay and Lesbian
Task Force
http://www.thetaskforce.org The Task Force works to identify and correct discriminatory
practices against LGBT individuals. Free downloadable re-
search reports and resources specifc to aging are available.
Note. LGBTQ = lesbian, gay, bisexual, transgender, and queer; LGBTQI = lesbian, gay, bisexual, transgender, queer, and intersexed.
49 Journal of GerontoloGical nursinG Vol. 39, no. 11, 2013
fore, aggressive preventive techniques
such adequate physical exercise, good
nutrition, proper sleep hygiene, and
sufcient medication management
of HIV and comorbid conditions is
strongly considered as a way to coun-
teract some of these negative physical
affects (Vance, Eagerton, Harnish,
McKie, & Fazeli, 2011; Vance, Fazeli,
Moneyham, Keltner, & Raper, 2013).
Addressing these preventive tech-
niques may also be a way to help
with successful cognitive aging in
those with HIV. Several studies have
shown that older adults with HIV
may be more vulnerable of develop-
ing cognitive decits, perhaps due to
the systemic inammation that also
promotes neuroinammation (Vance,
Fazeli, et al., 2013). For example, in
a sample of 162 younger and older
adults with and without HIV, Vance,
Fazeli, and Gakumo (2013) found
that in a battery of nine neuropsy-
chological and everyday function-
ing measures, older adults with HIV
performed the worst compared to the
other three groups. Thus, as people
age with HIV, the development of
such cognitive decits may result in
poorer everyday functioning, inabil-
ity to meet work-related demands,
poorer nancial management, and
decreased driving ability, all of which
can affect social functioning as well
(Vance, Bayless et al., 2011).
Decreased social functioning has
been shown to be a risk factor of un-
successful aging in healthy adults and
those aging with HIV. In a sample of
160 older adults (50 or older) with
HIV living in New York City, Shippy
and Karpiak (2005) found that 71%
lived alone, 47% were not in a com-
mitted intimate relationship, and
57% indicated that their emotional
needs were unmet. For LGBT older
adults who may not have traditional
and convenient sources of social sup-
port, these ndings may be especially
problematic. In fact, in addition to
homophobia and ageism, HIV-re-
lated stigma may further impact so-
cial functioning and quality of life in
those aging with HIV. In a sample of
60 older gay men with HIV, Slater et
al. (2013) examined the predictors of
quality of life; these researchers found
that in addition to more medical co-
morbidities, more HIV-related stigma
and emotional-focused coping and
less perceived emotional/information
social support was associated with
poorer quality of life. Likewise, in a
related study of 50 adults with HIV,
more negative affect was reported in
those who were older, experienced
more HIV stigma, and were more
lonely (Vance, 2006a). These ndings
are of concern given that studies have
shown that lack of meaningful social
contact as well as social withdrawal
and isolation, which are common
with a diagnosis of HIV, can predis-
pose one to less social stimulation and
poorer cognitive health (Vance, 2010;
Wilson et al., 2007). Thus, there is a
concern that all adults with HIV, in-
cluding LGBT older adults, must be
proactive in seeking out and main-
taining social supports, which can af-
fect physical and cognitive health, and
even perhaps spiritual health.
The spiritual resources of those aging
with HIV can also help facilitate wheth-
er one is aging successfully (Vance,
Brennan, et al., 2011). In a sample of 50
aging adults with HIV, Vance (2006b)
found that 72% indicated their spiri-
tuality changed after being diagnosed.
On further questioning, 44% indicated
they considered their HIV to be a bless-
ing. Many participants commented that
they realized once they were HIV posi-
tive, that this was a wake up call for
them to live life better in every way (i.e.,
physically, socially, spiritually). As a re-
sult, many used their HIV diagnosis to
improve their lives by reducing/ceasing
substance use, going back to school, or
seeking a deeper relationship with God.
