You are currently viewing Enhancing Care for LGTBQ Seniors with SAGE’s Tim Johnston, PhD

Enhancing Care for LGTBQ Seniors with SAGE’s Tim Johnston, PhD

Episode #13 & 63 (Repost)June 9, 2021

Get ready for the confetti because it’s Pride!!

How do Pride and the Psychology of Aging fit together? Well, let me tell you, there are an estimated more than 3 million LGBTQ folks over 50 living in the US. This number is expected to more than double to 7 million by 2030. Okay, but here’s the thing. These are just estimates the numbers are probably higher, but they’re estimates because the US Census hasn’t captured how many LGBTQ folks actually live in America.

Whether you’re working with older adults as a professional, caring for older LGTBQ loved ones, are an LGTBQ older adult yourself, or are an ally like me, we all need to be aware of the unique needs and challenges that LGBTQ older adults face as well as the strengths that they possess.

According to SAGE (Services and Advocacy for GLBT Elders), LGTBQ older adults are twice as likely to be single and live alone, and four times less likely to have children. They’re more likely to experience depression, discrimination, social stigma, and the negative effects of prejudicial treatment and as a result are more likely to face homelessness, poverty and have poor physical and mental health outcomes than heterosexual older adults. This is why it’s so important that there are organizations like SAGE.

SAGE is a national advocacy and services organization that’s been looking out for LGBT elders since 1978. SAGE builds welcoming communities and keeps LGBT issues in the national conversation which ensures a fulfilling future for all LGBT people.

Today, I am delighted to interview Dr. Tim Johnston, the Senior Director of National Projects at SAGE. In this role, Dr. Johnston oversees the SAGECare cultural competency training program, and national partnerships with other advocacy organizations. Dr. Johnston is the author of Welcoming LGBT Residents: A Practical Guide for Senior Living Staff, which is the first comprehensive book on how to create a positive and safer experience for LGBT older adults in senior living settings. And today, he’s going to share his expertise with us.

Here’s a look inside my interview with Dr. Tim Johnston:

  • [04:44] Dr. Johnston shares about the important work that he and SAGE are doing to serve and advocate for LGTBQ older adults.
  • [10:33] Older LGTBQ adults spent many years of their life in a cultural and political context that was very hostile to LGBT people and staying in the closet or remaining private about their identity was often a matter of survival. Learn about how these experiences have affect older LGTBQ as they age.
  • [12:55] If you’re a professional, learn what you can do to create a space that is affirming for older LGTBQ adults.
  • [16:33] Dr. Johnston shares tips for what to do an say when an older LGTBQ individual reveals their identity to you.
  • [17:10] Discover generational differences between the use of some of the LGTBQ terms.
  • [23:55] Dr. Johnston reveals the unique needs of older LGBTQ folks who are living with dementia and how care communities can provide affirming and validating care.
  • [28:00] Older LGTBQ adults possess many resiliency factors that need to be highlighted and validated. We explore a few of those here.
  • [30:02] COVID is disproportionately affecting older adults. Learn some of the ways that COVID is affecting LGTBQ seniors specifically.
  • [32:41] There’s a lot that older LGBTQ folks can do to enhance their own physical and mental health as they age. Dr. Johnston shares several tips.
  • [39:50] Allies, friends, and family! You have an important role in promoting the health and wellness of older LGBTQ folks. Learn what you can do here!

By the end of this episode, you’ll have a deeper understanding of the unique needs of LGBTQ older adults, what LGTBQ seniors can do to enhance their physical and mental wellness, and what health providers and allies can do to to create affirming places for older LGTBQ folks. 




Resources for LGTBQ Older Adults & Professionals


  • Link here to learn more about SAGE’s PRIDE events for June 2021


  • For LGTBQ Older Adults:
    • SAGEConnect links LGBT elders with their broader community, reducing isolation and promoting well-being- connect online here. If you know someone who would benefit from SAGEConnect, but doesn’t have internet, call the registration line at 929-484-4160.
    • Check out SAGE’s LGBTQ Aging Guides and Resources
    • Considering Long-Term Care? Check out these resources for LGTBQ seniors
    • Facing discrimination in your senior community? Lambda Legal defends the rights of LGBT and HIV-positive seniors who face discrimination related to their sexual orientation, gender identity or HIV status, including discrimination by staff and residents at senior centers, senior housing, long-term care and beyond.





