Healthcare Needs and Protective Factors of Transgender and Gender Nonconforming Older Adults: A Systematic Integrative Review

Abstract

Transgender and gender nonconforming (TGNC) older adults encounter discrimination in healthcare settings and experience health disparities and lack of access to healthcare. However, given these disparities, TGNC elders have protective factors like resilience that may mitigate healthcare challenges. A systematic integrative review was conducted to synthesize and analyze recent studies addressing the needs and protective factors of TGNC older adults living in the US. Methods included a systematic literature search of PubMed, CINAHL, Web of Science, PsychINFO, and Google Scholar and a thematic analysis of selected studies. Twenty-nine articles met inclusion criteria. Seven themes were identified, including: (1) Inclusivity and acceptance, (2) Antidiscrimination protections, (3) Community, (4) Care of mind, body, and spirit, (5) End of life preparations, (6) Financial security, and (7) Intersectionality of race/ethnicity and gender identity. Within each theme, several healthcare challenges and protective factors were identified, indicating that while TGNC older adults face numerous barriers and disparities, including discrimination in healthcare settings, they also rely on strengths like resilience to face the challenges. These findings highlight the need for increased training for healthcare providers to provide safe, gender-inclusive care environments; the need for policy to combat discrimination across all healthcare settings; the need for supportive community resources and healthcare advocacy; the need for empowerment of TGNC older adults to cultivate their healthcare strengths; and the need for more research to discern the role of intersectionality in the applicability of the identified themes to TGNC older adults generally.