Table 7. Needs and Recommendations identified through the consensus process.

Rank	Top 10 Needs	Score	Rank	Top 10 Recommendations	Score
1	To feel respected and for your partner to feel respected.	9.6	1	At first contact with services/ at diagnosis, everyone should be given a multitude of resources including information about LGBTQIA+ services.	7.25
2	To feel safe in expressing your identity if you want to.	9.5	2	LGBTQIA+ older adults should have a choice between integrated and dedicated services.	6.63
3	To know that you, or your partner, are entering into a safe environment.	9.5	3	Integrated services with mandatory comprehensive training for staff should be available where dedicated services are unavailable.	6.63
4	To have dignity in all areas of treatment, especially end of life care.	9.4	4	LGBTQIA+ specific services for older adults and people with dementia should be introduced.	6.38
5	Care that values your needs as individuals and as LGBTQI or A+ people.	9.3	5	Services’ LGBTQIA+ inclusiveness and training should be auditable by a relevant health authority.	6.13
6	To be safe from abusive families of origin (if you have an abusive family of origin).	9.3	6	Service-users should be asked who they would like to help them in their care and decision making as their dementia symptoms progress	6.0
7	In a nursing home/ residential care setting, to be safe from homophobic/transphobic bullying/mistreatment from other residents.	9.1	7	Independent advocates for people with dementia should be triggered upon diagnosis. Advocates can work with people with dementia and their close networks to give them the care they desire most.	5.0
8	Not to feel pressured into expressing your identity if you don’t want to/ or don’t feel safe.	8.8	8	Training should include understanding differences in LGBTQIA+ networks and how to incorporate an individual’s network in care without making assumptions; as well as intervening with homophobic/ transphobic bullying/mistreatment from family of origin/other.	4.25
9	Provide specific trans* and intersex medical training for doctors and care staff working with older LGBTQIA+ people, to enable them to work safely with unfamiliar bodies.	8.8	9	When working with transgender people with dementia, care providers should address them as the gender they are presenting as in the current moment and not engage in any kind of coercion regarding their gender expression.	4.13
10	The need to support trans* people with dementia while also recognising the reality of biology and that some supports may require a focus on sex and not gender.	8.3	10	An explicitly LGBTQIA+ inclusive ethos message and visible displays of LGBTQIA+ acceptance should be clearly displayed in leaflets and webpages of dementia services. This must be accompanied by staff trained in LGBTQIA+ affirmative care.	3.0