A new series starts this week on how we can improve end of life experiences and care needs for people in minority communities. Robert Killeen MD, who works in hospice and palliative medicine in the USA, introduces the series.
In recent years I reported on a transgendered lady whose plight exemplified the difficulties of the transgendered in society and medicine. The patient was an elderly female (male-to-female) with metastatic cancer that was unresponsive to chemotherapy. She was admitted to the hospice inpatient unit for symptomatic care. She subsequently improved and was well enough to leave the unit though not well enough to go back home. She was to be placed in a nursing home but she was too poor to afford a single room. Her dilemma began when she desired a female roommate. She was post-surgically and outwardly female. However, the nursing homes could not comply as they viewed her as a male. In the end she spent the remainder of her days within the hospice unit as her gender had caused her life to run aground. Trans people frequently find their exposure to the healthcare system, both in living and in dying, to be a daunting experience.
The transgendered community reside in a societal abyss where only the ‘passable’ come into the shadows and the few brave come into the light. Their first experience may come from a visit to their healthcare provider, where they feel they must achieve acceptance before they can hope to gain treatment. In a study by the University of Washington the results for the transgendered population were disheartening. Nearly a third of older transgendered adults surveyed reported their overall health as ‘poor’ yet almost half had reported receiving inferior health care. While 90% of the older transgendered had a primary care provider only 27% obtained routine checkups. Mental health issues have the foremost difficulties as trans people carry high rates of depression (48%), and even higher rates of suicide (71%). The fear of being ‘outed’ and judged by medical practice cause many to refrain from being seen for their maladies. This apprehension allows their treatable illnesses to become incurable problems.
In the previous century both race and sexuality were primary issues; in this century gender identity has come to the forefront. At present, the transgendered are coming forward slowly, carefully, and lonely. Societal acceptance, at times, seems unclear. For the medical field this shouldn’t even be in question. We are here to treat equally people of all stations, of all walks of life. Acceptance is a given, not an option.
Killeen R. Hospice and the Transgendered. GeriPal, www.geripal.org, June 12, 2013.
Fredriksen-Goldsen KI, Kim HJ, Emlet CA, et al. The Aging and Health Report: Disparities and Resilience among Lesbian, Gay, Bisexual, and Transgender Older Adults. Seattle: Institute for Multigenerational Health. University of Washington. 2011.
Follow the EAPC Blog on Wednesday and next week when Dr Kathryn Almack and Dr Richard Harding will be sharing some of their research findings and new studies.