Expressing identity or orientation for LGBTQ+ people with dementia

Advice and practical tips for enabling an LGBT+ person with dementia to express their identity or orientation. 

Telling others about sexual orientation or gender identity

For an LGBTQ+ person, choosing how to tell others about (‘disclose’) their sexual orientation or gender identity can be a difficult decision. They may also be unsure who to tell. When a person develops dementia, this decision can be even more challenging. However, if they have made decisions about this regularly in the past, they may be more used to doing this.

It is for the person to decide whether they want to disclose this information. If they do, it’s important that the person is able to choose who they want to share these parts of their identity with.

When they do want to tell others 

Some people will want professionals to know about them being LGBTQ+ so that services can provide them with appropriate support. If so, the person may want this information to be recorded in their care plan.

When they do not want to tell others

Equally, the person may be worried about negative attitudes and may choose not to share their identity with someone. If this is the case, their wish should be respected, and you should not disclose this information.

You may find the person’s decision upsetting or hard to deal with, and it’s important that you are able to manage these feelings. For information about emotional support see ‘Looking after yourself as a carer’ on this page.

When they are unable to make a decision

If the person is unable to decide whether to disclose their sexual orientation or gender identity, they should be supported to make a decision as far as possible. If they do not have the ability to decide even with support, there may be circumstances where their carer may have to make this decision.

It’s important that any decision is made in the person’s best interests, and not to satisfy anyone else. For example, there might be medical or health reasons for disclosing this information.

Disclosing trans status

Some trans people will have sex reassignment surgery, while other trans people may not. Professionals providing personal care may become aware of the person’s trans status even if they haven’t chosen to disclose it.

However, it’s important for the person to be respected and there are ways to manage this. It can help to: talk to the person in advance about how they would like to address a situation like this.

Consider building relationships with care professionals early so that the person feels safe and comfortable with them. They should be able to support the person appropriately and with dignity and respect.

If someone chooses to tell a professional about their trans status, or if the professional learns about it in another way, they cannot then disclose this information to others without the person’s consent.

This means that the professional must treat this information as confidential and not tell others unless the person wants them to. There may be several people involved in their support and care and they may have to decide whether to disclose this information to all of them.

Losing sexual inhibition

People with dementia can sometimes lose their sexual inhibitions. In addition, as dementia changes the brain over time, people can become much more or much less interested in sex.

These changes can affect anyone with dementia. However, for an LGBTQ+ person who has not shared their sexual orientation or gender identity, the ways they behave may reveal these to other people.

For example, a bisexual woman with dementia may express emotional, romantic, or sexual attraction to another woman in front of people who don’t know she is bisexual.

It may help to talk to each other about what to do in this situation so that you are both prepared. For example, ask the person if they would want to disclose their sexual orientation if this happened.

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