Dr. Tim Johnston
But some of the things that I'm concerned about in a residential care context is making sure that LGBT folks or people who are expressing same sex, sexual desires, are given the same rights and have the same advocates on their side as non LGBT folks. So for example, it might be the case that maybe somebody living with dementia who has been in heterosexual relationships, their whole life, suddenly becomes physically affectionate with someone of the same sex. And this could be very surprising to the family. And what I don't want to see as care providers assuming that that's predatory or that that's just the disease, when in fact, it could be the expression of something that the dementia is now kind of creating some space for.

Dr. Regina Koepp [0:50]
I'm Dr. Regina Koepp. I'm a clinical geropsychologist, which means that I'm a psychologist who specializes with older adults and families. And this is the psychology of aging podcast, your go to resource for Mental Health and Aging.

If you're a professional working with older adults, it's essential that you are informed about LGBTQ rights, needs and resilience with aging. Today, I'm rebroadcasting, an episode that I recorded about a year ago during pride with Tim Johnston, who works with sage and I'll tell you a little bit about Tim Johnston and sage in a minute. But first I want to share a meaningful little story. A few days ago, I posted a sage announcement of the events that they have for the month of June 2021, all around pride just for LGBTQ older adults and their families. In response to my post, my post was reshared by the executive director of a senior living community. And here's what he wrote, thank you to all our LGBT older adults, your resilience and standing up for who you are, has allowed me and future generations to live our true authentic selves #thankyou

That warmed my heart and inspired me to repost the interview I had with 10 Johnston from last year. Also there was a part two of the interview with Tim Johnston about LGBTQ caregivers. And I'll link to that in the show notes. And in a couple of days, I'll be rebroadcasting my interview with Laurie cook Daniels, about transgender aging, so be on the lookout for that as well. And I'll link to it in the show notes of this episode too. Now, let me tell you a little bit about Tim Johnston and sage. Dr. Tim Johnston is the Senior Director of national projects at sage. And this role Dr. Johnston oversees the sage care cultural competency training program and national partnerships with other advocacy organizations. Dr. Johnston is the author of welcoming LGBT residents, a practical guide for senior living staff, which is the first comprehensive book on how to create a positive and safer experience for LGBT older adults in senior living settings. And today, he is going to share his expertise with us. Now, let me tell you a little bit about sage. Sage: S-A-G-E, is a national advocacy and services organization that's been looking out for LGBT elders since 1978. Sage builds welcoming communities and keeps LGBT issues in the national conversation, which ensures a fulfilling future for all LGBT people. Sage has loads of helpful resources on their website. I'll link to some of these resources in the show notes. And please take some time to go and look at what Sage has to offer. Alright, let's jump into the interview from last year with Dr. Tim Johnston.

I'm curious, can you share a little bit about yourself and about Sage?

Dr. Tim Johnston 4:44
Yeah, absolutely. And thank you so much for having me. I'm really excited to be speaking with you. So my title is that I'm the Senior Director of national projects at SAGE and SAGE is the nation's oldest and also largest organization that advocates for lesbian, gay, bisexual and transgender older people. So we're headquartered in New York City, but we have affiliates all across the country. And my main role is to work with providers. So that could be a residential care provider, homecare, hospice and do training with them to give them information about our constituents. What kind of trainings do you do? So we call it cultural competency training. And it starts with just the basics on what it means to be LGBT, the differences between sexual orientation and gender identity, for example. But then we go into deeper topics as well, such as the unique needs of LGBT people with dementia, for instance, or the unique needs of transgender older adults in congregate living settings. We've created trainings that kind of run the gamut from introductory to pretty complex topics.

Dr. Regina Koepp 5:50
What are some of the common responses you get to your training?

Dr. Tim Johnston 5:54
A lot of people are really excited about it. The most common response I get when I tell people what I do isI never thought about LGBT people getting older. So there's a lot of kind of basic consciousness raising work. And once people learn about the unique needs of the community, they're very hungry for information on how they can work with these folks. There are others who are more resistant. We think that the training is political in nature, which it really isn't. It's about developing professional skills, but I have done trainings where I was less warmly received, put it that way. But those are often the groups that you really want to be working with to help show them why paying attention to our constituents is such an important part of their job.

Dr. Regina Koepp 6:39
Yes, and at risk and courage. I'm sure it takes a lot of courage on your part and bravery to stand and educate when people are resistant and not necessarily warm and welcoming.

Dr. Tim Johnston 6:54
Yeah, you know, I usually just kind of close my eyes and dive right in.

