Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support

Citation

Rebecca Manning (2016), "Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support", Quality in Ageing and Older Adults, Vol. 17 No. 1, pp. 78-80. https://doi.org/10.1108/QAOA-01-2016-0008

Very little research exists around the Lesbian, Gay, Bisexual and Transgendered (LGBT) community and the unique set of challenges and issues being faced. Ageing research has tended to focus on physical health, end of life or dementia and whilst relevant to the LGBT community, does tend to omit any specific needs of this group. This book makes a significant contribution to filling a huge gap in our knowledge.

This book will be beneficial for anyone who may come into contact with not only LGBT individuals, in later life but also anyone who identifies as LGBT, in the delivery of frontline care and services. It is a great resource in the facilitation of learning during professional development for; nurses, social workers, midwives, support workers and allied health care professionals, as well as a key text informing equality and diversity training for any stat/voluntary or private organisation.

The subject matter is comprehensive and varied, bringing together empirical data, qualitative and quantitative research and most importantly, the voices of service users are clearly brought to the fore through its narrative focus. Anecdotal data are an important part of understanding the LGBT person’s needs and providing good quality inclusive services and most importantly, empathy. It is the biographical focus that brings the knowledge life, makes the text very relatable and through the service users own experiences, is able to connect with the readers’ empathy. The real people quoted (often unabridged) makes for a candid and honest picture of what life is like for those who identify as LGBT. This approach is more powerful in facilitating a care provider’s ownership of the role they can play in care provision rather than just seeing LGBT issues in the policies and procedures folder.

The topics covered are diverse, and range from examining the dynamic in LGBT relationships, to responding to the physical health needs of trans people including vaginal dilation, and complex issues such as how to meet health need not routinely considered, e.g. prostate examinations as a trans woman and breast and cervical exams for trans men.

The content spans physical, mental and sexual health. I loved the quote “I am older than I ever thought I would be” which reminds us that in the 1980s, HIV/AIDS was considered a death sentence. This is a powerful statement, requiring the reader to re-evaluate their views on HIV and the LGBT community and which challenges preconceived ideas, which no longer have a place in modern society. Advancement of treatment and education, for example, has meant that there are older people living full lives with HIV/AIDS in later life.

The contributors to this book provide a wide range of expertise in the field and encompass a wide range of roles, skills and experiences in the LGBT agenda, including prominent academics, leaders in practice and those who have lived experience of LGBT issues. This results in a well-rounded compendium of theory and practice where first person accounts really add value and real world experience through which practice can be developed. This is one of the core features of this text in my view. There are a number of very good sources referenced adding a further rich layer of information particularly as there are too few reliable sources available to anyone conducting LGBT research. It reinforces the continuing need for more qualitative and quantitative data for this client group. Chapter 3 presents the life of Trans people and while it does a good job, this booked missed out on the largest trans study in the UK (McNeil et al., 2012), which would be a good addition to some of the facts and figures presented, and would have given a more up to date insight and provided more robust data for this chapter. Likewise, Chapter 9 written by Age UK Opening Doors organisation provided good examples of valuable community based practice, Chapter 10 “Ageing in Gay Brighton” presents the reader with good quality quantitative data, and dispels a myth that Brighton is the gay capital of the UK. The authors used a variety of data sources including prominent websites used by the LGBT community.

This book highlights the substantial and ongoing stigma towards this community and highlights the inability of services to appreciate the older LGBT person and by giving attention to later life challenges a stereotype and myth that anyone LGBT is a gay, white, young man. Staying with that theme; what I also liked was that trans and bisexual people were not just a group “added on” given the depth of knowledge and understanding generally afforded to gay men and to a slightly lesser extent, lesbians in the LGBT literature. In the past trans people have been relatively ignored or research has been undertaken half-heartedly and inadequately. This book does not pay lip service to trans issues in that respect.

One of the strengths of this text is that it is very readable and accessible to readers from a variety of backgrounds whether service user, frontline professional or top-level executive. Its strength lies in its application for practice and for day to day care delivery. The challenge however is to how to actually get people to read it because as stated into the introduction, many professions do not see the value and significance of LGBT ageing in equality and diversity in practice nor do they feel it is directly relevant in their practice.

Inclusive practice is a requirement embedded into every professional code and policy and practitioners can get defensive when this is challenged and it is challenging to bring attention to heteronormative biases in everyday interactions between older LGBT people and professionals. What may seem as trivial assumptions of practitioners; such as the assumption of opposite gender partners, the desire for children and the need to assign a gender to individuals, is actually a much larger concern and source of anxiety in the LGBT community. It is only when challenged, that practitioners become aware that these assumptions can be a barrier to care for LGBT people. Further training is required and this book is a good resource in this regard.

As a founder and CEO of a trans-focused social enterprise, a qualified nurse and a person with professional and lived experience of the LGBT community, this book gives me hope that we can change practice. As part of our duty of care, it is our responsibility to ensure that we conform to the Equality Act (2010), we provide best practice and promote a safe, comfortable health service for those who identify as LGBT.

About the reviewer

Rebecca Manning BSc Mental Health Nursing. Rebecca works with a social enterprise which helps to support those who question their gender identity and is active in education to promote user perspectives in working with a better understanding of trans issues and best practices. Rebecca Manning can be contacted at: rebeccamanning@me.com