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SageHealth Network is dedicated to promoting the sexual health, socialization and positive aging of older adults and seniors. We offer unique health promotion workshops and social events focusing on older adults and seniors' needs and overall wellbeing.




Sunday, October 28, 2007

Aging and Gay, and Facing Prejudice in Twilight


By Jane Gross, The New York Times
October 9, 2007

Even now, at 81 and with her memory beginning to fade, Gloria Donadello recalls her painful brush with bigotry at an assisted-living center in Santa Fe, N.M. Sitting with those she considered friends, “people were laughing and making certain kinds of comments, and I told them, ‘Please don’t do that, because I’m gay.’”

The result of her outspokenness, Ms. Donadello said, was swift and merciless. “Everyone looked horrified,” she said. No longer included in conversation or welcome at meals, she plunged into depression. Medication did not help. With her emotional health deteriorating, Ms. Donadello moved into an adult community nearby that caters to gay men and lesbians.

“I felt like I was a pariah,” she said, settled in her new home. “For me, it was a choice between life and death.”

Elderly gay people like Ms. Donadello, living in nursing homes or assisted-living centers or receiving home care, increasingly report that they have been disrespected, shunned or mistreated in ways that range from hurtful to deadly, even leading some to commit suicide.

Some have seen their partners and friends insulted or isolated. Others live in fear of the day when they are dependent on strangers for the most personal care. That dread alone can be damaging, physically and emotionally, say geriatric doctors, psychiatrists and social workers.

The plight of the gay elderly has been taken up by a generation of gay men and lesbians, concerned about their own futures, who have begun a national drive to educate care providers about the social isolation, even outright discrimination, that lesbian, gay, bisexual and transgender clients face.

Several solutions are emerging. In Boston, New York, Chicago, Atlanta and other urban centers, so-called L.G.B.T. Aging Projects are springing up, to train long-term care providers. At the same time, there is a move to separate care, with the comfort of the familiar.

In the Boston suburbs, the Chelsea Jewish Nursing Home will break ground in December for a complex that includes a unit for the gay and lesbian elderly. And Stonewall Communities in Boston has begun selling homes designed for older gay people with support services similar to assisted-living centers. There are also openly gay geriatric case managers who can guide clients to compassionate services.

“Many times gay people avoid seeking help at all because of their fears about how they’ll be treated,” said David Aronstein, president of Stonewall Communities. “Unless they see affirming actions, they’ll assume the worst.”
Homophobia directed at the elderly has many faces.

Home health aides must be reminded not to wear gloves at inappropriate times, for example while opening the front door or making the bed, when there is no evidence of H.I.V. infection, said Joe Collura, a nurse at the largest home care agency in Greenwich Village.

A lesbian checking into a double room at a Chicago rehabilitation center was greeted by a roommate yelling, “Get the man out of here!” The lesbian patient, Renae Ogletree, summoned a friend to take her elsewhere.

Sometimes tragedy results. In one nursing home, an openly gay man, without family or friends, was recently moved off his floor to quiet the protests of other residents and their families. He was given a room among patients with severe disabilities or dementia. The home called upon Amber Hollibaugh, now a senior strategist at the National Gay and Lesbian Task Force and the author of the first training curriculum for nursing homes. Ms. Hollibaugh assured the 79-year-old man that a more humane solution would be found, but he hanged himself, Ms. Hollibaugh said. She was unwilling to identify the nursing home or even its East Coast city, because she still consults there, among other places.
While this outcome is exceedingly rare, moving gay residents to placate others is common, said Dr. Melinda Lantz, chief of geriatric psychiatry at Beth Israel Medical Center in New York, who spent 13 years in a similar post at the Jewish Home and Hospital Lifecare System. “When you’re stuck and have to move someone because they’re being ganged up on, you put them with people who are very confused,” Dr. Lantz said. “That’s a terrible nuts-and-bolts reality.”

