Skip to main content
SpringerLink
Log in

Marginalized Geriatric Patients

  • Chapter
  • First Online:
Geriatric Psychiatry

  • 2423 Accesses

Abstract

Marginalized older adults represent a diverse spectrum of individuals coming from different social groups, including those who are racialized, those who identify as LGBTQ (lesbian, gay, bisexual, transgender, and/or queer), those who have a physical and/or developmental disability, those who are immigrants or refugees, those who are homeless, and/or those who come from low socioeconomic status backgrounds. Marginalized geriatric patients are a heterogeneous group with unique physical and mental health issues that require recognition in order to optimize psychiatric assessment and treatment. Recognizing the impact of social determinants of health in geriatric patients who are marginalized is an important capacity for all healthcare practitioners to possess; recognizing the complexity that older marginalized patients bring to assessment and treatment is fundamental to providing appropriate, patient-centered, and anti-oppressive care to these individuals. A comprehensive assessment is an important step in the process of mitigating the effects of healthcare disparities for traditionally underserved populations. This chapter will focus on the concept of anti-oppressive practice as well as the importance of addressing the issue of culture as part of psychiatric assessment and treatment in older adults. Given that it would be impossible to include all potentially marginalized groups within this chapter, we will focus on several traditionally underserved groups, including LGBTQ-identified people, people who are racialized, people who are homeless, and people who have an intellectual or developmental disability.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Veltman A, La Rose T. Anti-oppressive approach to assessment. In: Hategan A, Bourgeois JA, Seritan AL, Hirsch C, editors. On-call geriatric psychiatry—a handbook of principles and practice. New York: Springer; 2016. p. 55–62.

    Google Scholar 

  2. Shragge E. Activism and social change: lessons for community organizing. Toronto: University of Toronto Press; 2013.

    Google Scholar 

  3. Reicher S, Spears RS, Haslam A. The social identity approach in social psychology. In: Wetherell MS, Mohanty CT, editors. Sage handbook of identities. London: Sage; 2010. p. 45–62.

    Chapter  Google Scholar 

  4. Training for change—An integrated anti-oppression framework: a tool for trainers and community service organizations. Rainbow Health Network. 2009. http://www.oaith.ca/ assets/files/Publications/intersectionality/FrameworkARAO-Training.pdf. Accessed 15 Mar 2017.

  5. Mullaly R. Challenging oppression: a critical social work approach. Oxford: Oxford University Press; 2002.

    Google Scholar 

  6. Baines D. Doing anti-oppressive practice: social justice social work. 2nd ed. Halifax: Fernwood; 2011.

    Google Scholar 

  7. Knott C, Scragg T. Reflective practice in social work. 3rd ed. Washington: Sage; 2015.

    Google Scholar 

  8. Larson G. Anti-oppressive practice in mental health. J Prog Hum Ser. 2008;19(1):39–54.

    Google Scholar 

  9. Clemens K. Anti-oppression toolkit. National Campus and Community Radio Association. 2013. http://www.ncra.ca/equity/ncra-anti-oppression-toolkit.pdf. Accessed 15 Mar 2017.

  10. Fook J. Social work: critical theory and practice. 2nd ed. Thousand Oaks: Sage Publications; 2012.

    Google Scholar 

  11. Kinney M. Being assessed under the 1983 mental health act—can it ever be ethical? Ethics Soc Welfare. 2009;3(2):329–36.

    Article  Google Scholar 

  12. Baines D. Doing anti-oppressive practice: building transformative politicized social work. Halifax: Fernwood; 2007.

    Google Scholar 

  13. Healy K. Social work methods and skills: the essential foundations of practice. New York: Palgrave MacMillan; 2012.

    Book  Google Scholar 

  14. Heinonen T, Spearman L. Social work practice: problem solving and beyond. Toronto: Nelson Education; 2010.

    Google Scholar 

  15. La Rose T. Digital media stories through the lens of multimodal analysis: a case study of Erahoneybee’s song about a child welfare agency. J Technol Hum Serv. 2012;30(3/4):299–311.

    Article  Google Scholar 

  16. Abramson TA, Trejo L, Lai DWL. Culture and mental health: providing appropriate services for a diverse older population. Generations. 2002;26(1):21–7.

    Google Scholar 

  17. Ivey AE, Ivey MB, D’Andrea M. Theories of counseling and psychotherapy: a multicultural perspective. Boston: Allyn and Bacon; 2002.

    Google Scholar 

  18. Centers for Disease Control and Prevention. Rationale for regular reporting on health disparities and inequalities—United States. Morb Mortal Wkly Rep. 2011;60(Suppl):3–10.

    Google Scholar 

  19. Fredriksen-Goldsen KI, Muraco A. Aging and sexual orientation: a 25-year review of the literature. Res Aging. 2010;32:372–413.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chandavarkar RV, Khan MS. Older lesbian, gay, bisexual and transgender persons in the UK: reviewing issues and concerns. J Ger Care Res. 2015;2(1):9–11.

