Are dementia services and support organisations meeting the needs of Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers of LGBT people living with dementia? A scoping review of the literature

Objectives More than 60% of people with dementia live at home, where assistance is usually provided by informal caregivers. Research on the experiences of the Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers is limited. This scoping review of the literature synthesizes international evidence on support provision for the population of LGBT caregivers. Methods Eight electronic databases and Google Scholar were searched using terms including ‘Dementia’, ‘LGBT’ and ‘Caregiver’ for all types of articles, including empirical studies, grey literature and sources from charity/third sector/lobbying organisations. Article selection was performed by two raters. Data were analysed through deductive thematic analysis, and three themes were established a priori: Distinct experiences of LGBT caregivers; current barriers to support; strategies to overcome the current challenges. Results Twenty articles were included. Distinct experiences of LGBT caregivers included a loss of LGBT identity, the impact of historical events, families of choice, and disclosing LGBT identities. Current barriers to support included poor representation of LGBT caregivers in support services, negative attitudes of staff and reluctance of caregivers to seek support. Strategies to overcome the current challenges included staff awareness training and kite-marking inclusion. Conclusion Limited cultural competency of staff and a subsequent reluctance to seek help have an impact on use of support services among LGBT caregivers. Implications for practice include the development of cost-effective, feasible, and acceptable inclusiveness training for services. Implications for policy include implementation in organisations of top-down agendas supporting staff to understand sexuality and non-heteronormative relationships in older age

The views and experiences of bisexual people regarding their psychosocial support needs: a qualitative evidence synthesis

Introduction Despite consistent evidence of poor mental health among what is a relatively large population group, research examining bisexual mental health remains sparse. Aim To identify the psychosocial needs of people who are bisexual and establish factors that may support or inhibit access to appropriate psychosocial interventions and supports. Method A qualitative evidence syntheses of the empirical evidence. Results A total of 15 papers were included in the review. The PRISMA process was used. Following data analysis, four main themes emerged that were (a) experiences of being bisexual, (b) mental health experiences and concerns, (c) service access and responses and (iv) communities and supports. Discussion Bisexual people have unique and specific psychosocial support needs that relate to, but are also different from, the needs of the broader LGBTIQ+ community. This study provides valuable insights into how future policy, practice, education and training and research can better address the needs of this highly vulnerable group. Implications for Practice This study highlights the psychosocial complexities associated with bisexuality and provides evidence for the need for improvement in current support services to ensure inclusivity and culturally competent care

The return of the fifties: Trends in college students' values between 1952 and 1984

Five identical surveys were carried out in 1952, 1968–1969, 1974, 1979, and 1984 among undergraduate men at Dartmouth College and the University of Michigan to measure value trends. In most value domains the trends are U-shaped, showing that the trends from the fifties to the sixties and seventies have reversed, and attitudes in 1984 were either similar to the fifties or moving in that direction. The domains include traditional religion, career choice, faith in government and the military, advocacy of social constraints on deviant social groups, attitudes about free enterprise, government and economics, sexual morality, marijuana use, and personal moral obligations. Two attitude areas do not show a return of the fifties: (1) other-direction was high in 1952, then dropped to the sixties and did not rise; (2) the level of politicization rose greatly from 1952 to the sixties, then dropped again only slightly.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45659/1/11206_2005_Article_BF01106623.pd

Later life sex and Rubin’s ‘Charmed Circle'

Gayle Rubin’s now classic concept of the ‘charmed circle’ has been much used by scholars of sexuality to discuss the ways in which some types of sex are privileged over others. In this paper, I apply the concept of the charmed circle to a new topic– later life – in order both to add to theory about later life sex and to add an older-age lens to thinking about sex hierarchies. Traditional discursive resources around older people’s sexual activities, which treat older people’s sex as inherently beyond the charmed circle, now coexist with new imperatives for older people to remain sexually active as part of a wider project of ‘successful’ or ‘active’ ageing. Drawing on the now-substantial academic literature about later life sex, I discuss some of the ways in which redrawing the charmed circle to include some older people’s sex may paradoxically entail the use of technologies beyond the charmed circle of ‘good, normal, natural, blessed’ sex. Sex in later life also generates some noteworthy inversions in which types of sex are privileged and which treated as less desirable, in relation to marriage and procreation. Ageing may, furthermore, make available new possibilities to redefine what constitutes ‘good’ sex and to refuse compulsory sexuality altogether, without encountering stigma

Insulin resistance, lipotoxicity, type 2 diabetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009

Insulin resistance is a hallmark of type 2 diabetes mellitus and is associated with a metabolic and cardiovascular cluster of disorders (dyslipidaemia, hypertension, obesity [especially visceral], glucose intolerance, endothelial dysfunction), each of which is an independent risk factor for cardiovascular disease (CVD). Multiple prospective studies have documented an association between insulin resistance and accelerated CVD in patients with type 2 diabetes, as well as in non-diabetic individuals. The molecular causes of insulin resistance, i.e. impaired insulin signalling through the phosphoinositol-3 kinase pathway with intact signalling through the mitogen-activated protein kinase pathway, are responsible for the impairment in insulin-stimulated glucose metabolism and contribute to the accelerated rate of CVD in type 2 diabetes patients. The current epidemic of diabetes is being driven by the obesity epidemic, which represents a state of tissue fat overload. Accumulation of toxic lipid metabolites (fatty acyl CoA, diacylglycerol, ceramide) in muscle, liver, adipocytes, beta cells and arterial tissues contributes to insulin resistance, beta cell dysfunction and accelerated atherosclerosis, respectively, in type 2 diabetes. Treatment with thiazolidinediones mobilises fat out of tissues, leading to enhanced insulin sensitivity, improved beta cell function and decreased atherogenesis. Insulin resistance and lipotoxicity represent the missing links (beyond the classical cardiovascular risk factors) that help explain the accelerated rate of CVD in type 2 diabetic patients