Expert Commentary

Older Adult Lesbian, Gay, Bisexual, and Transgender Patients: Special Considerations

Ellen Haller, MD

Professor of Clinical Psychiatry

University of California, San Francisco

San Francisco, CA


Older adult Lesbian, Gay, Bisexual, and Transgender (LGBT) patients face unique stresses which can take a toll on their physical and mental health. Because their partnerships are not legally recognized in the same way that heterosexual marriages are, they are not eligible for social security and pension survivor benefits, and may also pay a larger amount in taxes when inheriting from a partner. All of these factors contribute to high rates of poverty in this group. Discrimination, prejudice, lack of civil rights, and isolation can all contribute to increased risks of depression and substance abuse. In addition, many older patients will have a long history of being closeted, and when in a doctor’s office or long-term care facility, may not feel comfortable disclosing their full history to their clinicians.


Clinicians can take proactive steps to make LGBT individuals feel accepted in their practices and comfortable being honest. One example is to include an option for “domestic partner” on intake forms, and to train intake or other staff to ask generally about who is important in a person’s life, rather than ask specifically about a husband or wife. Simple steps like these can help make older adult LGBT patients feel more comfortable in your practice.




1. Addis S, Davies M, Greene G, Macbride-Stewart S, Shepherd M. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health Soc Care Community. 2009;17(6):647-658.

2. Claes JA, Moore W. Issues confronting lesbian and gay elders: the challenge for health and human services providers. J Health Hum Serv Adm. 2000;23:181-202.

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