1002 A CASE STUDY OF GENDER DYSPHORIA IN THE ELDERLY

Abstract The aging Lesbian, Gay, Bisexual, Transgender (LGBT) population is a patient group which has not been extensively researched in terms of its specific clinical needs. There is growing improvement in the awareness of LGBT patients; however there appears to be a disparity between care provided for younger and older LGBT individuals. The LGBT community suffers from disproportionately reduced access to care as well as healthcare discrimination and a lack of specialist medical expertise thereby increasing the risk to their physical and mental health. Combined with the implications and challenges of living with frailty, older LGBT individuals are some of the most vulnerable members of our society. Our patient a 90-year-old man with gender dysphoria, falls into this subset. This case study follows our patient’s internal struggle with his longstanding concealment of his transsexualism, issues accessing specialist care, reduced treatment options in view of his age and the repercussions. These include an impact on his physical health by means of a self-inflicted injury resulting in a urethral fistula and his mental health with worsening depression and reduced ability to rationalise his gender dysphoria. The study presents challenges from both a clinical perspective, in terms of an accurate psychiatric diagnosis, as well as the challenges experienced by the patient in the healthcare setting. While this case explores both the causes and effects of these difficulties; the specific needs and experiences of older LGBT patients remain largely unknown. Through highlighting this patient’s experiences, we hope to encourage thought and discussion of such issues amongst other healthcare professionals to ensure a holistic approach of care.