The most common reaction, in a generation accustomed to being in the closet, is a retreat back to the invisibility that was necessary for most of their lives, when homosexuality was considered both a crime and a mental illness. A partner is identified as a brother. No pictures or gay-themed books are left around.

Elderly heterosexuals also suffer the indignities of old age, but not to the same extent, Dr. Lantz said. “There is something special about having to hide this part of your identity at a time when your entire identity is threatened,” she said. “That’s a faster pathway to depression, failure to thrive and even premature death.”

The movement to improve conditions for the gay elderly is driven by demographics. There are an estimated 2.4 million gay, lesbian or bisexual Americans over the age of 55, said Gary Gates, a senior research fellow at the Williams Institute at the University of California, Los Angeles. That estimate was extrapolated by Dr. Gates using census data that counts only same-sex couples along with other government data that counts both single and coupled gay people. Among those in same-sex couples, the number of gay men and women over 55 has almost doubled from 2000 to 2006, Dr. Gates said, to 416,000, from 222,000.

California is the only state with a law saying the gay elderly have special needs, like other members of minority groups. A new law encourages training for employees and contractors who work with the elderly and permits state financing of projects like gay senior centers.

Federal law provides no antidiscrimination protections to gay people. Twenty states explicitly outlaw such discrimination in housing and public accommodations. But no civil rights claims have been made by gay residents of nursing homes, according to the Lambda Legal Defense Fund, which litigates and monitors such cases. Potential plaintiffs, the organization says, are too frail or frightened to bring action.

The problem is compounded, experts say, because most of the gay elderly do not declare their identity, and institutions rarely make an effort to find out who they are to prepare staff members and residents for what may be an unfamiliar situation.

So that is where Lisa Krinsky, the director of the L.G.B.T. Aging Project in Massachusetts, begins her “cultural competency” training sessions, including one last month at North Shore Elder Services in Danvers.

Admissions forms for long-term care have boxes to check for marital status and next of kin. But none of the boxes match the circumstances of gay men or lesbians. Ms. Krinsky suggested follow-up questions like “Who is important in your life?”

In the last two years, Ms. Krinsky has trained more than 2,000 employees of agencies serving the elderly across Massachusetts. She presents them with common problems and nudges them toward solutions.

A gay man fired his home health aide. Did the case manager ask why? The patient might be receiving unwanted Bible readings from someone who thinks homosexuality is a sin. What about a lesbian at an assisted-living center refusing visitors? Maybe she is afraid that her friends’ appearance will give her away to fellow residents.

“We need to be open and sensitive,” Ms. Krinsky said, “but not wrap them in a rainbow flag and make them march in a parade.”

Some of the gay elderly chose openness as the quickest and most painless way of finding compassionate care. That is the case for Bruce Steiner, 76, of Sudbury, Mass., whose 71-year-old partner, Jim Anthony, has had Alzheimer’s disease for more than a decade and can no longer feed himself or speak.

Mr. Steiner is resisting a nursing home for Mr. Anthony, even after several hospitalizations last year. The care had been uneven, Mr. Steiner said, and it was unclear whether homosexuality was a factor. But Mr. Steiner decided to take no chances and hired a gay case manager who helped him “do some filtering.”

They selected a home care agency with a reputation for treating gay clients well. Preparing for an unknown future, Mr. Steiner also visited several nursing homes, “giving them the opportunity to encourage or discourage me.” His favorite “is one run by the Carmelite sisters, of all things, because they had a sense of humor.”

They are the exception, not the rule.

Jalna Perry, a 77-year-old lesbian and psychiatrist in Boston, is out, she said, but does not broadcast the fact, which would feel unnatural to someone of her generation. Dr. Perry, who uses a wheelchair, has spent time in assisted-living centers and nursing homes. There, she said, her guard was up all the time.

Dr. Perry came out to a few other residents in the assisted-living center — artsy, professional women who she figured would accept her. But even with them, she said, “You don’t talk about gay things.” Mostly, she kept to herself. “You size people up,” Dr. Perry said. “You know the activities person is a lesbian; that’s a quick read.”