Dr. Regina Koepp 6:58
You're courageous. That's admirable. Back to the political point that I am I did a workshop on sexuality and aging, especially in the context of capacity to consent in the context of dementia disorders. And part of the training included education about LGBTQ older adults. And in the surveys, somebody responded in the in the surveys, like evaluating my workshop on it didn't need to be political. And I was thinking, like, was I political? And I was like, racking my brain. And then I thought, Oh, you're equating the first one was equating my educating about LGBTQ older adult means with politics. And I was like, well, that That's bizarre because I don't even see the two as can. I mean, it took me a while to figure it out.

Dr. Tim Johnston 7:52
Yeah, I think, you know, some people do think that it's a very politicized topic. And for those folks, it's really good to help them understand being LGBT and being open is about much more than politics. And it's about much more than just sexual expression. It's about our our histories, our communities, our support networks, because another common response that I get is why do I need to think about what our residents do in the bedroom? Like, well, you know, for a lot of reasons, you should think about that anyway, in terms of supporting their sexual expression and health. But, you know, conflating LGBT identity to just sex acts or politics is a pretty common form of pushback that we see but also something we help people to move past.

Dr. Regina Koepp 8:32
So you've shared a bit about what you do with education. Can you share more about what SAGE does as an organization?

Dr. Tim Johnston 8:39
Yep, absolutely. So as I mentioned before, we're headquartered in New York City where we have a number of LGBT senior centers. So these are senior centers that are open to anyone so allies are welcome to come as well. An ally being somebody who themselves is not LGBT but supports the community. But they have a kind of an LGBT spin. So the best example I can give is that we do have bingo, but it's run by a drag queen.

So out of the senior center is that's where we do a lot of our direct service work and where we serve meals to folks. On the national scale. We have an affiliate network where we partner with local organizations to help them do programming and community outreach. We partner with other nonprofits like the Alzheimer's Association to help augment their LGBT cultural competency so that they can then help our constituents who are living with dementia. And we also do federal and state policy work advocating for non discrimination legislation and also making sure that LGBT older people are designated as a group of highest social need so that they get some extra resources and attention from state agencies.

Dr. Regina Koepp 9:49
Excellent. I also was reading over the past year that SAGE is doing advocacy with living communities in terms of promoting inclusive spaces for LGBTQ folks in senior living communities,

Dr. Tim Johnston 10:03
Right, so part of that is the training work that I do so that there's no wrong door to walk through if you're an LGBT person looking for housing, but we are also supportive of groups who are trying to build new housing that is specifically geared toward LGBT folks. That might be market rate housing, it might be affordable housing, but we really approach our housing work through both lenses because there's such a demand for safe housing

Dr. Regina Koepp 10:28
And a lot of discrimination.

Dr. Tim Johnston 10:30
Mm hmm. Precisely.

Dr. Regina Koepp 10:33
Can you share a little bit about some of the unique concerns and needs of LGBTQ folks as they grow older?

Dr. Tim Johnston 10:40
Absolutely. So if you think about it, these are folks who spent many years of their life in a cultural and political context that was very hostile to LGBT people and staying in the closet or remaining private about their identity was often a matter of survival. Certainly, it was important if you wanted to keep your job or be able to see your family. So these are folks who have a lot of fear and a lot of trauma, especially at the hands of the government, medical institutions, that kind of larger sectors of our society. So these are folks who are more likely to be suspicious of care providers and kind of approach them with what I think of as a trust deficit. Providers really need to show them that they're going to be treated with respect, because the LGBT person might fear discrimination. And they also experience discrimination and harassment at higher levels than non LGBT older people. So it's both a fear rooted in their experience, and a fear that's really rooted in reality. A couple other things I'll note is that, due to employment discrimination, and lack of marriage equality for many years, a lot of LGBT folks are more likely to be impoverished or have less wealth. That's particularly true for trans older adults and for LGTB older adults of color. So there's some additional challenges in terms of accessing services, especially those that are private pay, and not supported or subsidized in some way.

Dr. Regina Koepp 12:13
Yeah, I was reading a statistic that 20% of LGB. Older adults don't reveal their sexual orientation to their primary care provider for fear of discrimination. And 44% of trans older adults don't reveal their identity for fear of discrimination to their provider, their primary care provider.

Dr. Tim Johnston 12:35
Yeah, providers really need to go out of their way to send a mesSAGE that they're an affirming space and that LGBT folks are welcome. Because all LGBT people, not just LGBT older people are kind of looking for signals and signs and often will be testing you out and testing the waters before they figure out if they can come out to safely.

Dr. Regina Koepp 12:55
Mm hmm. So what can providers do to indicate that their space is affirming of older LGBTQ folks?