As a result, it was not surprising to see
that those who considered HIV to be
a blessing and those whose spirituality
changed as a result of being diagnosed
indicated that that they were aging
more successfully than those who did
not see HIV as a blessing. For those
who are LGBT, this change in spiritual-
ity may be more pronounced, as many
have to break away from the beliefs
of their family concerning their sexual
orientation, HIV diagnosis, or both.
In fact, Cotton et al. (2006) remarked
in their study that as many as 25% of
those with HIV felt alienated from their
place of worship due to HIV-related
stigma and 10% switched their place
of worship. Furthermore, Brennan,
Strauss, and Karpiak (2010) found that
in older adults with HIV, less than 50%
reveal their serostatus to those in their
congregation and 15% report attending
religious services less. Given the social
and personal benets of engaging in
ones faith as well as the effect of HIV
in the LGBT community, these biopsy-
chosocial and spiritual trends in older
adults with HIV deserve consideration
in the topic of LGBT aging.
SPECIFIC TRANSGENDER
CONCERNS
Transgender older adults have
the greatest difculty with accessing
health care. They are most likely to
experience nancial barriers, receive
inferior care, and be denied health care
(Fredriksen-Goldsen, Cook-Daniels,
et al., 2013). In one study, 11% of
LGB older adults stated that they
have either received inferior care or
have been denied health care because
of their sexual orientation compared
to 40% of transgender older adults
(Fredriksen-Goldsen et al., 2011). The
issue of poor health care is further ex-
acerbated by lack of knowledge on the
part of clinicians. As Kaufman (2010)
noted, few clinicians have had content
regarding the health needs of trans-
gender individuals. Clinicians may not
realize that physical examinations or
intimate care are sources of extreme
anxiety to transgender older adults.
Sex-reassignment surgery may have
not been an option for older transgen-
der adults; others may have undergone
surgery when techniques were less
rened, resulting in scarring and geni-
talia that may appear abnormal to the
clinician (Feldman, 2010). As noted in
more detail below, it is important for
clinicians to understand that physi-
cal examinations and screening tests
50 Copyright SLACK Incorporated
KEYPOINTS
Jablonski, R.A., Vance, D.E., & Beattie, E. (2013). The Invisible Elderly: Lesbian, Gay,
Bisexual, and Transgender Older Adults. Journal of Gerontological Nursing, 39(11), 46-52.
1
Older adults ages 50 to 64 are more likely to disclose their sexual
orientation or gender identity than those 65 or older.
2
As people age with HIV, the development of cognitive decits
may result in poorer everyday functioning, inability to meet work-
related demands, poorer nancial management, and decreased
driving ability, all of which can impact social functioning as well.
3
When caring for transgender older adults, clinicians need to un-
derstand that physical examinations and screening tests are predi-
cated on the organs actually present instead of the appearance of
the person.
4
Questions about sexual orientation and gender identity should be
routinely asked of all patients or residents.
are predicated on the organs actually
present instead of the appearance of
the person (Kaufman, 2010). Many
transgender older adults use, or have
used, exogenous hormones. These
hormones raise the risk of breast, ovar-
ian, uterine, and prostate cancers. For
example, a male-to-female older adult
who used exogenous female hormones
will require mammograms to screen
for breast cancer (Feldman, 2010).
IMPLICATIONS FOR NURSES
Content about the specic care
needs of LGBT individuals, espe-
cially older adults, is virtually nonex-
istent in nursing textbooks (Eliason,
Dibble, & DeJoseph, 2010). Only
eight of 5,000 nursing journal ar-
ticles concentrated on LGBT health
issues (Eliason et al., 2010). Without
this information, nurses cannot pro-
vide culturally competent care. The
rst step nurses can take to care for
LGBT older adults is to realize that
they already have LGBT patients or
residents. Given lifetime experiences
of negativity at best and violence at
worst, LGBT older adults may not
always openly share their identity
with health care providers. Further-
more, LGBT older adults may have
prior life experiences, such as having
been married or having children, that
cause nurses to assume heterosexu-
ality (National Resource Center on
LGBT Aging, 2012b).