Trickier was an aide who was gentle with others but surly and heavy-handed when helping Dr. Perry with personal tasks. Did the aide suspect and disapprove? With a male nurse who was gay, Dr. Perry said she felt “extremely comfortable.”

“Except for that nurse, I was very lonely,” she said. “It would have been nice if someone else was out among the residents.”

Such loneliness is a source of dread to the members of the Prime Timers, a Boston social group for older gay men. Among the regulars, who meet for lunch once a week, are Emile Dufour, 70, a former priest, and Fred Riley, 75, who has a 30-year heterosexual marriage behind him. The pair have been together for two decades and married in 2004. But their default position, should they need nursing care, will be to hide their gayness, as they did for half a lifetime, rather than face slurs and whispers.

“As strong as I am today,” Mr. Riley said, “when I’m at the gate of the nursing home, the closet door is going to slam shut behind me.”

Dan Frosch contributed reporting

Source
http://www.globalaging.org/elderrights/us/2007/aginggay.htm

Seniors and Sexuality: Enjoying Intimacy and a Healthy Lifestyle


By Michele Cauch, Executive Director
SageHealth Network

(Source: Help's Here Magazine: Resources for Seniors & Caregivers, Fall/Winter 2007)

Ageist attitudes have had a strong hold over our collective Western psyche. Moving away from the beginning of life's spectrum, aging has been perceived as a negative process and something that we must tirelessly rail against. Taking this notion of ageism one step further, most people cannot imagine seniors as being sexual into retirement age and beyond. For many young people, it's impossible to associate physical intimacy with older adults. Senior sexuality is an uncomfortable and unbelievable concept to not only young adults but also seniors themselves. There is
the belief that seniors are too old to engage in sexual intimacy or they are undesirable to potential mates. It may be news to many, but it's time we all realized
and rejoiced in the fact that seniors are indeed sexually active well into the
Third Age.

The Good and Bad News
Seniors are sexually active and enjoying all forms of intimacy. A study by the American Association of Retired Persons estimated 62% of men and 27% of women over 60 years old consider sex very important in their lives. Approximately one-third of all respondents of which 49% had regular sexual partners, reported they had sexual intercourse once a week or more often. Slightly more than half engage in sexual touching or caressing, and around two-thirds kiss or hug their partner on a regular basis (AARP Sexuality at Mid Life and Beyond, 2005).

As encouraging as this revelation is, it also presents cause for concern - ndividuals
50 and over are at greater risk for contracting sexually transmitted infections (STIs), such as genital herpes, syphilis, gonorrhea, chlamydia, hepatitis B, and HIV/AIDS. There are a variety of reasons why older adults are at risk for contracting STIs: lack of education and awareness campaigns targeting older adults, reliance on outdated information, and common misconceptions about seniors' sexuality on the part of health care providers. Many seniors have assumptions and beliefs about sexuality that are difficult to change. Very few sexually active older adults use condoms as a form of safe sex. They may not use condoms because they associate condoms with preventing pregnancy - something that is not a concern when in your 70s or 80s. Many seniors may believe that HIV/AIDS is a disease that affects young people or gay men and could not possibly affect them at their age. Some older adults are perhaps newly single, widowed or divorced after long term monogamous relationships years of marriage and do not know of the sexual health dangers that exist nowadays. These individuals are seeking new partners and are in a vulnerable situation due to lack of information and awareness of sexually transmitted infections
and the facts about HIV/AIDS.

The Viagra craze has contributed a lot to the increase in STIs in older adults also.
More seniors are having more sex; however, drug companies have not provided sufficient education on sexual health risks nor safer sexual practices.