Dr. Tim Johnston 13:07
Yeah, there's a couple of suggestions. The first and most important thing is making sure that you and your staff are trained, and that you have the information that you need to be sure that you can treat people with respect when they come through your doors. Once there's that training, you could do things like rainbow stickers, or some kind of rainbow sign to show that it's a welcoming place. We recommend including optional places where people can disclose their gender identity and sexual orientation on intake forms are kind of when they're first accessing your services. So that would also include options beyond just male and female, for people to respond. that sends a mesSAGE that you care about keeping track of the LGBT members of your community and want to be sure that you can know how many folks that you're serving.

And then I think there are things folks can do in terms of proactive outreach depending on the kinds of service you have. So diversifying the types of people on your website or brochures, and making it really clear in any language that you have about non discrimination or diversity that that includes LGBT people. Well, those are great tips. That's excellent. I was also reading a bit about this this past November was at the gerontological Society of America conference, and I attended a session on Advanced Directives for older LGBTQ folks and the need for providers to initiate discussions around advanced directives. Do you all do any work with that? Yeah, we mostly do that work will occasionally do clinics at our centers. A lot of the advocacy that we do around Advanced Directives is educating care providers. Because a lot of times someone doesn't realize who their legal next of kin is, and they might have a fractured or contentious relationship with that person if that next of kin doesn't accept their identity, and we've seen instances where the family comes in and ISIS out the partner kicks them out of the house makes decisions on behalf of the older adult that are inappropriate. So having those conversations early, in particular, if there's the possibility of a dementia diagnosis is really crucial.

Dr. Regina Koepp 15:21
Yeah, I'm so curious in a minute to talk about dementia. I will say for older transgender individuals who I work with, I'll ask if (and I work in a mental health context)... so I'll ask if we need to contact their emergency contact, which gender they want us to use. Sometimes they're the persons not out to their family or their children. There was one situation I had with an older trans individual where she was not out to her children was out to us, and she needed a higher level of mental healthcare, then we could provide an outpatient context and so we had to call her family to assist her she was close with. We were in this bind, because we hadn't asked her what she wanted. And and then we were worried that we would hurt her by disclosing her identity when she wasn't ready for that, or the relationship was not ready for that or for whatever reasons. And so we learned a valuable lesson that we needed to ask if, if this person is your next of kin, or you want us to contact this, your durable power of health attorney or your emergency contact? What is okay for us to use in terms of gender identity (in this case)?

Dr. Tim Johnston 16:33
Yeah, I think you know, one thing that I'll tell people, especially people who are not LGBT is to remember how stressful it can be to come out. So if somebody does come out to you, I think that usually a very appropriate and affirming reaction is to thank them, recognize that it was probably stressful, and then don't leave that conversation without saying, Is this something that you've only shared with me or do other people know? How do you want me to help you navigate disclosure here? Because for exactly that reason you need to know the kind of limits of how you can protect this information that you've had someone share with you.

Dr. Regina Koepp 17:10
Yes, I think that goes back to the history of trauma and discrimination and unsafe spaces. So helpful. You had mentioned to me in a previous conversation, terms that generations use that might be terms that were once used but might be different now or vice versa. Will you talk a little bit about multi generational terms?

Dr. Tim Johnston 17:35
Yeah, absolutely. And listeners who are paying close attention might hear that you're saying LGBTQ, and I'm saying LGBT so I can explain why that's the case. So when we talk about the "Q" that usually stands for two different words that can stand for Questioning, which is a word to create a space for somebody who's not sure if they're LGBT, but they are kind of feeling it out. But it also usually stands for Queer. And this is one of those terms that definitely has generational differences to it. Because for a lot of older folks, the word queer has very traumatic associations and hearing it can trigger those negative memories. But it's what we think of as a reclaimed term, meaning that folks have taken it from a negative and turned it into a positive term. So it's not exactly generational. I know plenty of older people who use the word queer and I know plenty of younger people who don't like it. But it's a term that we recommend providers tread lightly with and use with caution unless they know for certain that the person that they're working with finds that term to be affirming and safe.

Another term that I think has kind of a generational difference is transsexual, rather than transgender so I tend to associate the word transsexual, more with the medical aspects of transitioning rather than the broader term of transgender which describes a difference between your sex assigned at birth and your gender identity. But again, when you're working with folks, and you hear them use the term, the kind of simple best practice is to say, Hey, I heard you use the term transsexual to describe yourself. Can you tell me more about what that means to you? And is that a word that you would feel comfortable with me using? Or is that a word that only you use? You know, fill it out to get a little bit more information?