Nurses can also change the way
they ask for information, both ver-
bally and in writing. Questions about
sexual orientation and gender iden-
tity should be routinely asked of all
patients or residents. Given the dis-
crimination faced by LGBT older
adults, the nurse must preface this
information with why the questions
are being asked: To provide the best
and most sensitive care for all of our
patients, we ask questions that may
seem different. Also, questions
about sexual orientation and gender
identity need to be asked separately,
as they are unrelated. On forms, a
blank line can be included after the
male and female choices, to al-
low older adults to label their own
gender (National Resource Center on
LGBT Aging, 2012b). Another op-
tion is to ask What is your gender?
and leave a blank to allow for an indi-
vidual to complete the question as he
or she believes appropriate (National
Resource Center on LGBT Aging,
2012a). Questions such as marital
status may need to be amended; one
possibility is to offer the choice mar-
ried/partnered. The Table includes
helpful resources for nurses and other
health care providers. Additionally,
the nurse should inquire about so-
cial support and the size of the older
adults social network. A recent study
found that higher levels of social sup-
port and larger social networks acted
as protective factors for gay, lesbian,
and bisexual older adults (Fredriksen-
Goldsen, Cook-Daniels, et al., 2013).
These protective factors reduced the
odds that the older adult would suf-
fer from depression and overall poor
health (Fredriksen-Goldsen, Cook-
Daniels, et al., 2013).
If an older adult identies as trans-
gender, the nurse must ask how the
client wishes to be addressed. Also,
the nurse must inquire as to how the
older adult prefers his or her informa-
tion recorded on permanent medical
records (National Resource Center
on LGBT Aging, 2012a). The nurse
must also ask what surgeries have
been completed. For male-to-female
sexual reassignment surgery, a vagina
may have been created using the glans
penis; the prostate is not routinely
removed. In this case, the older adult
would need both a prostate surface
antigen test or digital rectal examina-
tion and a Pap smear (Feldman, 2010).
The nurse should query about medi-
cations, especially hormones such as
estrogen and testosterone. For ser-
vices that are segregated according
to gender, such as room assignments
and restrooms, the decision should
be based on the older adults gender
identity, not biological gender (Na-
tional Resource Center on LGBT
Aging, 2012a,b).
CONCLUSION
The current cohort of LGBT older
adults has encountered a lifetime of
discrimination, violence, and even
persecution. These experiences have
left many suspicious of health care
providers and systems. Nurses rst
need to acknowledge that they are al-
ready providing care to LGBT older
adults in a variety of settings that
are heterocentric. The next step is to
change how nurses obtain informa-
tion regarding gender, identity, and
51 Journal of GerontoloGical nursinG Vol. 39, no. 11, 2013
signicant others. In the case of trans-
gender older adults, nurses require
tact and sensitivity when obtaining
medical and surgical histories, as well
as during physical examinations and
intimate procedures. By adopting in-
clusive language and practices, nurses
are in the best position to provide
thoughtful and culturally appropriate
care to these older adults.
REFERENCES
Averett, P., Yoon, I., & Jenkins, C.L. (2011).
Older lesbians: Experiences of aging, dis-
crimination, and resilience. Journal of Wom-
en & Aging, 23, 216-232. doi:10.1080/08952
841.2011.587742
Brennan, M., Strauss, S.M., & Karpiak, S.E.
(2010). Religious congregations and the
growing needs of older adults with HIV.
Journal of Religion, Spirituality & Aging,
22, 307-328. doi:10.1080/15528030.2010.4
99746
Cotton, S., Tsevat, J., Szaarski, M., Kudel, I.,
Sherman, S.N., Feinberg, J.,Holmes, W.C.
(2006). Changes in religiousness and spiritu-
ality attributed to HIV/AIDS: Are there sex
and race differences? Journal of General In-
ternal Medicine, 21(Suppl. 5), S14-S20.
Eliason, M.J., Dibble, S.L., & DeJoseph, J. (2010).
Nursings silence on lesbian, gay, bisexual, and
transgender issues: The need for emancipatory
efforts. Advances in Nursing Science, 33, 206-
218. doi:10.1097/ANS.0b013e3181e63e49
Feldman, J. (2010). Medical and surgical manage-
ment of the transgender patient: What the
primary care clinician needs to know. In H.J.
