University of Vermont

Eyler Co-Edits Book Focused on Gay, Lesbian, Bisexual and Transgender Aging

University of Vermont Associate Professor of Psychiatry and Family Medicine, A. Evan Eyler, M.D., M.P.H.
University of Vermont Associate Professor of Psychiatry and Family Medicine, A. Evan Eyler, M.D., M.P.H.

For many older adults, identifying as gay, lesbian, bisexual or transgender has long been associated with potentially serious social repercussions, as well as deep anxiety and fear of discovery leading to discrimination and abuse.  Now, as they age and are dealing with declining physical health, members of this population are faced with the need for personal disclosure that accessing health care often entails, a prospect that may be difficult to consider as they are more likely to have hidden their sexual identity for most if not all of their lives.    

University of Vermont Associate Professor of Psychiatry and Family Medicine, A. Evan Eyler, M.D., M.P.H., is co-editor of a new book exploring clinical and practical concerns related to LGBT health and aging. Titled Gay, Lesbian, Bisexual and Transgender Aging: Challenges in Research, Practice and Policy (Johns Hopkins University Press), it is intended for healthcare professionals and students, particularly those who are interested in aging and LGBT concerns.

“One of the goals of the book is to reach out to people in clinical settings,” Eyler says, noting that there is often a need to improve patient care for this group of individuals. With LGBT service programs typically focused on youth, and geriatric services not necessarily addressing the needs of this particular population, physicians and other healthcare providers have the opportunity to make a difference for older LGBT patients.

Chapter authors combine biological and social science research with case studies and, in many instances, lived experiences to address a host of crucial aspects of older adulthood, including death and dying, long-term care, and the psychosocial effects of discrimination over time. Co-editor Tarynn Witten, Ph.D., L.C.S.W., F.G.S.A., is a gerontologist, researcher and biostatistician.  In part what makes the book – one of very few focused on the LGBT communities and aging – possible, is new data.

“This cohort of older adults who are LGBT identified is used to keeping the personal aspects of their lives secret,” Eyler says. Only recently has that started to change, allowing researchers and other healthcare providers to interview and survey this population. Two studies Eyler referenced in a recent Grand Rounds at Fletcher Allen Health Care – a 2010 survey from the MetLife Mature Market Institute and the American Society on Aging, focused specifically on the experiences and concerns of LGBT-identifiedmembers of the Baby Boomer generation, and a 2011 Institute of Medicine report on LGBT health – are examples of work that lays the foundation for further research.

One area ripe for study is the concept of resilience.  For example, research has shown that as a group, older LGBT adults are less likely to have children, and to be more socially active, forging connections through community service and close friendships. One goal of researchers and service providers is to look at this population through the lens of resilience --the factors that have sustained this cohort in the past, and helped them to find healthy, meaningful lives despite experiencing severe discrimination--with an eye on helping them to maintain those strengths and ties as they age.

Improving medical care for older LGBT individuals hinges in part on working through long-held beliefs about their “otherness” after decades of institutionalized discrimination and bias. As a group, older LGBT adults “often tended to avoid medical care when possible,” Eyler says. “People do tend to be self-disclosing when there’s a supportive foundation and a welcoming attitude.”

Medical schools and other healthcare education programs are laying the groundwork for this inclusive approach by addressing LGBT patient care in the curriculum, something that the UVM College of Medicine has been doing through several courses in the Vermont Integrated Curriculum, including Professionalism, Communication and Reflection, and Generations. Eyler notes that using case studies and other material that features LGBT individuals with medical issues unrelated to their sexual orientation or gender identity also helps to normalize and mainstream this group as patients seeking care for any number of concerns.

This shift in curriculum is a part of the movement towards acceptance of differences in sexual orientation and gender identity as a part of normal human variation, Eyler says, which is consistent with the available scientific evidence.  Reflecting this evolution in perspective, the past several decades has been “a time of very rapid social change,” with recent developments including the repeal of DOMA and nearly half of the states adopting full, state-level marriage equality.

It wasn’t that long ago – just 40 years - that homosexuality was considered a diagnosable mental disorder. To commemorate the 40th anniversary of the American Psychiatric Association’s (APA) vote to remove homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), Eyler interviewed Saul Levin, M.D., M.P.A., the CEO and medical director of the APA, for LGBT Health, a new academic journal for which Eyler serves as an associate editor. In the interview, Eyler and Levin discuss this “pioneering move with the legal, political, and cultural context of the time,” and reflect on current issues facing the LGBT community.

Read the full text of Dr. Eyler’s interview with the APA’s Saul Levin, M.D., M.P.A.