Department of Psychiatry, Yale University, New Haven, CT.
Department of Medicine, Division of General Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Mental Health Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
Am J Geriatr Psychiatry. 2018 Jul;26(7):719-738. doi: 10.1016/j.jagp.2018.01.208. Epub 2018 Feb 7.
With the overarching goals of improving the healthcare of older transgender individuals and of inspiring pertinent clinical research, a session at the 2017 American Association for Geriatric Psychiatry Annual Meeting focused on an interdisciplinary approach to transgender aging. The older the transgender adult, the more likely the individual grew up in a historical context when there was greater social stigma towards their gender identity, even among mental health professionals. In order to provide optimal healthcare to transgender adults, mental health care providers should become familiar with the basic terminology presented in this article. Transgender older adults face greater risks of poor physical health, disability, anxiety and depressive symptoms, victimization, and stigma, and higher rates of smoking, excessive alcohol use, and risky sexual behavior compared with non-transgender older adults. In spite of notable health disparities, some evidence points to resilience among transgender older adults. The mental health professional often serves as the first contact for a patient who is struggling with gender identity. The role of a mental health professional can be divided into five categories: 1) assessment of gender dysphoria; 2) psychoeducation of patients and family members about the diversity of gender identities and various options for alleviating gender dysphoria; 3) referral to and collaboration with other healthcare professionals; 4) treatment of coexisting mental health concerns; 5) advocating for transgender patients and for the transgender community. Recently, the criteria for medical and surgical transition have been simplified. End-of-life preparations are especially important for transgender individuals.
本次 2017 年美国老年精神病学协会年会的一个会议聚焦于跨性别者老龄化的跨学科方法，其总目标是改善老年跨性别者的医疗保健，并激发相关临床研究。跨性别成年人年龄越大，他们在成长过程中所处的历史时期就越有可能对他们的性别认同存在更大的社会污名，即使在心理健康专业人员中也是如此。为了向跨性别成年人提供最佳的医疗保健，心理健康护理提供者应该熟悉本文介绍的基本术语。与非跨性别成年人相比，老年跨性别者面临着更大的身体健康不良、残疾、焦虑和抑郁症状、受害和污名、更高的吸烟率、过度饮酒和危险性行为的风险。尽管存在显著的健康差异，但一些证据表明，老年跨性别者具有韧性。心理健康专业人员通常是与性别认同挣扎的患者的第一联系人。心理健康专业人员的角色可以分为五类：1）评估性别焦虑；2）向患者和家属提供关于性别认同多样性和缓解性别焦虑的各种选择的心理教育；3）转介给其他医疗保健专业人员并与他们合作；4）治疗并存的心理健康问题；5）为跨性别患者和跨性别群体辩护。最近，医学和手术过渡的标准已经简化。临终准备对跨性别者尤为重要。
