Transgender and gender diverse older people: health, aging and dementia

Abstract

Background and Objectives 262,000 people in the UK identify as transgender and gender diverse (TGD), and this population is believed to be growing. As the population is aging, an increase in older TGD people accessing health and social care can be anticipated. Despite a recent expansion in research exploring the TGD population, older TGD people are often excluded from the narrative. This review aims to address gaps in the literature by exploring the complex ways older TGD adults access health and social care and how this affects health outcomes with a specific focus on dementia. Methods The search was conducted using NUsearch, CINAHL, PsycINFO, PubMed, Google Scholar, and MEDLINE, in addition to cross-referencing and hand searches. Data were analyzed in a narrative, exploratory manner. Findings Older TGD adults face many barriers when accessing health and social care including experiences of discrimination, gatekeeping by healthcare professionals and limited access to services. These barriers impact on health outcomes in this population and their interactions with the health and social care system. There are high reported rates of poor physical and mental health, including HIV, mental illness and issues associated with gender-affirming treatment. Older TGD people are also reported to be at an increased risk of dementia, which is partly due to high incidences of dementia-associated risk factors. The epidemiology and experiences of older TGD people living with dementia are largely unknown due to limited research. However, the available literature suggests the current health and social care system is ill-equipped to manage their needs. Conclusion Greater research exploring the major health problems faced by this population is needed, to address health inequalities. Several approaches have been suggested to help improve services for older TGD people including, expert patient programmes, co-production, and a systems approach.