Older Lesbian, Gay, Bisexual, Transgender, and Queer Adults' Experiences With Discrimination and Impacts on Expectations for Long-Term Care: Results of a Survey in the Southern United States.

The number of older adults in the United States is projected to increase in coming years, including the number of lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) older adults requiring long-term care (LTC) services. We conducted an online survey of older LGBTQ+ adults living in the Southern United States between January and March of 2018 to inquire about their anticipation of discrimination in and willingness to utilize LTC services. We found that 78.6% of respondents (N = 789) anticipated discrimination in LTC. Previous experiences with discrimination, higher educational attainment, and queer/questioning sexual orientation were associated with greater expectation of discrimination. Higher anticipation of discrimination was also associated with a greater preference for utilizing LTC services offered by LGBTQ+ providers or for LGBTQ+ older adults. These findings suggest that LTC staff and researchers may be uniquely positioned to craft outreach and policies to protect LGBTQ+ LTC residents.

Appointment of a Healthcare Power of Attorney Among Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Adults in the Southern United States.

BACKGROUND: The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients' wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States. METHODS: An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018. PARTICIPANTS: The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018. RESULTS: Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA (n = 311, 64.5%). CONCLUSIONS: Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.