Dr. Regina Koepp 19:25
That phrasing is great, too. That's very helpful. I, as you were talking about my use of "Q" that it's so helpful because I was trained, being an ally for LGBTQ folks using Q and then and not with older adults. And then it was after that, like my early training that I worked with older adults, and I just carried it over. But that's so helpful. Thank you, I'm, I'll be more thoughtful about how I use it with my older individuals.

Dr. Tim Johnston 19:54
Well, and I should say to that, I don't think you're doing anything wrong, and I didn't mean to imply that and I think I'm finding increasingly that even with older adults, nobody really cares if you just say "Q" like LGBTQ that's not really triggering the differences between saying LGBTQ and like, come to this queer events or look at that queer person, it's usually hearing it said in a phrase that's more alarming. So it's age, it's pretty much 5050 of people say LGBT or LGBTQ, especially because a lot of our staff identify as queer. So they want to be able to still see that and have it be present in these conversations. So all that is to say, there's no right way to do this. It's just differences and how people approach it.

Dr. Regina Koepp 20:40
Will you review what all of the letters stand for?

Dr. Tim Johnston 20:44
Yeah, absolutely. So gay is a term that describes men who are attracted to other men. It can also be an umbrella term for same sex attraction. So a woman might also use the term Gay to describe her sexual orientation. Lebian describes a woman who is attracted to other women. The term Bisexual describes people who are attracted to multiple genders, or both men and women. So one way that I've heard it described that I like quite a bit is that it's the capacity or potential to be attracted to people of multiple genders. Because a lot of bisexual folks do tend to date more men or more women, but they retain that attraction in a more global way.The one thing to note about bisexual folks is there are twice as many bisexual folks as there are gay and lesbian folks, it's far and away the largest subgroup in the LGBT community. But a lot of times people just make assumptions based on someone's partner. So they look at you and they say, Oh, you know, that's a gay couple, or that's a straight couple and they don't think that somebody in that dyad might identify as BI.

So those terms, describe attraction or sexual orientation. The term transgender describes someone whose gender identity or that deeply felt sense of being masculine, feminine, or a different gender identity is different from the sex they were assigned at birth. So how they were treated as a child and into their early adolescence. So when we're talking about transgender women, those are folks who were assigned male at birth and who probably were raised as boys and then men, but who are and identify as women. And likewise, transgender man describes someone who was assigned female at birth, but who is and identifies as a man.

Dr. Regina Koepp 22:40
Thank you. And cisgender is a term that we are using more and more. Yep. Will you talk about that?

Dr. Tim Johnston 22:48
Definitely. So this might be a term that's newer for folks. cisgender describes someone whose gender identity does match up with the sex they were assigned at birth. So I'll use myself as an example, when I was born, the doctor said, it's a boy, put an M on my birth certificate. And I've always felt comfortable living as a boy. And now as a man, there's never been any discomfort there. So I could use the term cisgender to describe my gender identity. And the reason I like using this term is because it's kind of like a way of saying not transgender, but it helps us remember that everybody has a gender identity, even if it's not something that you've really thought about, in your own experience.

Dr. Regina Koepp 23:34
Yeah, and cis means same.

Dr. Tim Johnston 23:37

Dr. Regina Koepp 23:37
Is that your understanding of this?

Dr. Tim Johnston 23:39
Yep. So trans means to crossover. So we can think of it as crossing into a different gender. Cis means to stay on the same side as, so that's a handy way to kind of remember the difference.

Dr. Regina Koepp 23:51
Thank you. Yes. And it's spelled C-I-S. Yep. So you've mentioned a couple of times the unique needs of older LGBTQ folks and dementia. Can you talk a little bit about that?

Dr. Tim Johnston 24:04
Yeah, absolutely. And a lot of this is anecdotal. But there is some research that's starting to come out. There was a study published last year, looking at some aggregated data that found LGBT people were more likely to experience memory loss. And we think that that's due to some of the health disparities that we see within the community. But some of the things that I'm concerned about in a residential care context is making sure that LGBT folks or people who are expressing same sex sexual desires are given the same rights and have the same advocates on their side as non LGBT folks. So for example, it might be the case that maybe somebody living with dementia who has been in heterosexual relationships, their whole life suddenly becomes physically affectionate with someone of the same sex and this could be very surprising to the family. And what I don't want to see as care providers assuming that that's predatory, or that that's just the disease, when in fact, it could be the expression of something that the dementia is now kind of creating some space for as those inhibitions fall away.