Protecting Your Sexual Health
If you've recently begun dating and are thinking about becoming sexually active,
you should discuss sexual health and safe sex practices with your partner. You should never feel pressured to engage in sex if you're not ready. When you do
decide to initiate physical intimacy, you have to be cautious about protecting your
sexual health. If you're sexually active, speak to your partner about your concerns
for both of you getting tested for certain sexually transmitted infections and HIV. It may be an uncomfortable subject to discuss, but remember; ultimately it's you that must make informed decisions about your own health.

Additionally, some healthcare providers assume that their older patients are not sexually active and may not routinely test older patients for STIs or ask them questions about their sexual practices or history. They don't want to be perceived as prying into the private lives of their older patients. Don't wait for your physician to talk to you about sexual health. If your doctor doesn't ask, you have to break the silence. You and your doctor need to have a frank and open conversation about your sexual health and assessing your level of risk.

Sexual intimacy brings physical and emotional pleasure, increases feelings of self esteem, and heightens feelings of closeness in partners. Knowing that your sexual health and that of your partner is a priority, will only serve to strengthen your relationship. Everyone, regardless of age, has the right to sexual expression,
the right to information on how to protect their sexual health and the responsibility
to make informed health decisions. Age is no barrier against sexually transmitted infections.

Enjoy life and intimacy, but be sexually responsible.

What are STIs?
~STIs are sexually transmitted infections.
You can be infected without showing
symptoms.
~STIs can be transmitted through sexual
contact and some can be transmitted
through skin to skin contact.
~Most STIs, particularly HIV, are passed
through body fluids: blood, semen,
vaginal fluid.
~STIs do not always show symptoms.
If you are sexually active, speak to your
doctor about STIs and getting tested.

Condoms 101
~Always use a latex or polyurethane
condom
~Never use a condom more than once
~Use personal lubricants
~Be responsible - men AND women
should carry condoms


This material is designed for information purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

Michele Cauch, Executive Director, SageHealth Network. SageHealth Network is an organization dedicated to promoting sexual health awareness and sexual health educationin older adults and care providers.

For more information: www.sagehealth network.com or email: info@sagehealthnetwork.com

Older African-American Men with HIV Often Have Sex Without Condoms

By Annette Whibey, Journal of Advanced Nursing

October 16, 2007

As many as four out of ten HIV positive African-American men could be putting their partners at risk by not using condoms, according to research in the Journal of Advanced Nursing 60.4.

A study of 130 middle-aged and older men in the USA found that many of the 40 to 65 year-olds were engaging in high-risk sexual practices.

38 per cent didn’t use condoms during oral sex, with 25 per cent having unprotected vaginal sex and 22 per cent having unsafe anal sex. The research also showed that men who were single and displayed fewer HIV symptoms were least likely to use condoms during sex.

“Despite the worrying number of men not using condoms, 78 per cent of those who took part in the study were able to answer questions about HIV and AIDS correctly and 25 per cent claimed to be knowledgeable about the subject but still engaged in risky sex” says Dr Christopher Lance Coleman from the University of Pennsylvania School of Nursing in Philadelphia.

“These findings are of particular concern as HIV and AIDS rates among black (non-Hispanic men) in the USA and in people over 50 have risen considerably in recent years. In fact, AIDS prevalence statistics for minority men in the USA are staggering.”

For example:

• In 2005, 127.6 per 100,000 cases of HIV/AIDS were African-American men compared to 18.5 for White men, according to data for 33 US states using confidential name-based reporting. The US Center for Disease Control suggests that this ethnic group is eight times as likely to develop AIDS as white males.

• Figures for 2005 also show that 44 per cent of all new cases of HIV were black (non-Hispanic) males, based on the latest data from 50 US states.

• AIDS rates are also rising in people over 50. In 2006, 27 per cent of adults living with AIDS in the USA were over 50.

77 per cent of the 130 African-American men who completed the questionnaire for this study, after responding to advertisements posted in two infectious disease clinics, were single. The average age of the participants was 46.

60 per cent were homosexual and 40 per cent were heterosexual. 32 per cent had received mental health treatment during the last year and the majority earned less than $10,000.

