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Elderly Lesbians and Breast Cancer

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Running Head: ELDERLY LESBIANS AND BREAST CANCER

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Elderly Lesbians and Breast Cancer California State University, Dominguez Hills School of Nursing MSN 533-08 Theoretical Aspects of Aging

Running Head: ELDERLY LESBIANS AND BREAST CANCER

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Elderly Lesbians and Breast Cancer Cancer health disparities have been documented in specific populations in the United States. Elderly lesbians are one such population, with factors related to lifestyle, socioeconomic status, healthcare practices, and access to services (Brown & Tracy, 2008). There is a pressing need for understanding of the health care disparities faced by elderly lesbians, so that the needs of this group can be adequately met. In the United States, breast cancer is the most common cancer among women. Several risk factors for breast cancer are at least partially modifiable, and are present more among the lesbian population than heterosexual women (Brown & Tracy, 2008). Breast cancer is the most common invasive cancer among women worldwide, with rates significantly higher in developed nations. Over 80% of all female breast cancers occur among post-menopausal women. Breast cancer is not primarily found to be hereditary, but women who have the BRCA1 and BRCA2 genes (which can be inherited) have a considerably higher breast cancer risk (Miller, 2012). Lesbian elders have particular well-being requirements, but often suffer from subpar care and reduced access to services. Fear of discrimination, low rates of health insurance, and negative experiences or feelings of discrimination by healthcare providers are all issues that have been documented to lead to increased rates of breast cancer among lesbian elders in comparison with heterosexual women (Barnes, 2012). Poor diet, lower exercise levels, greater body mass index, and hesitation to perform routine screening and self-exams are lifestyle patterns that lead to increased risk of lesbian elders for developing certain health care issues, including breast cancer. Lesbians are four times less likely than heterosexual women to have had a mammogram.

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Some lesbians are also at increased risk for breast cancer related to higher alcohol intake and nulliparity (Barnes, 2012). Age-related changes among lesbians In aging women, frequency of ovulation diminishes and menstrual cycles become shorter and irregular. Hormonal changes also occur, as post-menopausal women produce approximately 90% less estrogen (Miller, 2012). Mental changes, such as sensation, perception, reasoning, and memory, occur among all aging adults. The lesbian/gay/bisexual/transgender (LGBT) population undergoes the same changes and dysfunctions, while also facing additional challenges. Currently, there are over two million Americans over the age of 65 in the LBGT community. Of these, over 40% of LGBT elderly suffer from depression (Eliason, Dibble, & DeJoseph, 2010). Aging lesbian and bisexual women have a 1.35 times greater risk of experiencing depression than aging heterosexual women (Wallace, Cochran, Durazo, & Ford, 2011). The Healthy People goals for 2020 specifically address mental health disparities of the LGBT population, as discrimination against LGBT persons has been associated with high rates of psychiatric disorders, substance abuse, and suicide (Healthy People, 2011). Elderly lesbians can experience role changes as normal physical aging changes result in loss of independence. Psychological influences of this phenomenon can be severe, and vary with each individual. Identification of normal signs of psychological changes in the elderly population, so as not to be confused with symptoms of depression, can help to improve quality of life (Christensen & Elkin, 2011). Advanced nursing role promotion as advocate and educator The aging lesbian population is presented with multifaceted challenges when compared to the heterosexual aging population. Public, as well as political, discrimination, combined with

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a lack of cultural competency by health care professionals, can create an isolating environment for the elderly lesbian (Cook-Daniels, 2009). Through a combination of problem identification, public education, implementation of evidence based practice (EBP), and advocacy for policy development, health care providers can help to promote a higher quality of life for the lesbian elderly population. Advanced practice nurses in education and advocacy roles can support elderly lesbian patients in maintaining independence and quality of life, while teaching them to cope with illness and utilize appropriate services. Advanced professional nurses can inspire communication and advocacy for lesbian elders by encouraging participation in culture specific groups such as the National Center for Transgender Equality. Provision of optimal care for lesbian elders requires: maintenance of a welcoming clinical environment, promotion of open communication, and encouraging individuals to feel comfortable discussing sexual identity, behavior, attractions, and any conflicts or concerns. Through staff education and recognition, cultural competence can be assured. Providers must be guided to provide care and education that is nonjudgmental, genderappropriate, and professional. Lack of trust has been documented as a major hindrance to effective patient/provider communication, and must be addressed and ramified (Christensen & Elkin, 2011). Utilizing community resources and increasing quality of life Having breast cancer, in itself, can lead to feelings of stigmatization. The combined effects of breast cancer’s stigma and that of being lesbian or gay can lead to decreased quality of life. Breast cancer patients who had more social contact and family support were shown to have better adjustment patterns. This is especially important for the elderly lesbian subpopulation (Fobair et al., 2002).