In terms of transgender folks, we want to make sure that they're given the ability to choose how they express their gender, so that staff are working with them to be dressing them and grooming them in the way that feels most affirming, even if that's different than what folks had expected based on their previous history. And the last thing that I'll know, but I could talk about this forever, is that sometimes folks might not remember if they've come out, or they might be confused as to what decade it is. So they might be thinking they're back in the 60s. So it's not safe to be out they can't disclose and their stress level could be really heightened. Or they might be in a context where they're noticing changes to their memory, but they don't feel like they can be out. And they're afraid that as the disease progresses, they'll lose the ability to stay in the closet. So we do a lot of work with providers to help the staff create, almost like physical environments that have a lot of symbols and signs of safety so that somebody can, if they're unsure if they've come out or if it's safe, they can be reassured by those reminders in their environment.

Dr. Regina Koepp 26:28
Well, that's beautiful, the creating a context that feels safe and affirming and reassuring. There is a lot of research on health disparities and dementia, what we know about high rates of post traumatic stress disorder. When people have chronic Post Traumatic Stress Disorder, they're at an increased risk of developing a dementia disorder. We know that people who have history of disenfranchisement and assault and hostility like LGBTQ folks like African American individuals have higher rates of dementia disorders as a result of the disparities that you're talking about with access to health care, and also high rates of trauma.

Dr. Tim Johnston 27:07
Yeah, I think that's right. And that's where that kind of intersectional approach is so important, because if you're, let's say, an older black lesbian woman, you not only have the kind of distrust and trauma that you've built up as a lesbian person, but also as a person of color, and the kind of institutional racism that makes you doubly reluctant to access institutionalized care, for example, or, as you noted, doubly in jeopardy are more at risk of developing some of these disorders.

Dr. Regina Koepp 27:39
Yeah. And so for an older, black lesbian woman, she might have quadruple jeopardy. She's older. Yeah. Older is a Jeopardy African American as a jeopardy. LGBTQ identities puts a person in jeopardy and woman right if she even if she identifies as a cisgender woman. You know, that relatively has less power. But so it it's all of these Jeopardy sort of added up. Yeah. And then, and then there's the other side of this coin, which is high rates of resilience. Can you speak a little bit about that?

Dr. Tim Johnston 28:20
Absolutely. I mean, one of the things that I say is that if you're working with an LGBT older person, they've made it to being an older person, which means that they've developed a lot of a lot of resiliency. You know, one of the ways that we see this happening most clearly is in the creation of what we call families of choice, or mutual aid, kind of support networks. So a lot of LGBT folks might not have very good relationships with their biological or their legal family members, but they create these chosen families. My favorite example of this as the Golden Girls, the 80s sitcom, they weren't LGBT but that was pretty much it. Chosen family in terms of how it was structured. So there's a lot of resilience there. And when I hear interviews with LGBT older people or when I'm speaking with them, and they're kind of reflecting on, you know how that is where they got to where they are today. There's very often a strong undercurrent of activism and advocacy, and kind of coming together as a community both to support one another, but also to change things. And I've noticed that with a lot of our older adults, there's a strong commitment to social justice and that advocacy mentality, which I think makes them more resilient as they age and it makes the community more resilient as we all kind of age together.

Dr. Regina Koepp 29:50
Yeah, that's great and that there is the community there is so much resilience and advocacy that a community and even SAGE was formed. How was SAGE formed I don't know, the history?

Dr. Tim Johnston 30:02
SAGE was formed by a group of activists who realized they were getting older and that there was no one out there to support them. So they needed to develop that kind of mutual aid. And from there, it's really grown from just providing for the direct needs of folks in New York City to this national advocacy group.

Dr. Regina Koepp 30:20
Can you share a little bit about how COVID has been impacting older LGBTQ folks?

Dr. Tim Johnston 30:26
Definitely. This is something very troubling. So as we know, there are risk factors that makes somebody more vulnerable to the virus or to increase mortality rates. So a lot of our folks are living with hypertension, diabetes, a lot of our folks are living with HIV so they're immunocompromised. So there's a lot to be scared of just in terms of protecting their physical health. And in terms of mental health, LGBT older people are already more likely to be isolated, to be living alone, to have smaller support networks, and we're concerned that the quarantine is exacerbating that isolation. So, we've been able to do a lot of online programming and keep our groups moving and running. We started a new program called SAGEConnect, which is a volunteer program where we'll match a volunteer with an LGBT older person to do friendly check-in calls.

