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

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Clinical implications: 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.