Makadon, K. Mayer, J. Potter, & H. Gold-
hammer (Eds.), The Fenway guide to lesbian,
gay, bisexual and transgender health. Phila-
delphia, PA: American College of Physicians.
Fredriksen-Goldsen, K.I., Cook-Daniels, L.,
Kim, H.J., Erosheva, E.A., Emlet, C.A., Hoy-
Ellis, C.P.,Muraco, A. (2013). Physical and
mental health of transgender older adults:
An at-risk and underserved population. The
Gerontologist. Advance online publication.
doi:10.1093/geront/gnt021
Fredriksen-Goldsen, K.I., Emlet, C.A., Kim,
H.J., Muraco, A., Erosheva, E.A., Goldsen,
J., & Hoy-Ellis, C.P. (2013). The physical and
mental health of lesbian, gay male, and bisex-
ual (LGB) older adults: The role of key health
indicators and risk and protective factors.
The Gerontologist, 53, 664-675. doi:10.1093/
geront/gns123
Fredriksen-Goldsen, K.I., Kim, H.J., Emlet,
C.A., Muraco, A., Erosheva, E.A., Hoy-Ellis,
C.P.,Petry, H. (2011). The Aging and Health
Report: Disparities and resilience among lesbi-
an, gay, bisexual, and transgender older adults.
Retrieved from http://caringandaging.org/
wordpress/wp-content/uploads/2011/05/
Full-Report-FINAL-11-16-11.pdf
Haber, D. (2009). Gay aging. Gerontol-
ogy & Geriatrics Education, 30, 267-280.
doi:10.1080/02701960903133554
Institute of Medicine. (2011). The health of les-
bian, gay, bisexual, and transgender people:
Building a foundation for better understand-
ing. Retrieved from http://books.nap.edu/
openbook.php?record_id=13128
Kaufman, R. (2010). Introduction to transgender
identity and health. In H.J. Makadon, K.H.
Mayer, J. Potter, & H. Goldhammer (Eds.),
The Fenway guide to lesbian, gay, bisexual,
and transgender health. Philadelphia, PA:
American College of Physicians.
Knochel, K.A., Croghan, C.F., Moone, R.P., &
Quam, J.K. (2012). Training, geography, and
provision of aging services to lesbian, gay, bi-
sexual, and transgender older adults. Journal
of Gerontological Social Work, 55, 426-443. do
i:10.1080/01634372.2012.665158
National Resource Center on LGBT Aging.
(2012a). Inclusive questions for older adults: A
practical guide to collecting data on sexual ori-
entation and gender identity. Retrieved from
http://www.lgbtagingcenter.org/resources/
pdfs/InclusiveQuestionsOlder%20Adults_
Guidebook.pdf
National Resource Center on LGBT Aging.
(2012b). Inclusive services for LGBT older
adults: A practical guide to creating welcoming
agencies. Retrieved from http://www.lgbtag-
ingcenter.org/resources/resource.cfm?r=487
Rodger, A.J., Lodwick, R., Schechter, M., Deeks,
S., Amin, J., Gilson, R.,...Phillips, A. (2013).
Mortality in well controlled HIV in the con-
tinuous antiretroviral therapy arms of the
SMART and ESPRIT trials compared with
the general population. AIDS, 27, 973-979.
doi:10.1097/QAD.0b013e32835cae9c
Shippy, R.A., & Karpiak, S.E. (2005). The aging
HIV/AIDS population: Fragile social net-
works. Aging and Mental Health, 9, 246-254.
Slater, L.Z., Moneyham, L., Vance, D.E., Raper,
J.L., Mugavero, M.J., & Childs, G. (2013).
Support, stigma, health, coping, and quality
of life in older gay men with HIV. Journal of
the Association of Nurses in AIDS Care, 24,
38-49. doi:10.1016/j.jana.2012.02.006
Stein, G.L., Beckerman, N.L., & Sherman, P.A.