But another big concern that kind of ties into what we were talking about before is that some of these folks might really not trust hospitals or the medical establishment and not want to reach out for help or are afraid that they'll be discriminated against once they get into this context. So that makes it even more difficult for somebody to be supported if they're concerned about leaving their house for all of those reasons.

Dr. Regina Koepp 31:52
Yeah, and so they might not access medical care when they need it for fear of discrimination or mistreatment.

Dr. Tim Johnston 31:58
Correct. And a lot of our folks are saying that this really reminds them of the HIV AIDS epidemic.This it's obviously very different because this is impacting a lot of people very quickly, whereas that disease because it was kind of located in the gay community didn't get attention at first and was kind of sidelined in a way that was very traumatic for folks.So on the one hand, some people are saying, like, we've gotten through this before we'll get through it. Again, they're really drawing on that experience as a strength. But for a lot of folks that is bringing up those difficult memories and complicating the forms of grief that they're experiencing now.

Dr. Regina Koepp 32:41
Tim, will you share some recommendations about how older LGBTQ folks can enhance their own health and wellness as they age?

Dr. Tim Johnston 32:51
Yeah, absolutely. So I think one thing to think about would be if they are in an identity category, that's at a higher risk for particular disease. So hypertension and diabetes are two that we've mentioned, to be aware of the fact that you might be more likely to be impacted by that. And then to think about what kind of preventative care, you can seek out. I would say for folks who are concerned about reaching out for care and reaching out for help, because they're not sure how they'll be treated, you could look for providers that SAGE has trained, it's totally appropriate in initial conversations with the provider to ask if they have LGBT clients, if they say no, that's a pretty strong sign that they do, but they're staying in the closet. You could ask about non discrimination policies. Those are all very powerful ways to get a sense for a provider. And I think too, you can take someone with you to your appointments and make sure that you have an advocate for you. If there's not someone that you immediately can think of a local LGBT Center might have a volunteer program or somebody could help you in that way. But I think the best things that folks can do are get the care that they need, especially preventative care. And then try to build and strengthen your social bonds so that you are feeling connected to community and feeling connected, not just to the LGBT community, but also folks more broadly.

Dr. Regina Koepp 34:20
At the time of this recording or airing, I'll have done a podcast on suicide risk for older adults. And one of the primary factors for suicide risk is social disconnection. So the more we can help people get socially connected, the better so your SAGEConnect program just warms my heart and I'm and hopefully I can put a link can I put a link in my show notes to the SAGEConnect program?

Dr. Tim Johnston 34:47
Yeah, absolutely.

Dr. Regina Koepp 34:47
Is it still active and going okay. Oh, excellent. Because I also know that you have a hotline, a SAGE hotline, is that different than SAGEConnect?

Dr. Tim Johnston 34:55
It is different. Yeah. So the hotline is more for folks. You can use it for social means if you're just wanting someone to chat to, but it's a little bit more like a resource locator or a two on one type numbers. So that would be a hotline. If you're saying, you know, I want to know that the person I'm going to speak to I can be open with and I need help accessing homecare or home delivered meals, that kind of thing. So it's a little bit more of an information and referral source.

Dr. Regina Koepp 35:26
Okay. That's helpful distinction. Okay. So SAGEConnect is the social connection platform. And the hotline is a resource line.

Dr. Tim Johnston 35:33

Dr. Regina Koepp 35:34
Okay. Great. Thank you. I needed that.

Dr. Tim Johnston 35:37
You know, one last thing that you were when you were asking about what LGBT older people can do for their own health. I talked a lot about the physical side of things, but I think also really encouraging folks to reach out as it relates to their mental health as well. I think a lot of us grow up thinking that our LGBT identity is a sickness, something that's wrong with us and that makes it very scary. To reach out to a mental health provider because you might be afraid that you're just going to get put through the wringer or they're going to try to change you in some fundamental way. But I think it's incredibly important for folks to have that space to process what's happening to them, especially in such turbulent times. And I know there are a lot of providers that are doing, you know, short 15 week, tele health work, that's mental health focused. If I were in the world, everyone would have access to 60 minutes of psychotherapy every week, but just really encourage folks to reach out for that behavioral health if that's something that we find helpful as well.

