LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

HIV prevalence among a retrospective clinical cohort of transgender women in Canada: Results of the Montreal-Toronto Trans study, collected 2018-2019

BACKGROUND

HIV prevalence data among transgender (trans) people are not routinely collected in national estimates, including Canada, contributing to gender-based inequities. We examined HIV prevalence and associated factors among trans women in clinical care in two large Canadian cities.

METHODS

Retrospective chart data of trans women aged 16+ were collected from six family medicine and/or HIV clinics in Montreal and Toronto, Canada, 2018-2019. Multinomial logistic regression was used to analyze factors associated with documented HIV positive or missing HIV status relative to documented HIV negative status.

RESULTS

Among 1,059 patients, 7.5% were HIV positive, 54.4% HIV negative, and 38.1% missing HIV data. Findings showed lower odds of being HIV positive for those <30 years or 30-50 years (vs. >50 years); higher odds were seen for those: of Black race/ethnicity (vs. white), landed immigrant or refugee (vs. Canadian citizen), receiving social assistance (vs. not), and whom ever having used recreational drugs.

CONCLUSIONS

Albeit high, the prevalence of HIV was lower than expected based on global estimates. Missing HIV status data suggest gaps in testing. Findings highlight socioeconomic and clinical realities among trans women in Canada and inform future HIV prevention and support.

Continuing education with a holistic approach to the Brazilian LGBT+ population through use of the m-health App

AIM

This article aims to discuss the development of a continuing education course for health care professionals to provide competent healthcare assistance to the Brazilian LGBT+ population and the implementation of this course using a m-Health solution.

BACKGROUND

There is a scarcity of continuing education courses in the Brazilian context that update provides evidenced-informed education to ensure health care professional competence in the delivery of health care to LGBT+ individuals.

METHODS

Based on Bloom's taxonomy, with a main focus on the cognitive domain, the course "Ally: A Holistic Approach to the LGBT+ Individual'' was developed in five months. This was based on the Nurse's Health Education for LGBT Seniors (HEALE), the Curriculum Implementation and Institutional Climate manual, Changes to Improve Healthcare for LGBT People, Gender Nonconforming or Born with DSD" and the National Comprehensive Health Policy for LGBT+ People, among others.

RESULTS

Comprising six modules: i) human sexuality; ii) equitable care and appropriate terminology; iii) public health policy for the LGBT+ population; iv) cultural skills for health professionals; v) aging and health care for the LGBT+ population; and vi) mental health of LGBT+ people. Content validity indexing was established using an expert panel and was Ally was supported by a m-Health Solution called "Over the Rainbow'' and totals of 60 h of education.

CONCLUSIONS

This m-Health solution and continuing education course for health professionals can be an opportunity to change health professionals' practice to offer more equitable health care for the LGBT+ population.

Queer Aging: Older Lesbian, Gay, and Bisexual Adults' Visions of Late Life

Background and Objectives

Diversity in aging has received increased attention in recent years in the field of gerontology. However, older lesbian, gay, and bisexual (LGB) people have largely been missing from these conversations. In this study, I examine older LGB people's subjective views on the aging process, focusing specifically on visions of late life.

Research Design and Methods

Life story interviews were conducted with 60 LGB individuals over the age of 55 who reside in the Southeastern and Midwestern portions of the United States. Inductive coding (e.g., line-by-line, focused) and analyses were conducted.

Results

Four major themes emerged from the data: (1) financial distress linked to past events of homophobic discrimination, (2) anxieties regarding staying in paid care settings, (3) desires to age in place or "in community" with other lesbian, gay, bisexual, transgender, and queer people, and (4) a prioritization of quality of life over longevity via plans to pursue assisted suicide.

Discussion and Implications

The findings of this study suggest that views of aging and visions of late life are tied to social group membership, highlighting the need for gerontologists to further consider cumulative inequality processes. The study also offers evidence of queer aging, wherein queer culture, history, and experience produce distinct meanings of aging.

Clinical outcomes of COVID-19 infection among patients with Alzheimer's disease or mild cognitive impairment

INTRODUCTION

Alzheimer's disease (AD) and COVID-19 share common risk factors including hypertension. Angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) are frequently prescribed antihypertension medications.

METHODS

This study analyzed 436,823 veterans tested for SARS-CoV-2 infection. We conducted both classical and propensity score weighted logistic models to compare COVID-19 outcomes between patients with AD or mild cognitive impairment (MCI) to those without cognitive impairment, and examined effect of ACEI/ARB prescription.

RESULTS

There was a statistically significant association between AD and increased odds of infection and mortality. MCI was not found to be a risk factor for infection. Subjects with MCI exhibited poor clinical outcomes. Prescribing ARBs but not ACEIs was significantly associated with a lower risk of COVID-19 occurrence among AD and MCI patients.

DISCUSSION

Exploring beneficial effects of existing medications to reduce the impact of COVID-19 on patients with AD or MCI is highly significant.

HIGHLIGHTS

There is significant association between Alzheimer's disease (AD) and increased risk of COVID-19 infection and odds of mortality. Subjects with mild cognitive impairment (MCI) defined by claims data exhibit poor clinical outcomes, but MCI was not found to be a risk factor for severe acute respiratory syndrome coronavirus 2 infection. Prescribing angiotensin II receptor blockers was significantly associated with a lower risk of COVID-19 occurrence among AD/MCI patients.

"By the time she got sick it was just kind of too late": A qualitative study on advanced care planning among bereaved lesbian, gay, and bisexual older women

BACKGROUND

Lesbian, gay, and bisexual (LGB) older women have unmet communication needs around palliative and end-of-life care. Past research has found communication differences for LGB women patients. Consequently, older LGB women may experience healthcare communication barriers around advance care planning.

AIM

To explore experiences of bereaved LGB older women to understand perspectives regarding advance care planning communication between clinicians, patients, and dyads.

DESIGN

Guided by queer gerontology as a theoretical framework, this qualitative descriptive study employed individual interviews with purposively recruited participants. Interviews were conducted in person using a semi structured protocol and analyzed using inductive thematic analysis.

SETTING/PARTICIPANTS

Sixteen LGB women, age 60 years or older from across the United States who had lost a spouse/partner within the past 5 years.

RESULTS

Four main themes emerged from the transcripts, LGB older women: (1) experience unclear advance care planning communication and end-of-life care support from clinicians, (2) often avoid advance care planning discussions with spouse or partners, (3) lack of knowledge about palliative or end-of-life care, and (4) have more positive experiences when there is consistent communication with spouse or partner and clinicians during a spouse/partner's illness and end-of-life.

DISCUSSION

While certain experiences and opinions may reflect those of non-LGB older adults, novel advance care planning barriers exist for LGB older women. Greater understanding among clinicians is needed regarding advance care planning conversations with LGB dyads. We recommend four improvements in training, recognition, acceptance, and dyad-based communication interventions.