Navigating Gender Identity and Dementia in Transgender Older Adults: Ethical Challenges and Patient-Centered Care

As transgender individuals age, they are at risk for neurocognitive disorders which pose not only medical but also bioethical questions. We present a case study of a transgender older adult with dementia who experienced changes in gender identity and explore the bioethical implications of identity over time, including end-of-life care.

We reviewed clinical notes and relevant medical history to describe the transition and detransition process and examined ethical frameworks related to autonomy, psychological continuity, and transgender care.

The individual transitioned as a transgender woman in mid-life but detransitioned shortly before being diagnosed with dementia. This case highlighted conflicts between precedent autonomy and current gender identity in the context of neurocognitive decline and end-of-life care.

The case underscores the complexity of managing gender identity in transgender older adults with dementia, emphasizing the need for personalized and ethically sound care plans.

Clinicians should be vigilant about the impact of neurocognitive disorders on gender identity, balancing respect for patients' prior decisions with their current values, and develop personalized end-of-life care plans that honor the evolving identities and preferences of transgender individuals with dementia.