1. Grey and Gay: Incorporating LGBT Elder Health into a Geriatric Curriculum Kristin J Anderson, MD, MPH Carroll Haymon, MD Swedish First Hill Family Medicine Residency Program Seattle, WA

2. Grey and Gay: Objectives To describe specific social and health issues which affect lesbian, gay, bisexual, and transgendered older adults Participants will learn how to incorporate awareness of health concerns of LGBT older adults to improve cultural competency in their geriatric curricula Participants will given specifics tools to implement changes to their current geriatric curriculum Participants will become familiar with patient and provider resources available for further learning about LGBT Elder health

3. Grey and Gay: Outline Background Survey Results: A Needs Assessment Curricular components –Didactic Lectures –Nursing Home Teaching –EMR Templates –Website & Readings –Works in Progress Resources for more information

4. GREY & GAY: BACKGROUND

5. Background Info To quote the STFM-endorsed AAFP geriatric curricula requirements, residents must “integrate factors of the patient’s family life, home life and general lifestyle into the diagnostic and therapeutic process”. “The largely unspoken but widely held assumption that elders are sexually inactive, heterosexual, and monogamously coupled or widowed does a disservice to all older adults – but it places LGBT elders at perhaps the greatest risk for neglect, discrimination and abuse.” -Outing Age 2010, National Gay & Lesbian Task Force Policy Instititute In the US, est that in 2010: approx 2M LGBT elderly, but in 2030: 7M+

6. Gates, Gary. The Urban Institute, 2003 Where to find your elderly LGBT patients…

7. GREY & GAY: NEEDS ASSESSMENT SURVEY

8. Grey and Gay Pre Test 13 item survey, including information about resident panels and basic knowledge assessment. 36 residents completed the survey – 10 R1 – 14 R2 – 12 R3 Most said they “didn’t know” if they had any LGBT patients over 60.

9. “I have attended a lecture which addressed LGBT elder health”

10. “I routinely ask about ‘families of choice’ of my geriatric patients” Comments: “what is this?” “what are you talking about?” “what does this mean?”

11. “I am aware of resources for physicians/ patients regarding LGBT elder health”

12. Knowledge Assessment

13. GREY & GAY: CURRICULAR COMPONENTS

14. Didactic Lectures “Grey and Gay” – Highlights issues of an underserved & understudied population – Barriers to successful aging & health disparities of LGBT Elders

15. Didactic Lectures “ The Aging of HIV” – By 2015, 50% of all US residents living with HIV will be > 50 yo – Aging with, and from, HIV – Treatment of HIV in the elderly

16. Nursing Home Teaching Small-group teaching sessions during nursing home visits Topic: LGBT Older Adults in LTC Facilities – Areas of concern – Experiences related to real or perceived sexual orientation/gender identity – Relevant Laws governing LTC Facilities – Recommendations for Change – Screening questions for LGBT-friendly facilities – Resources for additional learning

17. EMR Templates Goal to standardize templates to be inclusive in regard to gender identity, sexual orientation and families of choice Modified EMR templates for Geriatric Assessments to include screening for sexual activity and concerns of sexual function

18. Website & Readings Handouts/Links on LGBT Elder Topics Health Disparities Cultural Competency Aging of HIV Housing & Long-Term Care Hospice Advanced Directives Webpage Links

19. Work in Progress… Post-Survey Assessment end of R2 year Integrating points specific to LGBT elders in general rotation of geriatric didactic lectures – ie Advanced Directives, Sexual Changes in the Elderly, Preventative Care in Geriatrics… EMR: After Visit Summary Templates Developing specific milestones for evaluation of compentency Continuing efforts in advocacy – Access to experiential learning via community lectures, organization meetings, film showings …

20. GREY & GAY: ADDITIONAL RESOURCES

21. Grey and Gay: Resources Websites National Resource Center on LGBT Aging: www.lgbtagingcenter.orgwww.lgbtagingcenter.org SAGE (Services and Advocacy for Gay Elders): www.sage.orgwww.sage.org OLOC (Old Lesbians Organizing for Change): www.oloc.orgwww.oloc.org National Coalition for LGBT Health: www.lgbthealth.netwww.lgbthealth.net Transgender Aging Network: www.forge-forward.org/tanwww.forge-forward.org/tan Graying of Aids: www.grayingofaids.orgwww.grayingofaids.org Lamda Legal: www.lambdalegal.orgwww.lambdalegal.org LGBT Health Resources and Research: www.lgbthealth.netwww.lgbthealth.net LGBT Health: www.kingcounty.gov/healthservices/health/personal/glbt.aspxwww.kingcounty.gov/healthservices/health/personal/glbt.aspx The Fenway Institute Research: www.fenwayhealth.orgwww.fenwayhealth.org Films Gen Silent, directed by Stu Maddox, 2010: http://stumaddux.com/GEN_SILENT.htmlhttp://stumaddux.com/GEN_SILENT.html Edie and Thea: A Very Long Engagement, 2009: : http://www.blessblessproductions.com/ediethea.html http://www.blessblessproductions.com/ediethea.html Ten More Good Years, 2008: www.tenmoregoodyears.comwww.tenmoregoodyears.com

22. Thank You. Kristin.Anderson@swedish.org Carroll.Haymon@swedish.org

23. Grey and Gay: References Improving the Lives of LGBT Older Adults. March 2010 Grant, Jaime M. Outing Age 2010: Public Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender Elders. National Gay and Lesbian Task Force Policy Institute. LGBT Aging: What Makes it Different? A Training Curriculum from the New York State Health & Human Services network, compiled and edited by SAGE. Oct 2009. Still Out, Still Aging: The MetLife Study of Lesbian, Gay, Bisexual, and Transgender Baby Boomers. March 2010. Healthy People 2020. www.healthypeople.gov/2020www.healthypeople.gov/2020 Mayer, et al. “Sexual and Gender Minority Health: What We Know and What Needs to Be Done.” American Journal of Public Health. 98. (2008): 989-995. HIV & AGING POLICY WHITE PAPER. Services and Advocacy for GLBT Elders (SAGE). January 2010. Antiretroviral treatment of adult HIV infection: 2010 recommendations of the International AIDS Society- USA panel. JAMA. 2010;304(3):321. The HIV and Aging Consensus Project. Recommended Treatment Strategies for Clinicians Managing Older Patients with HIV. Nov 2011. Fredriksen-Goldsen, K. I., Kim, et al. (2011). The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle: Institute for Multigenerational Health.