    Google Scholar 

  21. Bauer GR, Pyne J, Francino MC, Hammond R. Suicidality among trans people in Ontario: implications for social work and social justice. Serv Soc. 2013;59(1):35–62.

    Article  Google Scholar 

  22. Fredriksen-Goldsen KI, Kim H-J, Emlet CA, Muraco A, Erosheva EA, Hoy-Ellis CP, et al. The aging and health report: disparities and resilience among lesbian, gay, bisexual and transgender older adults. Seattle: Institute for Multigenerational Health; 2011.

    Google Scholar 

  23. Muraco A, Fredriksen-Goldsen KI. “That’s what friends do”: informal caregiving for chronically ill midlife and older lesbian, gay, and bisexual adults. J Soc Pers Relat. 2011;28:1073–92.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Butler SS. Gay, lesbian, bisexual and transgender (GLBT) elders: the challenges of this marginalized group. J Hum Behav Soc Environ. 2006;94:25–44.

    Google Scholar 

  25. Brotman S, Ryan B, Cormier R. The health and social service needs of gay and lesbian elders and their families in Canada. Gerontologist. 2003;43(2):192–202.

    Article  PubMed  Google Scholar 

  26. Price E. All but invisible: older gay men and lesbians. Nurs Older People. 2005;17:16–8.

    Article  PubMed  Google Scholar 

  27. Blando JA. Twice hidden: older gay and lesbian couples, friends and intimacy. Generations. 2001;25:87–9.

    Google Scholar 

  28. Risdon C. Lesbian and bisexual women—challenging our heterosexist assumptions. Can Fam Phys. 1998;44:1567–8.

    CAS  Google Scholar 

  29. Addis S, Davies M, Greene G, Macbride-Steward 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):647–58.

    Article  PubMed  Google Scholar 

  30. Veltman A, Chaimowitz G. Canadian Psychiatric Association Position Paper: Mental Healthcare for Individuals who Identify as Lesbian, Gay, Bisexual and Transgender and/or Queer (LGBTQ). Can J Psychiatry. 2014;59(11):1–8.

    Google Scholar 

  31. Gates GJ. How many people are lesbian, gay, bisexual and transgender? Los Angeles: The Williams Institute; 2011.

    Google Scholar 

  32. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, healthcare use, and mental health status of transgender persons: implications for public health intervention. Am J Public Health. 2001;91(6):915–21.

    Google Scholar 

  33. Fredriksen-Goldsen KI, Cook-Daniels L, Kim H-J, Erosheva EA, Emlet CA, Hoy-Ellis CP, et al. Physical and mental health of transgender older adults: an at-risk and underserved population. Gerontologist. 2014;54(3):488–500.

    Article  PubMed  Google Scholar 

  34. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington, DC: National Centre of Transgender Equality and National Gay and Lesbian Task Force; 2011.

    Google Scholar 

  35. Bradford J, Reisner SL, Honnold JA, Xavier J. Experiences of transgender-related discrimination and implications for health: results from the Virginia Transgender Health Initiative Study. Am J Public Health. 2013;103(10):1820–9.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Stewart M, Shizha E, Makwarimba E, Spitzer D, Khalema EN, Nsaliwa CD. Challenges and barriers to services for immigrant seniors in Canada: “you are among others but you feel alone”. Int J Migration Health Soc Care. 2011;7(1):16–32.

    Article  Google Scholar 

  37. Benjamin A, Este D, James C, Lloyd B, Bernard WT, Turner T. Race and well-being: the lives, hopes, and activism of African Canadians. Halifax: Fernwood Publishing; 2011.

    Google Scholar 

  38. Jimenez DE, Cook B, Bartels SJ, Alegria M. Disparities in mental health service use of racial and ethnic minority elderly adults. J Am Geriatr Soc. 2013;61(1):18–25.

    Article  PubMed  Google Scholar 

  39. Smith K. Occupied spaces: unmapping standardized assessments in health and social service organizations. In: Baines D, editor. Doing anti-oppressive practice: social justice and social work. Halifax: Fernwood Publishing; 2011. p. 197–205.

    Google Scholar 

  40. Bittles A, Petterson B, Sullivan S, Hussain R, Glasson E, Montgomery P. The influence of intellectual disability on life expectancy. J Gerontol A Biol Sci Med Sci. 2002;57(7):M470–2.

    Article  CAS  PubMed  Google Scholar 

  41. Haveman M, Heller T, Lee L, Maaskant M, Shooshtari S, Strydom A. Major health risks in aging persons with intellectual disabilities: an overview of recent studies. J Policy Pract Intellect Disabil. 2010;7(1):59–69.