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The lesbian community is an at-risk group that has historically faced significant challenges in shifting to retirement. Safe, accessible, affordable housing is a pressing need for the elderly, and the many require outside services to help maintain independence. Elderly persons who receive emotional support primarily from family, in comparison to those with additional community support, are more vulnerable to health-related issues (White, Philogene, Fine, & Sinha, 2009). Thus, an expansive social support network separate from the family unit can be beneficial to the mental and physical health of our LGBT elders. Poverty has a significant impact on longevity, with the poor experiencing an average lifespan that is 20 years shorter than those not living in poverty. Members of the lesbian, gay, bisexual and transgender (LGBT) community, on average, are poorer than their peers in other groups (Miller, 2012). Affliction with illnesses such as breast cancer, combined with the emotional and other stressors associated with poverty, can lead to reduced quality of life in the older adult. Access to Assisted Living Facilities (ALFs), nursing homes (NH), and retirement centers (RCs) can be expensive, and the majority of older LGBT are dependent upon Social Security, with an average annual income of $10,899 for females, as of 2000 (Cahill, 2002). Lesbian elders are not eligible to receive Social Security or veterans affair partner benefits, and are sometimes denied pensions as well. The lesbian community has also been historically financially disadvantaged due to discrimination, and many do not have children or extended family to help relieve the financial burden. Discrimination toward the LGBT community also affects elderly LGBT quality of living, and societal stigma may lead to homophobic elder abuse. There is a need for communities where

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LGBT elderly live among those who understand their needs, so that they may live without fear of harassment or even neglect due to sexual orientation (Neville & Henrickson, 2012). In rural areas, lack of access to an LGBT community, combined with less access to knowledgeable providers, can prevent elderly lesbians from receiving appropriate, culturally competent care. Stigma still takes place among families, relationships, community, and society Elderly lesbians who utilize social support from within gay communities have been shown to have higher mental quality of life, lower depression, and decrease internalized homophobia (Masini and Barrett, 2008). Conclusion Elderly LGBT are a vulnerable group with specific healthcare needs that have been largely unrecognized by healthcare professionals. Identification and addressing of social disparities that disproportionately affect lesbian elders is a crucial primary step in eliminating these social disparities. Familiarity with cultural issues and needs of elderly lesbians can assist advanced practice nurses in providing appropriate, compassionate care (Simone & Applebaum, 2011). Healthcare providers must identify their LGBT patients in a safe and sensitive manner, be sensitive to the specific challenges faced by this group, and provide the appropriate support and resources that address their needs. In a combined effort with patients, community leaders, and other stakeholders, health care providers can have a significant impact on the reduction of breast cancer among elderly lesbians (Brown & Tracy, 2008).

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References Barnes, H. (2012). Health needs of lesbians. Primary Health Care 22(6), 28-30. Bith-Melander, P., Sheoran, B., Sheth, L., Bermudez, C., Drone, J., Wood, W., & Schroeder, K. (2010). Understanding sociocultural and psychological factors affecting transgender people of color in San Francisco. Journal of the Association of Nurses in AIDS Care, 21(3), 207-220. Brown, J. P., & Tracy, J. K. (2008). Lesbians and cancer: an overlooked health disparity. Cancer Causes & Control, 19(10), 1009-1020. Cahill, S. (2002). Long term care issues affecting gay, lesbian, bisexual and transgender elders. Geriatric Care Management Journal, 12(3), 4-8. Center for Disease Control and Prevention. (2013). Public health and aging: trends in aging – United States and Worldwide. Retrieved from www.cdc.gov/mmwr/preview Christensen, B.L., Elkin, M.E. (2011). Health promotion and care of the older adult. In B.L.Christensen, E.O.Kockrow (Eds.). Foundations and Adult Health Nursing. (6th Ed.). (pp1082-1120). St. Louis, MO: Elsevier Saunders. Cook-Daniels, L. (2009). It’s about time: LGBT aging in a changing world. Retrieved November 1, 2013 from http:// www. forge-forward.org/wpcontent/docs/SAGE_Conference-Findings.pdf Crimmins, E.M., Kim, J.K., & Seeman, T.E. (2009). Poverty and biological risk: The earlier “aging” of the poor. Journal of Gerontology Series: A Biological Sciences and Medical Sciences, 64(A), 286-292. Department of Health & Human Services. (2010). Administration on aging. Retrieved from www.aoa.gov/Aging_Statistics/future_growth.aspx#age

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Eliason, M. J., Dibble, S., & DeJoseph, J. (2010). Nursing's silence on lesbian, gay, bisexual, and transgender issues: The need for emancipatory efforts. Advances in Nursing Science, 33(3), 206-218. doi: 10.1097/ANS.0b013e3181e63e49 Fobair, P., Koopman, C., Dimiceli, S., O'Hanlan, K., Butler, L. D., Classen, C., ... & Spiegel, D. (2002). Psychosocial intervention for lesbians with primary breast cancer. Psycho‐Oncology, 11(5), 427-438. doi: 10.1002/pon.624 Healthy People (2011) About Healthy People. Retrieved from http://healthypeople.gov/2020/about/default.aspx Masini, B. E. & Barrett, H., A. (2008). Social support as a predictor of psychological and physical well-being and lifestyle in lesbian, gay, and bisexual adults aged 50 and over. Journal of Gay & Lesbian Social Services, 20(1-2), 91-110. doi:10.1080/10538720802179013 Miller, C.A. (2012) Nursing for Wellness in Older Adults (6th ed.). Philadelphia: Wolters Kluwer\Lippincott, Williams, & Wilkins. Neville, S., & Henrickson, M. (2010). ‘Lavender retirement’: A questionnaire survey of lesbian, gay and bisexual people's accommodation plans for old age. International Journal of Nursing Practice, 16(6), 586-594. Simone, M. D., & Appelbaum, J. S. (2011). Addressing the Needs of Older Lesbian, Gay, Bisexual, and Transgender Adults. Clinical Geriatrics, 19(2), 38-45. Wallace, S. P., Cochran, S. D., Durazo, E. M., Ford, C. L. (2011). The health of aging lesbian, gay, and bisexual adults in California. UCLA Center for Health Policy Research, UCLA. Retrieved from http://escholarship.org/uc/item/9gv99494

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