“While we think that our findings are compelling, it would be unwise to conclude that - as with any study - they are representative of all older African-American men who are HIV positive” stresses Dr Coleman.

“However, the findings of this study are worrying, particularly in view of rising HIV and AIDS rates in both ethnic communities and the over 50s. They definitely point to the need for further research into why older African-American men with HIV don’t use condoms.”

In 2006 UNAIDS - the joint United Nations programme on HIV and AIDS – estimated that there are now 39.5 million cases of HIV and AIDS worldwide. And they called for an international response to curb the stigma experienced by homosexual men who are HIV positive.

“We welcome this move as we believe it is essential to break down barriers to condom use among all people with AIDS and HIV” says Dr Coleman. “Some studies have even suggested that homosexual men have sex with women to hide their sexuality and HIV status.”

The authors hope that their findings will add to the ongoing debate about safe sex and condom use and highlight the need for more tailored initiatives to be developed for older African-American men.

“Health promotion messages have traditionally been targeted at young people” says Dr Coleman. “But the increased prevalence of older ethnic males with HIV and AIDS makes it essential for health professionals to promote safe sex and increase condom use to this target audience.”

Source
http://www.globalaging.org/health/us/2007/africanamericanhiv.htm

Saturday, October 6, 2007

Doctors Silent on Senior Sexuality

By MCauch
SageHealth Network

Last month, the New England Journal of Medicine caused quite a stir and media buzz with its extensive study on senior sexuality. Everyone was surprised, delighted and shocked by the statistics of seniors’ sexual activity, frequency of activity and types of behaviour:

• 73% reported being sexually active
• 2/3 had sex at least twice a month
• More than half had sex at least twice a month into their 80s
• More than half of those aged 57 to 75 and 1/3 or 75-85 year olds said they gave or received oral sex

However, there was another statistic on doctor-patient communication was not so much titillating as it was cause for concern:

Only 22% of women and 38% of men had discussed sex with a doctor since age 50 (NEJM, 2007).

The high rates of sexual activity compared with low rates of how many seniors talk to their physicians about sex shows a huge disparity. Withholding information may put many individuals at risk. This absence of open communication is a barrier to health education and results in major societal consequences. Older adults are embarrassed to broach the subject with their doctors and doctors are embarrassed to discuss sex with their older patients.

"Sex is an important indicator of health," Georgeanne Patmios of the National Institute on Aging, remarked in the NEJM study. Sexual problems can be a warning sign of diabetes, infections, cancer or other health woes. Untreated sex issues can lead to depression and social withdrawal; emotional stress; extra marital affairs and divorce; low self esteem and poor body image. “This subject has been taboo for so long that many older people haven’t even talked to their spouses about their sexual problems, let alone a physician,” said the lead author, Dr. Stacy Tesser Lindau, a University of Chicago gynecologist(NEJM, 2007).

Another problem stemming from this doctor-patient silence is that older adults may be at increased risk of contracting sexually transmitted infections. Many doctors perhaps are simply ignorant of the fact that their older patients are sexually active or could even be injection drug users.

Dr. Marianne J. Legato of Columbia University College of Physicians & Surgeons in New York stated, “Physicians need to detoxify the sexual subject for themselves and learn more about the physiology of normal sexual experiences. This should be taught in medical schools,” (Sexual Health Network, July, 1999).

It’s simply not enough to acknowledge the fact that many physicians are mum on sex when it comes to their older patients. Action must be taken to educate medical interns and make them aware of and counter their subconscious ageist attitudes. Physicians need sensitivity training and learn to be comfortable in assessing older patients lifestyles and health care issues. This includes being at ease with such topics as sexuality throughout the lifespan, risky sexual behaviours and querying about drug use.

This direct approach is imperative in providing holistic healthcare to seniors regardless of averted eye contact and blushing for both parties. Health care workers and medical professionals should not make the topic taboo, but should approach the discussion very matter-of-factly and as part of a normal health history.