(2010). Lesbian and gay elders and long-term
care: Identifying the unique psychosocial per-
spectives and challenges. Journal of Geronto-
logical Social Work, 53, 421-435. doi:10.1080/
01634372.2010.496478
Vance, D.E. (2006a). Self-rated emotional health
in adults with and without HIV. Psychological
Reports, 98, 106-108.
Vance, D.E. (2006b). Spirituality of living and
aging with HIV: A pilot study. Journal of
Religion, Spirituality & Aging, 19, 57-74.
doi:10.1300/J496v19n01_05
Vance, D.E. (2010). Implications of positive and
negative neuroplasticity on cognition in HIV.
Medical Science Monitor, 16(4), HY3-HY5.
Vance, D.E., Bayless, H., Kempf, M.C., Keltner,
N.L., & Fazeli, P.L. (2011). Aging, HIV and
wellness: Augmenting the components of
successful aging. Aging Health, 7, 435-446.
doi:10.2217/AHE.11.28
Vance, D.E., Brennan, M., Enha, C., Smith, G.L.,
& Kaur, J. (2011). Religion, spirituality, and
older adults with HIV: Critical personal
and social resources for an aging epidemic.
Clinical Interventions in Aging, 6, 101-109.
doi:10.2147/CIA.S16349
Vance, D.E., Eagerton, G., Harnish, B., McKie, P.,
& Fazeli, P.L. (2011). Cognitive prescriptions.
Journal of Gerontological Nursing, 37(4), 22-
29. doi:10.3928/00989134-20101202-03
Vance, D.E., Fazeli, P.L., & Gakumo, C.A. (2013).
The impact of neuropsychological perfor-
mance on everyday functioning between
older and younger adults with and without
HIV. Journal of the Association of Nurses
in AIDS Care, 24, 112-125. doi:10.1016/j.
jana.2012.05.002
Vance, D.E., Fazeli, P.L., Moneyham, L., Kelt-
ner, N.L., & Raper, J.L. (2013). Assessing and
treating forgetfulness and cognitive problems
in adults with HIV. Journal of the Association
of Nurses in AIDS Care, 24(1 Suppl.), S40-
S60. doi:10.1016/j.jana.2012.03.006
Vance, D.E., Mugavero, M., Willig, J., Raper,
J.L., & Saag, M.S. (2011). Aging with HIV: A
cross-sectional study of comorbidity preva-
lence and clinical characteristics across the
decades of life. Journal of the Association of
Nurses in AIDS Care, 22, 17-25. doi:10.106/j.
jana.2010.04.002
Vance, D.E., Struzick, T.C., & Masten, J. (2008).
Hardiness, successful aging, and HIV: Impli-
cations for social work. Journal of Geronto-
logical Social Work, 51, 260-283.
Wilson, R.S., Krueger, K.R., Arnold, S.E., Schnei-
der, J.A., Kelly, J.F., Barnes, L.L.,Bennett,
D.A. (2007). Loneliness and risk of Alzheim-
er disease. Archives of General Psychiatry, 64,
234-240.
ABOUT THE AUTHORS
Dr. Jablonski is Associate Professor,
School of Nursing, and Dr. Vance is Associ-
ate Director, Center for Nursing Research,
and PhD Coordinator, The University of
Alabama at Birmingham, Birmingham,
Alabama; and Dr. Beattie is Director,
Dementia Collaborative Research Centre,
School of Nursing, Queensland University
of Technology, Brisbane, Australia.
The authors have disclosed no potential
conicts of interest, nancial or otherwise.
Address correspondence to Rita A.
Jablonski, PhD, CRNP, Associate Professor,
School of Nursing, The University of Ala-
bama at Birmingham, NB 520, 1720 2nd
Avenue South, Birmingham, AL 35294-
1210; e-mail: rajablon@uab.edu.
Received: July 24, 2013
Accepted: August 15, 2013
Posted: September 24, 2013
doi:10.3928/00989134-20130916-02
52 Copyright SLACK Incorporated
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.