Supporting LGBT Elders

*Patient names have been changed to protect privacy


“No way,” the patient told nurse practitioner Sigrid Gabler when she asked to take his blood pressure.


Robert*, a 65-year old HIV positive gay man,  stopped having checkups after experiencing discrimination from health providers because of his sexuality,  though he regularly visited the emergency department when complications from untreated cardiac issues arose.   A year ago, he underwent emergency heart surgery, but never showed up for follow up care and didn’t take the prescribed medications. 


This March, a gastrointestinal ailment prompted him to see Gabler during nursing hours at SAGE, a nonprofit that provides services to LGBT elders. He told Gabler that he knew he had high blood pressure and had previously taken drugs to help bring it down to an acceptable level. But he didn’t like the side effects, so he stopped. He also reported that his previous providers rushed through appointments and didn’t adequately explain his condition. Gabler continued speaking with him, counseling him on safe sex practices and his HIV status.


Twice, during subsequent visits, she gently asked if she could take his blood pressure and twice he refused.  Finally, on his fourth visit, he agreed. The blood pressure monitor revealed Robert was at risk for a stroke.


Robert was given a list of LGBT-friendly primary care providers which the SAGE team recommended, and was urged to take the next step.


 “Earning his trust felt like a victory,” says Gabler.


Gabler works with elder LGBT patients like Robert as part of the e-linc initiative (Elder LBGT Interprofessional Collaborative Care Program) led by Columbia Nursing, which aims to eliminate health disparities in New York City’s LGBT elder population. Jeffrey Kwong, DNP, director, Adult-Gerontology Nurse Practitioner Program, secured a $1.5 million cooperative agreement from Health Resources and Service Administration earlier this year to help address common medical and mental health needs of the aging LGBT population. Walter Bockting, PhD, is co-director of the Initiative and also e-linc's associate director. In partnership with SAGE, interprofessional teams comprised of nurse practitioners, social workers, psychiatrists, psychologists, physical therapists, and occupational therapists provide culturally competent care to LGBT older adults in New York City.


A year into the program, the initiative has met one of its goals of serving 100 patients. Another of its goals is to link patients previously disconnected from the health care system with LGBT friendly providers. For example, e-linc’s health care providers have facilitated a breast cancer screening for a woman identifying a mass, and arranged for end-of-life care honoring the wishes of a woman with late stage cancer. Both of these patients had not been receiving care before connecting with e-linc.


 “Many times older LGBT people remain a silent population because they don’t mention their sexuality or talk about sex with their health providers,” says Kwong. “Our teams of health professionals develop comprehensive health assessment programs to help identify treatment needs that might otherwise go unnoticed.”


Recent estimates suggest that there are at least 1.5 million lesbian, gay, and bisexual people 65 and older in the US, and this population will double by the year 2030. Older LGBT people face significant physical and mental health disparities including HIV and depression. LGBT elders are more likely to live in isolation than their non-LGBT peers.


Columbia Nursing students participate in the program by fulfilling clinical hours and volunteering during SAGE nursing hours, serving as patient navigators, and making home visits. This fall, Columbia Nursing psychiatric mental health nurse practitioner students will work with e-linc patients as part of their clinical rotations.  E-linc plans to expand its services this year to an additional clinic on the Columbia University Medical Center campus.


As e-linc’s directors evaluate the impact of the program, Gabler considers working with Robert as one of its many patient successes.


After providing him with referrals, Robert frequently visited Gabler at SAGE just to chat. He reported making several doctor’s appointments but cancelled at the last minute. In one instance, he arrived at one of the appointments, but walked out of the waiting room because he felt the wait was too long.


This June, he came in to see Gabler, and told her he visited a doctor who prescribed him medication to lower his blood pressure and he was taking the pills as directed.  


The second time Gabler took his blood pressure, she was delighted to see it had dropped significantly.


Robert started taking a more active role in his health care. He visited a cardiologist and a urologist and brought Gabler his lab report for her to assess his HIV viral load.


 Most importantly, he has steered clear of the emergency department.


“He felt he wasn’t being heard or taken seriously in his previous provider relationships,” says Gabler. “He took a chance with new providers and it worked. Through e-linc, we are trying to keep people like Robert out of the emergency room by connecting them with preventative care through culturally sensitive providers.”