Yeah, and I can imagine it's especially scary because of the history of ECT for folks like Lou Reed, I think his family forced him to have a ECT right for conversion and then conversion therapy and all of the history of and just the diagnostic manual, right and the pathologizing sexual identity when when, of course, there's nothing wrong with sexual identity. But the diagnostic manual that psychiatrists and psychologists and mental health providers use historically had misinformation in there about LGBTQ folks. And we've been correcting and repairing that and we need to, we need to continue to correct and repair. I'll also say there are lots of LGBTQ identified mental health providers. So even if it feels unsafe still to work with somebody like me, who's an ally, there are also plenty of LGBTQ providers. And... I'm sure what I think I'll try to do too, is find the APA, which is the American Psychological Association division for LGBTQ folks, and then have a link there. So if you are looking for an LGBTQ provider, they might be able to help you find one.

Yeah, this is an interesting kind of effective pandemic as well which is that every. Everybody's rushing to get everything online as quickly as they can, which means that we're rapidly creating an infrastructure and a regulatory environment where telehealth is easier than ever to access. So for an isolated person with mobility concerns, or if you're just scared about reaching out for help, you know doing so from your own home, or if you want to, you could just hang up. Yeah, it's very different than going into the clinic and sitting face to face, which might be more intimidating.

Dr. Regina Koepp 38:28
Yeah, you can wade in you can see what it's like. I love that you added the mental health component, I think it's so important. I'll also say there's a term that we use in psychotherapy called corrective emotional experience. And this is where we use the therapy relationship to correct the wounds and to help heal the wounds of relationships that did not go well. And so I'm imagining for older LGBTQ folks who've had a lot of discrimination and alienation from people who look like me, right, who don't identify as LGBTQ. That to have a therapeutic process with me to correct that. Like where we build a trusting relationship and we engage in a healing process together is very restorative for folks when they're ready for that. And it has to be with the right provider and the right relationship.

Dr. Tim Johnston 39:24
My own experience in therapy would kind of mirror that we're like, I've had queer identified practitioners and there's a lot of good work you can do with them there. But there's also something about somebody who it's just so easy to project your feelings about your mom onto can be very healing in that way.

Dr. Regina Koepp 39:43
Yeah, I know for me and my own therapy as well. I had a I had a woman of female therapist who reminded me of my mom who was old enough to be my mom and I and I explicitly chose her so I could work on my my mom wounds.

Tim High Five... hug... Corona hug, which is from afar for adding in the mental health component, of course. You've shared a little bit about what health professionals can do, which is great, I will make sure that I am doing those things. What can allies and friends and family do to promote the health and wellness of older LGBTQ folks?

Dr. Tim Johnston 40:20
Yeah, that's a great question. I think one thing is just to talk about it, so that it's becomes a topic that people don't feel stigma around. So that could mean, you know, talking about this podcast that you're listening to right now, you, dear listener, see what kind of conversations that sparks up. I think asking your employers what policies are as it's related to LGBT people in the organization can be helpful. So that there's advocacy happening there, and it's not all on the shoulders of your LGBT co workers to be doing that. And then I think if folks want to become involved. Kind of locally, there are opportunities through LGBT centers, maybe there's a SAGE affiliate near you, if you wanted to volunteer. That's a way that you could support us. And there are SAGE's advocacy campaigns, where we look for regional and also national support for some of the policy goals that we have as an organization. And that's another place where we can always use as many voices as we can get.

Dr. Regina Koepp 41:27
Great, well, I'll be sure to participate in those advocacy campaigns.

Dr. Tim Johnston 41:30

Dr. Regina Koepp 41:31
Well, Tim, thank you so much for coming on the show and talking about, educating us about LGBTQ older adults, and what we can do what I can do as an ally, what friends and family can do, what other allied professionals can do, and more importantly, what older LGBTQ folks can do to age well, and live a life that's connected and meaningful during this chapter in their lives. So thank you. Thank you. Thank you for coming on during pride, to educate all of us about the great work that SAGE is doing. I really appreciate it.

Dr. Tim Johnston 42:08
You're very welcome. Thank you for having me.

Dr. Regina Koepp
If you have not yet seen the new my new website, I really encourage you to check it out. There are tons of great resources and information there for you. I have a great new guide called the memory loss and mental health guide. In that guide, I share signs and symptoms of dementia, I share signs and symptoms of depression and mental health concerns and what to do if you're concerned about your older loved one. If you're noticing signs of memory loss or mental health concerns, download that free guide as well. I'll link to that in the show notes too.

Oh, and if you haven't yet subscribed to this podcast, please please please subscribe. It really helps other people to find this show. I really want people to feel less alone in their caregiving journey. I want older adults to feel less alone in their mental health journey in their dementia journey if they have that. So please subscribe and leave a review. It really does help. Alright, I'll see you next week. Same time, same place. Bye for now.

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