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Up to 68,000 LGBTQ+ people are living with dementia in the UK according to the Bring Dementia Out Programme. Whilst healthcare services have a legal obligation to treat LGBTQ+ individuals fairly and without discrimination (Equality Act, 2010), this is not seen in practice and Stonewall's LGBT in Britain: Health Report reveals that 1 in 4 LGBTQ+ people have experienced discriminatory remarks from healthcare staff.

LGBTQ+ individuals face unique challenges when accessing dementia care. A prime example is the use of heteronormative and cis-orientated language (language that assumes everyone is heterosexual or cisgender). This can deter individuals from disclosing their sexuality and gender identity, which hinders the establishment of trusting relationships with health/social care professionals. Minor adjustments, such as asking about a "partner" instead of "husband/wife" are important. Issues can also arise regarding next of kin, with the fear of discrimination causing individuals to conceal their sexuality, thereby excluding partners from decisions about care.

The Dementia Action Alliance roundtable report on LGBTQ+ people and dementia featured a case study of Sue and Sandy, a lesbian couple. They expressed concerns about the heteronormativity of care, with Sandy explaining that she had to repeatedly explain their relationship to people who struggled to understand following Sue's diagnosis. She describes aggression from health and social care professionals and believes things would have been different if they were a heterosexual couple. Other case studies describe partners being excluded from care decisions based on their sexuality and relationship. This is regressive and discriminatory, and an individual's sexuality should never affect the quality of care they receive.

It is important to recognise that dementia predominantly affects those over 65, many of whom who have lived through times of hostility and prejudice due to their sexual orientation and gender identity. The use of heteronormative language and disregard for queer relationships can cause individuals with dementia to feel forced back into the closet and once again conceal their sexuality or gender identity. This can lead to the resurfacing of painful memories which can be distressing and create another layer of vulnerability on top of their existing dementia diagnosis.

The LGBT foundation and NHS England have collaborated to produce a good practice guide aimed at helping professionals initiate conversations about sexuality, gender, and transgender status. These are subjects that healthcare professionals often shy away from, at the risk of causing offence or uncertainty about the best approach. This campaign educates healthcare professionals on appropriate questions to ask and how to approach the topic respectfully. 

Additionally, Alzheimer's Society has produced a factsheet for individuals caring for or supporting LGBTQ+ people with dementia. They have also created a resource which is for individuals themselves who are LGBTQ+ and have dementia. You can access both resouces below:

• View the factsheet for individuals caring for or supporting LGBTQ+ people with dementia.
• View additional resource for individuals themselves who are LGBTQ+ and have dementia.

These resources indicate that progress is being made, and there is increased attention on the challenges faced by LGBTQ+ people in terms of accessing dementia care. It is now critical to translate these insights into action by creating an open and accepting environment within health and social care. It is important for professionals to recognise the significance of their language and any biases they may possess. Going forwards, Stonewall has recommended the creation of a highly visible national campaign to tackle homophobic, biphobic and transphobic discrimination in the NHS. Furthermore, medical and nursing schools should review their curricula and standards of training to ensure they cover discrimination facing LGBTQ+ people and how to provide inclusive care for this community.