Are all people living with a diagnosis of dementia treated equally?

There are thought to be around 650,000 people in the UK who are estimated to experience some degree of gender non-conformity (Gender Identity Research and Education Society).

It is widely recognised that there is limited evidence on the experiences of transgender people in Scotland and even less information regarding transgender people who have now developed Dementia.

For the first time, there is an ageing transgender population and as a result, many health and social care professionals are working with older transgender clients for the first time, many of whom have complex cognitive, social or bodily needs relating to their gender reassignment. We are only now seeing the first generation of transgender people in their 60s and over who have taken hormone therapy for 30 years or more, many of whom are living with gender reassignment surgeries performed using the very different techniques of the 1960s and 70s. Care is something that is often taken for granted. Illness and disability can occur without warning through accident or old age and the opportunity to arrange and to inform local caring services about their lifestyle or past as a male or female may not be possible. If the person in need of care is unable to wash, dress or manage basic care requirements then health and social care services will be involved, whether care at home services or care home services.

Many health and social care services are ill-equipped to deal with the needs of transgender seniors, and have had little exposure and so have little understanding of their history or the unique needs of transgender people, who fear that a move to assisted living or receiving care within their own home may leave them vulnerable to discrimination and harassment.

When we think about sexual orientation, gender identity and older people, we overwhelmingly assume that the older people who use our services are heterosexual and non-transgender. As a result, issues of sexual orientation and gender identity have often been invisible in the planning and commissioning of services for older people. The issue is further complicated through a societal culture which seldom seems to recognise or empower older people’s sexuality. This is particularly true in instances where the older person is perceived as vulnerable, specifically in a residential or nursing care setting where issues of capacity and consent may make the nurturing of an individual’s sexuality more complex. The progressive deterioration of the most recent memory for a transgender person could mean only remembering living in another gender, including not remembering having had gender affirmation procedures or surgery. A real concern of many transgender people is that they will be misgendered in the event that they become reliant on others for care.

One thing, though, is clear – for transgender people, ageing into the later years of life can present a unique set of challenges.

An example of this is older transgender people were reported to have become distressed within care settings because they couldn’t remember whether or not they have come out to fellow residents or staff and that this was causing significant anxietyto them.

There is limited understanding of how transgender people are affected by dementia. Whilst cultural awareness training for service providers is  required to improve the understanding of transgender clients and how appropriate and respectful care can be provided. Service providers also need resources and information to optimise culturally appropriate care for transgender people

There is a long way to go however, we must ensure that transgender people are protected against discrimination, harassment and victimisation on the grounds of gender reassignment.

To this end the Scottish government has begun engaging with transgender people to advise on trans-specific policies, thus enabling full participation in everyday, and public life by empowering transgender people, changing hearts and minds and creating a network of allies.

Last Updated on 7th June 2017 by Scottish Care