    Article  Google Scholar 

  42. Emerson E, Hatton C. Poverty, socio-economic position, social capital and the health of children and adolescents with intellectual disabilities in Britain: a replication. J Intellect Disabil Res. 2007;51(11):866–74.

    Article  CAS  PubMed  Google Scholar 

  43. Sullivan WF, Berg JM, Bradley E, Cheetham T, Denton R, Heng J, et al. Primary care of adults with developmental disabilities Canadian consensus guidelines. Can Fam Physician. 2011;57:541–53.

    PubMed  PubMed Central  Google Scholar 

  44. Cooper S-A, Smiley E, Morrison J, Williamson A, Allan L. Mental ill-health in adults with intellectual disabilities: prevalence and associated factors. Br J Psychiatry. 2007;190:27–35.

    Article  PubMed  Google Scholar 

  45. Heller T, Fisher D, Marks B, Hsieh K. Interventions to promote health: crossing networks of intellectual and developmental disabilities and aging. Disabil Health J. 2014;7:S24–32.

    Article  PubMed  Google Scholar 

  46. Calgary Region Community Board of Persons with Developmental Disabilities. Supports and services for older adults with developmental disabilities study: final report 2012. http://www.humanservices.alberta.ca/documents/PDD/pdd-calgary-supports-older-adults-study.pdf Accessed 15 Mar 2017.

  47. Thorpe L. Mental health issues of older people with intellectual disabilities. CPA Bulletin. 2003:9–16.

    Google Scholar 

  48. Stergiopoulos V, Herrmann N. Old and homeless: a review and survey of older adults who use shelters in an urban setting. Can J Psychiatry. 2003;48(6):374–80.

    Article  PubMed  Google Scholar 

  49. Flowers L, Gaucher C, Bourque J. Evaluating the planning and development phase of a demonstration project: at home/chez soi Moncton. Can J Commun Ment Health. 2014;33(4):7–22.

    Article  Google Scholar 

  50. Kushel M. Older homeless adults: can we do more? J Gen Intern Med. 2012;27(1):5–6.

    Article  PubMed  Google Scholar 

  51. Crane M, Byrne K, Fu R, Lipmann B, Mirabelli F, Rota-Bartelink A, et al. The causes of homelessness in later life: findings from a 3-nation study. J Gerontol B Psychol Sci Soc Sci. 2005;60(3):S152–9.

    Article  PubMed  Google Scholar 

  52. Crane M, Warnes AM. Homelessness among older people and service responses. Rev Clin Gerontol. 2010;20(4):354–63.

    Article  Google Scholar 

  53. Holt N, Christian J, Larkin M. Maintaining connectedness: exploring the experiences of older homeless men living in hostel accommodation. J Community Appl Soc Psychol. 2012;22:485–501.

    Article  Google Scholar 

  54. Kappel Ramji Consulting Group. Common occurrence: the impact of homelessness on women’s health. Phase II: community based action research—final report. Toronto: Sistering/Toronto Community Care Access Centre; 2002.

    Google Scholar 

  55. Burns VF. Oscillating in and out of place: experiences of older adults residing in homeless shelters in Montreal, Quebec. J Aging Stud. 2016;39:11–20.

    Article  PubMed  Google Scholar 

  56. Reynolds KA, Isaak CA, DeBoer T, Medved M. Aging and homelessness in a Canadian context. Can J Commun Ment Health. 2016;35(1):1–13.

    Article  Google Scholar 

  57. Brascoupé S, Waters C. Cultural safety exploring the applicability of the concept of cultural safety to aboriginal health and community wellness. J Aborig Health. 2009:6–41.

    Google Scholar 

  58. Ball J. Supporting Aboriginal children’s development. In Early Childhood Development Intercultural Partnerships, University of Victoria, 2007. www.ecdip.org/capacity/. Accessed 15 Mar 2017.

  59. Assembly of First Nations. First Nations Cultural Safety in Post-Secondary Education, 2008. http://www.afn.ca/article.asp?id=3962. Accessed 15 Mar 2017.

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada

    Albina Veltman MD

  2. School of Social Work, McMaster University, Hamilton, ON, Canada

    Tara La Rose

Authors
  1. Albina Veltman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tara La Rose
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albina Veltman MD .

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada

    Ana Hategan

  2. Baylor Scott and White Department of Psychiatry, Texas A&M University College of Medicine, Temple, Texas, USA

    James A. Bourgeois

  3. Division of General Medicine, University of California Davis Medical Center, Sacramento, California, USA

    Calvin H. Hirsch

  4. Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, California, USA

    Caroline Giroux

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Veltman, A., La Rose, T. (2018). Marginalized Geriatric Patients. In: Hategan, A., Bourgeois, J., Hirsch, C., Giroux, C. (eds) Geriatric Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-67555-8_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-67555-8_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-67554-1

  • Online ISBN: 978-3-319-67555-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation