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Purpose of Review The purpose of this review was to identify health disparities and culturally competent strategies for improving function and independence in a historically disadvantaged group. Recent Findings There are significant health disparities among LGBT older adults including increased disability rates, chronic conditions, and mental distress. There is a shift in the theoretical framework for addressing health disparities in LGBT older adults from an emphasis on minority stress theory, towards factors that facilitate resilience such as identity affirmation and social support networks. Summary Advocacy for cultural competency training and LGBT aging research is needed in multiple clinical domains including rehabilitation and geriatric care centers. There are very few studies that have identified effective intervention approaches for reducing mental health or mobility-related disparities in LGBT aging populations.

Informal care-givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care-giver is known to be associated with poorer health and well-being, and lesbian and gay care-givers re- port experiences of stigma and discrimination in the care-giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care-givers. We compared care-givers to non- caregivers on a range of health and well-being measures, including psychological dis- tress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care-givers who were caring for an LGBTI person to those who were caring for a non-LGBTI person. Among the lesbian women, care-givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indica- tors. Among the gay men, care-givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well-being compared to those caring for a non-LGBTI person. Overall, results from this study suggest that older lesbian and gay care-givers may be facing some challenges related to their well-being and feeling supported, especially if they are caring for another LGBTI person.

Recent Australian legislative and policy changes can benefit people of trans and/or non-binary experience (e.g. men assigned female with stereotypically {‘}female{’} bodies, women assigned male with ster…

In response to the very limited and mostly outdated literature on older lesbian sexuality, this exploratory study examined older lesbian sexual identity, romantic relationships, the impact of aging, and experiences of discrimination within these contexts. Utilizing an online survey that recruited via numerous online lesbian communities and snowball sampling, 456 lesbians over the age of 50 responded to closed, Likert scale, and open-ended questions that provided a preliminary understanding of older lesbian sexuality. The results indicated that older lesbians have experienced fluidity in past romantic and sexual relationships, as well as in erotic fantasies, despite strong identification with being lesbian. The findings also indicate a decreased focus on sexuality in the context of relationships, with more focus on stability and continuity. Future research is needed that provides greater specificity and detail about older lesbian conceptions of sexual behavior and sexual identity labels, as well as specific sex- ual behaviors.

Older lesbians are, at minimum, a triple threat of marginalization due to ageism, heterosexism, and sexism. A national survey specific to this often-invisible population has not occurred in over 25 years. The present study was completed to reveal the needs, strengths, and experiences of the current cohort of older lesbians. Four hun- dred fifty-six older lesbians responded to an online survey on topics including sociodemographics, social activity, health, sexual iden- tity, family relationships, romantic relationships, service/program use, mental health, end-of-life care, and discrimination. The results and implications are included as well as a comparison to the last studied cohort.

L{’}article interroge l{’}activité sexuelle des seniors vivant avec le VIH ainsi que son contexte conjugal et social. L{’}activité sexuelle des seniors séropositifs est l{’}une des préoccupations suscitées par le rapide vieillissement de la population séropositive. Elle est considérée comme l{’}une des dimensions de bien-être et d{’}intégration sociale. Plus ou moins étroitement liée à la conjugalité, elle renseigne également sur l{’}éventuelle prise en charge des seniors séropositifs quand le besoin se fera sentir. Une enquête a été menée auprès de 125 séropo- sitifs suivis dans les hôpitaux du COREVIH Vallée du Rhône (co-financeur de l{’}enquête), dont 80 par questionnaire et 45 par entretien approfondi. Au total, 80 seniors (50 ans et plus) ont été étudiés et comparés à 45 séropositifs plus jeunes. L{’}échantillon est constitué de fa ̧con aléatoire selon les rendez-vous à l{’}hôpital, mais le taux de refus est trop élevé pour considé- rer l{’}échantillon comme représentatif. Il a permis néanmoins de décrire une grande variété de situations et de repérer des régularités à l{’}intérieur des différentes catégories de seniors séropositifs. Ainsi, hommes et femmes hétérosexuels, HSH et bisexuels constituent quatre confi- gurations contrastées. Les hommes hétérosexuels ont tendance à continuer de vivre dans leur environnement familial (femme, enfants, parfois petits-enfants), mais sur un mode conflic- tuel et sans activité sexuelle. Les femmes hétérosexuelles vivent souvent seules {—} comme au moment de leur contamination {—} mais en bons termes avec leurs enfants. Les HSH vivent le plus souvent en couple séroconcordant, couple post-dépistage, affectif, harmonieux, mais peu sexuel. Les hommes bisexuels, enfin, vivent souvent seuls, sans activité sexuelle, en situation conflictuelle avec enfants et ex-compagnes. Ils semblent les plus isolés socialement et les plus fragiles psychologiquement.

There is little research at the international level to help us understand the experiences and needs of trans people living with dementia, despite population aging and the grow- ing numbers of trans people including the first cohort of trans older adults. There is a need to understand the widespread barriers, discrimination and mistreatment faced by trans people in the health and social service system, and the fears trans people express about aging and dementia. Anecdotal evidence from the scarce literature on the topic of LGBTQ populations and dementia suggest that cognitive changes can impact on gender identity. For example, trans older adults with dementia may forget they transitioned and reidentify with their sex/gender assigned at birth or may experience {‘}gender confusion.{’} This raises crucial questions, for example regarding practices related to pronouns, care to the body (shaving, hair, clothes, etc.), social gendered interactions, health care (con- tinuing or not hormonal therapy) and so on. This article fills a gap in current literature by offering a first typology of responses offered by academics who analyzed the topic of dementia and gender identity, to trans older adults with dementia who may be experi- encing {‘}gender confusion,{’} namely: (1) a gender neutralization approach; (2) a transaf- firmative stable approach; and (3) a trans-affirmative fluid approach. After providing critical reflections regarding each approach, we articulate the foundations of a fourth paradigm, rooted in an interdisciplinary dialogue regarding the interlocking systems of oppression faced by trans older adults with dementia, namely ageism, ableism/sanism, and cisgenderism.

This paper presents data from a small study exploring the impacts of homophobia on the lives of older lesbian and gay Australians. Eleven in-depth interviews were conducted with older lesbians (6) and gay men (5) ranging in age from 65 to 79 years. The study found that participants{’} sense of self was shaped by the dominant medical, legal and religious institutions of their youth that defined them as sick, immoral or criminal. Participants described enforced {\textquotedblleft}cure{\textquotedblright} therapies, being imprisoned, having employment terminated and being disowned and disinherited by family. In this context, intimate relationships and social networks provided refuge where trust was rebuilt and sexuality affirmed. Many created safe spaces for themselves. This equilibrium was threatened with increasing age, disability and the reliance on health and social services. Participants feared a return to institutional control and a need to {\textquotedblleft}straighten up{\textquotedblright} or hide their sexuality. In response, partners stepped into the role of caregiver, at times beyond their capacity and at a cost to their relationship. The study describes the importance of understanding social connections in the lives of older lesbians and gay men. It highlights the need for inclusive services to ensure that social networks are supported and that health and well-being are promoted.

Se fondant sur les méthodes d{’}études critiques féministes et queer, cet article explore les perceptions qu{’}ont les infirmières et les infirmiers de leur pratique avec des patientes lesbiennes, gaies, bisexuelles, transgenres ou queer (LGBTQ). L{’}étude a comporté la réalisation d{’}entrevues en profondeur semi-structurées avec 12 membres de la profession infirmière à Halifax, en Nouvelle-Écosse. Ces entrevues ont permis de faire la lumière sur diverses approches en matière de pratique infirmière. Les participants ont le plus souvent soutenu que les différences comme l{’}orientation sexuelle et l{’}identité de genre ne font pas de différence : tout le monde devrait être traité comme une personne distincte. Les participants semblaient tenir beaucoup à éviter la discrimination ou la stéréo- typisation en tentant d{’}éviter les suppositions. Ils étaient soucieux de ne pas offenser les patientes par leur langage ou leurs gestes. Lorsqu{’}il était tenu compte des différences sociales, l{’}accent se limitait souvent à la santé sexuelle, bien que certains participants aient montré une compréhension nuancée de l{’}oppression et de la marginalisation. Faire la distinction entre les généralisations et les stéréotypes peut aider le personnel infirmier dans ses efforts pour recon- na{\^\i}tre les différences sociales sans faire de tort aux patientes LGBTQ.

Cet article porte sur le vieillissement des a{\^\i}nés gais et lesbiennes selon une approche qualitative. Selon des recherches, plusieurs facteurs viennent influencer les perceptions et les expériences du vieillissement des a{\^\i}nés gais et lesbiennes. Les résultats sont tirés d{’}une recherche doctorale explorant la participation sociale des a{\^\i}nés gais et lesbiennes. L{’}article documente les représentations et perceptions du vieillissement, les enjeux spécifiques à l{’}intersection de l{’}orientation sexuelle et de l{’}avancée en âge ainsi que l{’}agentivité des a{\^\i}nés gais et lesbiennes.

Research on service needs among older adults rarely addresses the special circumstances of lesbian, gay, bisexual, and transgender (LGBT) individuals, such as their reliance on friend-centered social networks or the experience of discrimination from service providers. Limited data suggests that older LGBT adults underuti- lize health and social services that are important in maintaining independence and quality of life. This study explored the social care networks of this population using a mixed-methods approach. Data were obtained from 210 LGBT older adults. The average age was 60 years, and 71% were men, 24% were women, and 5% were transgender or intersex. One-third was Black, and 62% were Caucasian. Quantitative assessments found high levels of morbidity and friend-centered support networks. Need for and use of services was frequently reported. Content analysis revealed unmet needs for basic supports, including housing, economic supports, and help with entitlements. Limited opportunities for socialization were strongly expressed, particularly among older lesbians. Implications for senior programs and policies are discussed.

Purpose: This article reports on the findings of a study whose purpose was to explore the experiences of caregivers of gay and lesbian seniors living in the community and to identify issues that emerged from an exploration of access to and equity in health care services for these populations. Design and Methods: The study used a qualitative methodology based upon principles of grounded theory in which open-ended interviews were undertaken with 17 caregivers living in three different cities across Canada. Results: Findings indicated several critical themes, including the impact of felt and anticipated discrimination, complex processes of coming out, the role of caregivers, self-identification as a caregiver, and support. Implications: We consider several recommendations for change in light of emerging themes, including expanding the definition of caregivers to be more inclusive of gay and lesbian realities, developing specialized services, and advo- cating to eliminate discrimination faced by these populations.

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Current gay, lesbian, bisexual, and transgender (GLBT) individuals age 65 years and older grew up before the Gay Rights move- ment. They have learned over many years to hide their identities in order to avoid discrimination and ridicule. Unfortunately, this secrecy has led to the near invisibility of the elder GLBT population and to poor health and service access. This paper reviews what we know about GLBT el- ders, describes some of the unique strengths they bring to the aging pro- cess, and outlines some of the challenges they face. Micro, mezzo, and macro practice implications are suggested.

Geriatric nurses have a responsibility to promote the health of all older adults. Lesbian, gay, bisexual, trans- gender, and queer (LGBTQ) older adults are particularly vulnerable to poor health outcomes and are less likely to seek healthcare due to fear of discrimination. Despite elevated risk LGBTQ older adults are often ignored within geriatric nursing as there is little evidence to inform care. To adequately care for LGBTQ patients geriatric nurses should recognize the effects of bias, appreciate the importance of terminology, understand diversity within the LGBTQ community, advocate for the inclusion of sexual orientation and gen- der identity in admission assessments, share best practices, and advocate for increased visibility. Caring for this population may be challenging, as it will require geriatric nurses to expand their knowledge of LGBTQ health, explore their own biases, and challenge institutional norms. However, through coordinated efforts geriatric nurses can work toward improving care for LGBTQ older adults.

Conclusion. Successful ageing in lesbian, gay and bisexual older people is defined as a subjective and multifactorial concept that is characterised by support from families of origin/families of choice, access to lesbian, gay, and bisexual-friendly services and the development of crisis competence skills which impact the ageing experience of LGB individuals. Implications for practice. Successful ageing models can provide a roadmap for developing culturally competent interventions to address key healthcare issues present in this population. The nursing profession{’}s multidisciplinary knowledge and competence in providing health promotion makes nurses well positioned to take a leading role in reducing disparities of lesbian, gay and bisexual older people.

Many health and social service providers lack awareness of and knowledge about the long-term care (LTC) needs of the lesbian and gay population, about how to provide culturally-sensitive and affirming services and programs, and about ways to increase accessibility and acceptability of LTC options for les- bian and gay older adults. This arti- cle reviews the history of oppression experienced by lesbians and gay men, what is known about them, and issues for consideration by staff in LTC facilities. A life course perspective provides the conceptu- al framework for understanding the challenges and opportunities faced by older lesbians and gay men in LTC. Recommendations are provided to combat heterosexist assumptions and enhance culturally competent care.

Little is known about abuse experienced among African American men who have sex with men (MSM) who are 50 years and older. A series of focus groups were conducted to examine perspectives of seropositive African American MSM age 50 years and older who reported experiencing some form of psychological or physical abuse. Thirty African American MSM were divided into four focus groups and four themes emerged: {\textquotedblleft}Fear Being Gay,{\textquotedblright} {\textquotedblleft}No One Else to Love Me,{\textquotedblright} {\textquotedblleft}Nowhere to Turn,{\textquotedblright} and {\textquotedblleft}Sexual Risk {&} Control.{\textquotedblright} The data suggest there is a need to develop culturally tailored interventions for this population.

The concept of social capital is widely used in the social sciences and has, to an extent, been applied to the lives and social networks of older lesbian, gay and bisexual (hereafter LGB) adults. Developing existing research, this paper argues that while not without its problems, the concept of social capital enriches our understanding of these networks, whilst simultaneously deconstructing the negative stereotypes surrounding homosexuality in later life. However, little attention has been paid to the social factors that mediate access and participation in lesbian and gay communities and the implications of this on the quality and experience of later life. Drawing on qualitative research conducted in the United Kingdom, this paper illustrates how biography, gender and socio-economic status are significant mediators in the development and maintenance of social capital by older LGB adults. It concludes with a set of recommendations aimed at improving the social capital of older LGB adults, together with the importance of {‘}queering{’} the concept itself.

This article advocates incorporating biographical narratives into social work practice involving older lesbian, gay and bisexual service users. Offering a critique of {‘}sexuality-blind{’} conditions in current policy and practice, the discussion draws on qualitative data to illustrate the potential benefits of narrative approaches for both practitioners and service users.

It is estimated that there will be more than 5 million gays and lesbians aged 65 and over by 2030. This study examined attitudes of sexual orientation among a sample of certified nurse assistants who work in long-term care. A sample of 119 certified nurse assistants were recruited at a national con- ference and asked to complete a survey that included the Homophobic scale. Results indicate low levels of homophobia among the certified nurse assistants who participated.Age and acquaintances accounted for most of the variance in the homophobia scores of the certified nurse assistants. While scores show low levels of homophobia, caution is advised as scores may reflect a stereotype that elderly people are not sexually active and that their sexuality is no longer relevant.

The review aimed to examine the views and experiences of ageing gender and sexually diverse (GSD) women{&}mdash;a triple minority in relation to their age, gender and sexual orientation{&}mdash;in accessing health, social and aged care services. Eighteen peer reviewed articles identified from seven electronic databases in health and social sciences were evaluated according to predefined criteria and a thematic review methodology drawing upon socio-ecological theory was used to analyse and interpret the findings. Four major themes were identified from the analysis: {&}ldquo;The Dilemma of Disclosure{&}rdquo;, {&}ldquo;Belonging/Connection{&}rdquo;, {&}ldquo;Inclusiveness of Aged Care{&}rdquo; and {&}ldquo;Other Barriers to Access Care{&}rdquo;. In the dilemma of disclosure, older GSD women consider factors such as previous experiences, relationship with the provider and anticipated duration of stay with the provider before disclosing their sexual identifies. The review also revealed that aged care services lack inclusiveness in their policies, advertising materials, aged care spaces and provider knowledge and attitude to provide sensitive and appropriate care to GSD women. Overall, older GSD women experience multiple and multilevel challenges when accessing health, aged and social services and interventions are needed at all levels of the socio-ecological arena to improve their access and quality of care.

This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support.

Purpose: This study examines global social networks{—}including friendship, support, and acquaintance networks{—}of lesbian, gay, bisexual, and trans- gender (LGBT) older adults. Design and Methods: Utilizing data from a large community-based study, we employ multiple regression analyses to examine correlates of social network size and diversity. Results: Controlling for background characteristics, network size was positively associated with being female, transgender identity, employment, higher income, having a partner or a child, identity disclosure to a neighbor, engagement in religious activities, and service use. Controlling in addition for network size, network diversity was positively associated with younger age, being female, trans- gender identity, identity disclosure to a friend, religious activity, and service use. Implications: According to social capital theory, social networks provide a vehicle for social resources that can be beneficial for successful aging and well-being. This study is a first step at understanding the correlates of social network size and diversity among LGBT older adults.

Federal acknowledgement of LGBT elders remains scant, including in the 2015 White House Conference on Aging report and the Older Americans Act. This article outlines the many reforms and policy changes necessary for LGBT elders to age independently, in good health, and be financially secure in their homes and communities, without discrimination, and also stresses the need for more research on LGBT aging.

Objectives: In order to bolster gerontology{’}s knowledge base about transgender issues and advance conceptualizations of agency and social forces in life course scholarship, this study explores the conditions under which people contemplate or pursue a gender transition in later life. Methods: In-depth interviews were conducted with male-to-female identified persons (N = 22) who have seriously contem- plated or pursued a gender transition after the age of 50 years. Participant observation was also carried out at three national transgender conferences (N = 170 hours). Interpretive analyses utilized open and focused coding, analytical memo writing, and an iterative process of theory development. Results: Participants in this study faced unrelenting social pressures to conform to normative gender expectations through- out their lives, which were often internalized and experienced as part of themselves. Confronting these internalized forces often took the form of a {\textquotedblleft}dam bursting,{\textquotedblright} an intense emotional process through which participants asserted agency in the face of constraining social forces in order to pursue a gender transition in later life. Discussion: Thefindingsinthispaperareusedtoextendthelifecourseconceptofagencywithinstructure,whichhasimplica- tions for future life course research in aging, especially with respect to socially marginalized and oppressed minority groups.

Concepts of time are ubiquitous in studies of aging. This article integrates an existential perspective on time with a notion of queer time based on the experiences of older transgender per- sons who contemplate or pursue a gender transition in later life. Interviews were conducted with male-to-female identified persons aged 50 years or older (N = 22), along with participant obser- vation at three national transgender conferences (N = 170 hr). Interpretive analyses suggest that an awareness of {\textquotedblleft}time left to live{\textquotedblright} and a feeling of {\textquotedblleft}time served{\textquotedblright} play a significant role in later life development and help expand gerontological perspectives on time and queer aging.

Objectives. We investigated health disparities among lesbian, gay, and bi- sexual (LGB) adults aged 50 years and older. Methods. We analyzed data from the 2003{–}2010 Washington State Behav- ioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions. Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men. Conclusions. Tailored interventions are needed to address the health dispar- ities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Historical, environmental, and cultural contexts intersect with aging, sexuality, and gender across communities and genera- tions. My scholarship investigates health and well-being over the life course across marginalized communities, including LGBTQ (lesbian, gay, bisexual, transgender, and queer) midlife and older adults, native communities experiencing car- diovascular risk, and families in China living with HIV, in order to balance the realities of unique lives in contemporary society. By probing the intersection of age, sexuality, and gender, my analysis is informed by both personal and professional experiences. With the death of my partner occurring at a time of profound invisibility and silence before HIV/AIDS, I found my life out of sync, experiencing a loss without a name. My life was thrust into a paradox: My relationship was defined by a world that refused to recognize it. This essay provides an opportunity for me to weave together how such critical turn- ing points in my own life helped shape my approach to gerontology and how gerontology has informed my work and life. Reflecting on this journey, I illustrate the ways in which historical, structural, environmental, psychosocial, and biological factors affect equity, and the health-promoting and adverse pathways to health and well-being across marginalized com- munities. Although gerontology as a discipline has historically silenced the lives of marginalized older adults, it has much to learn from these communities. The growing and increasingly diverse older adult population provides us with unique opportunities to better understand both cultural variations and shared experiences in aging over the life course.

Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first federally funded study addressing aging among LGBTQ older adults throughout the United States. This article examine…

Background: LGBTQ* (lesbian, gay, bisexual, trans, and queer) older adults are demographically diverse and growing populations. In an earlier 25-year review of the literature on sexual orientation and aging, we identified four waves of research that addressed dispelling negative stereotypes, psychosocial adjustment to aging, identity development, and social and community-based support in the lives of LGBTQ older adults. Objectives: The current review was designed to develop an evidence base for the field of LGBTQ aging as well as to assess the strengths and limitations of the existing research and to articulate a blueprint for future research. Methods: Using a life course framework, we applied a systematic narrative analysis of research on LGBTQ aging. The review included 66 empirical peer-reviewed journal articles (2009{–}2016) focusing on LGBTQ adults aged 50 years and older, as well as age-based comparisons (50 years and older with those younger). Results: A recent wave of research on the health and well-being of LGBTQ older adults was identified. Since the prior review, the field has grown rapidly. Several findings were salient, including the increas{\-}ed application of theory (with critical theories most often used) and more varied research designs and methods. While {\-}existing life course theory provided a structure for the investigation of the social dimensions of LGBTQ aging, it was limited in its attention to intersectionality and the psychological, behavioral, and biological work emerging in the field. There were few studies addressing the oldest in these {\-}communities, bisexuals, gender non-binary older adults, intersex, {\-}older adults of color, and those living in poverty. {\-}Conclusions: The Iridescent Life Course framework highlights the interplay of light and environment, creating dynamic and fluid colors as perceived from different angles and perspectives over time. Such an approach incorporates both queering and trans-forming the life course, capturing intersectionality, fluidity over time, and the psychological, behavioral, and biological as well as social dimensions of LGBTQ aging. Work is needed that investigates trauma, differing configurations of risks and resources over the life course, inequities and opportunities in representation and capital as LGBTQ adults age, and greater attention to subgroups that remain largely invisible in existing research. More depth than breadth is imperative for the field, and multilevel, longitudinal, and global initiatives are needed.

Housing is widely recognized as a key determinant of health and yet many older lesbian, gay, bisexual and transgender (LGBT) Canadians continue to experience or are at risk of experiencing housing precarity or homelessness. This report offers the key findings from our national study on the housing issues facing older LGBT Canadians and recommendations on addressing these important inequities.

Lesbian, gay, bisexual, and transgender (LGBT) persons in the county of Riverside, CA and in the Palm Springs/Coachella Valley area, in particular, responded to a questionnaire addressing concerns about identity disclosure and comfort accessing social services. Distributed at a Pride festival, as well as through reli- gious, social, and service agencies, the final sample for analysis of 502 comprised 401 (80%) gay men and 101 (20%) lesbians in 4 groups: < 50 years of age (18%), 50 to 59 (26%), 60 to 69 (36%), and over 70 (20%). Results reveal that almost one-third of midlife and older gay men and lesbians maintain some fear of openly disclosing their sexual orientation. Along comparable lines with similar proportions, older gay men and lesbians maintain some discomfort in their use of older adult social services, even as the majority reports that they would feel more comfortable accessing LGBT-friendly identified services and programs. In both cases, les- bians reported greater fear and discomfort than did gay men; older gay men and lesbians reported that they would be less comfortable accessing LGBT-identified services and programs than did younger gay men and lesbians. These data support prior research on the apprehension of LGBT elders in accessing care, the crucial role of acceptance, with some suggestions of how social services might better prepare to address these needs.

The Canadian health care system{’}s delivery and policies are often based on a heterosexual nuclear family model. Long-term care (LTC) policy in particular is built on specific assumptions about women and caregiving. Current health care and LTC policies can thus disadvantage and marginalize women who do not fit such constructions, such as older lesbian and bisexual women. Drawing from literature on lesbian, gay, bisexual, and transgender women{’}s health, aging, and caregiving, this article uses a feminist political economy analysis to demonstrate that a gap exists in current research and policy with respect to the LTC needs of older lesbian and bisexual women.

This study examined mental and physical health, per- ceived social support, and experiences with HIV/AIDS of 416 lesbian, gay, and bisexual adults aged 60 to 91. Most participants reported fairly high levels of self-esteem; however, many experienced loneliness. Most also reported low levels of internalized homophobia, but men reported significantly higher levels than women did. Ten percent of respondents sometimes or often considered suicide, with men reporting significantly more suicidal thoughts related to their sexual orientation. Men also had significantly higher drinking scores than women, and more men could be classified as problem drinkers. Only 11% of the respondents said that their health status interfered with the things they wanted to do. Although 93% of the participants knew people diagnosed with HIV/AIDS, 90% said that they were unlikely to be HIV-infected. Participants averaged six people in their support networks, most of whom were close friends. Most support network members knew about the participants{’} sexual ori- entation, and the respondents were more satisfied with support from those who knew. Those living with domestic partners were less lonely and rated their physical and mental health more positively than those living alone

A survey research design was used to examine caregiving, care receiving, and the willingness to provide caregiving among lesbian, gay, and bisexual (LGB) older adults recruited from community groups. More than one-third reported receiving care from people other than health- care providers in the last five years; more than two thirds provided care to other LGB adults. Those who had given care were more likely than non-caregivers to give care in the future. The gender and sexual orientation of recipients of future help affected participants{’} willingness to provide care, as did their education level and style of coping. Participants willing to provide care to older LGB adults perceived such experiences to be less burdensome and more personally rewarding than those who were un-willing to provide care.

Aim In 2009, the Howard Brown Health Center received funding from the US Department of Health and Human Services, and Health Resources and Services Administration to develop and disseminate a peer-r…

This groundbreaking resource presents a wealth of findings and perspectives previously unseen in the LGBT literature. Its focus on psychological, sociopolitical and care delivery issues affecting LGBT elders reveals both the nuanced interplay between diverse sources of identity and multiple sources of stigma and discrimination. Specific chapters highlight challenges and resiliencies impacting subpopulations (e.g., racial groups, veterans, immigrants), examine employment and advocacy issues, discuss later-life concerns in context and offer guidelines for relevant, ethical practice. Contributors represent a wide range of fields from psychiatry and gerontology to public health and public policy, reflecting the scope and needs of this diverse and complex population. Among the topics in the Handbook: Family relationships of older LGBT adults. The intersection of identities: race, age, sexuality and care network. Bisexuality: an invisible community among LGBT elders. Implications of the Supreme Court ruling on same-sex marriage. No money, no work and you’re old. Disabilities among LGBT elders: responses of medicine, public health, rehabilitation and social work. Handbook of LGBT Elders is an essential reference for mental health professionals, psychologists and social workers who work with the LGBT community and the elderly, as well as researchers interested in the LGBT community and aging.

Conclusions. Remarkably, very little contemporary literature exists that addresses the health and well-being of older lesbian women, and this cohort remain posi- tioned on the peripheries of research and society. Older lesbian women continue to be marginalised because of their lesbian identity and actively cultivate support systems, negotiate disclosure and develop resilience to minimise the effects of their marginal position. Relevance to practice. Recognition that older lesbian women often create, and draw on, a family of choice for support is imperative. In addition, the clinical environment should be safe for older lesbian women to disclose their sexual orientation and other sensitive information.

The issue of sexuality is under-studied in the sociology of ageing. This article advocates placing sexuality at the centre of our analyses of ageing and later life in late modernity, by illustrating the issue of non-heterosexual ageing. The article employs personal narratives of lesbians and gay men aged between their fifties and eighties to demonstrate the importance of material, social and cultural resources in shaping their negotiations of ageing and later life. It indicates how sexuality, gender and age interact in influencing these, and argues that non- heterosexual experience illuminates possibilities that exist for both the reconfigu- ration and resilience of {‘}given{’} meanings and practices in relation to gender and ageing. It therefore provides insights into the uneven possibilities of reworking and/or undoing cultural meanings and social practices that shape gendered experiences of ageing and later life.

Nurse Education in Practice, 40 (2019) 102625. doi:10.1016/j.nepr.2019.102625

e or in a nursing home, hospital, or hospice. Although research on the needs of LGBTQ people at the end of life is sparse, drawing on what is available this article explores some of their unique concerns that practitioners should consider during their interactions….

By allowing lesbian, gay and bisexual older people and their partners to remain hidden in health and social care, nurses risk ignoring their specific needs, which encompass a variety of biological and psychosocial issues, as Thomas Hutchins explains

Les a{\^\i}né-es trans sont une population en devenir constituée d{’}individus aux identités, réalités et trajectoires très diversifiées. Cet article basé sur une recension des écrits, présente tout d{’}abord cette diversité, notamment en ce qui a trait à l{’}âge, tant à l{’}appartenance générationnelle qu{’}à l{’}âge du début de la transition. On y traite ensuite de la santé physique des a{\^\i}né-es trans, soit des problèmes et des besoins de santé qui leur sont propres, puis des barrières auxquelles ils et elles se heurtent dans leurs démarches pour avoir accès à des soins et des services de santé adéquats. Le~texte relève certaines difficultés comme l{’}isolement et le manque de soutien qui sont souvent le lot des a{\^\i}nés trans ainsi que les obstacles dans leur accès aux services sociaux et aux soins liés au vieillissement. L{’}article propose des pistes d{’}action pour les personnes professionnelles dans le domaine de la santé et des services sociaux et se conclut sur des pistes de recherche.

Background. Medical gender-affirming interventions (GAI) are important in the transition process of many trans persons. The aim of this study was to examine the associations between GAI and quality of life (QoL) of transitioned trans individuals. Methods. 143 trans persons were recruited from a multicenter outpatient Swiss population as well as a web-based survey. The QoL was assessed using the Short Form (36) Health Survey questionnaire (SF-36). Depressive symptoms were examined using the Short Form of the Center for Epidemiologic Studies-Depression Scale (ADS-K). Multiple interferential analyses and a regression analysis were performed. Results. Both transfeminine and transmasculine individuals reported a lower QoL compared to the general population. Within the trans group, nonbinary individuals showed the lowest QoL scores and significantly more depressive symptoms. A detailed analysis identified sociodemographic and transition-specific influencing factors. Conclusions. Medical GAI are associated with better mental wellbeing but even after successful medical transition, trans people remain a population at risk for low QoL and mental health, and the nonbinary group shows the greatest vulnerability.

In a survey exploring the reliability and validity of a screening tool, we explored the substance abuse and mental health issues among 371 elders; 74 were sexual minorities. Analyses by age group indi- cated that elders 55{–}64 years had significantly more problems with substance abuse, posttraumatic stress disorder (PTSD), depression, anxiety, and suicidal thoughts compared to those 65 and older. Bisexuals reported significantly greater problems with depression, anxiety, and suicidality than either heterosexual or lesbian or gay elders. Mental health and substance abuse treatment utiliza- tion was low among all elders with problems. Implications for assessment, access to care, and group-specific services delivery are discussed.

Much research on older gay, lesbian, bisexual and transgender (GLBT) adults has focused on refuting the widely held mis- conceptions people have about GLBT lifestyles. To date, however, few studies on older GLBTs have examined their social and health care needs. Further, most studies have collected survey samples of older GLBT adults in large metropolitan areas and have not specifically ad- dressed discrimination or bias in retirement care facilities. In the current exploratory study on perceptions of discrimination and bias in retire- ment care facilities, we surveyed a wide age range GLBT adults in a smaller metropolitan area of fewer than 400,000 people to discover the perceptions of both younger and older GLBTs. We surveyed perceptions of discrimination in retirement care facilities, sources of perceived dis- crimination, and suggestions for how discrimination might be reduced or eliminated in those settings. Respondents indicated that administra- tion, care staff, and residents of retirement care facilities themselves were all potential sources of discrimination, and that education address- ing awareness and acceptance of GLBTs is one potential remedy for dis- crimination against GLBTs in retirement care facilities. Respondents also indicated a strong desire for the development of GLBT-exclusive or GLBT-friendly retirement care facilities. Chi-square analyses of re- sponses to the discrimination questions and respondents{’} demographic characteristics revealed significant differences with regard to age, in- come, gender, community size, and education level of the respondents.

Proactively making end-of-life (EOL) preparations is important to ensure high quality EOL care. Critical to preparation is the discussion of preferences with one{’}s primary health care providers. Lesbian, gay, bisexual, and transgender (LGBT) people often experience discrimination from health care providers that will detrimentally affect their ability to commu- nicate their care preferences. Structural barriers, such as those based on sexual orientation and gender identity, may impede timely and quality care when one is most in need. The aim of this study was to examine the prevalence of EOL preparatory behaviors among LGBT people, with particular focus on transgender individuals. Eight survey instruments with 30 prevalence estimates found in the literature were analyzed. EOL discussions between LGBT people and their primary health care providers were rare (10%). Transgender people were found to be even less prepared for EOL; they were 50{–}70% less likely than their LGB counterparts to have a will, a living will or to have appointed a healthcare proxy. A need exists for future mixed-methods research focused on LGBT populations accompanied by the cultural sensitivity needed to ensure their wishes are honored at the EOL.

There remains a salient need to conceptualize lesbian, gay, bisexual, transgender, and queer (LGBTQ) aging as an area of study. Although the limited body of theoretical literature in this field has delineated systemic silence or invisibility as a prominent feature of marginalization among LGBTQ elders, this model{&}nbsp;does not appear to account for mechanisms of surveillance and control that often regulate sexuality and gender identity in old age. This paper represents a preliminary attempt at developing a framework of LGBTQ aging that addresses social processes in which queerness{&}nbsp;and gender variance are monitored and limited in later stages of the life course. The analysis is guided by the Foucauldian notion of neoliberal governmentality, which enables consideration of bodies of discourse and technologies of power that together drive these systemic phenomena in contemporary political and economic contexts. The paper concludes with implications of this analysis on theory and empirical inquiry in the field of LGBTQ aging.

This article reflects on the experience of undertaking a knowledge exchange project with a local government authority to improve services for older lesbian, gay, bisexual and trans (LGBT) adults. It frames this project in terms of local government equality work, existing research and initiatives concerning older LGBT people and the coming of austerity. The project methodology is detailed, including discussion of the generation and measurement of impact. Some critical issues that arose during the project are considered, including suggestions that these may have been related to economic austerity. The article concludes that although knowledge exchange work with older LGBT people faces challenges in such times, future research and initiatives are warranted.

Purpose {–} The purpose of this paper is to contribute to debates about lesbian, gay, bisexual and transgender (LGBT) housing later in life by placing these in a theoretical context: social capital theory (SCT). Design/methodology/approach {–} After a discussion of SCT, emanating from the works of Robert Putnam and Pierre Bourdieu, the paper draws on existing studies of LGBT housing later in life, identifying key concerns that are identified by this body of literature. Findings {–} The paper then applies SCT to the themes drawn from the LGBT housing later in life literature to illustrate the usefulness of putting these in such a theoretical context. Originality/value {–} Hence, overall, the paper fills an important gap in how the authors think about LGBT housing later in life; as something that is framed by issues of social networks and connections and the benefits, or otherwise, that accrue from them.

In recent years there has been a growth in organizational discourse concerning the lives of older lesbian, gay and/or bisexual (LGB) adults, which has started to address the serious omission and invisibility of this group of people in research, policy making and service provision. Whilst this development is welcomed, it inevitably draws attention to the identification {‘}older LGB adults{’} on which it is based. Using insights from queer theory, in addition to the sociological perspectives of ethnomethodology and conversation analysis, this article troubles or {‘}queers{’} such identifications. It does this, not only theoretically, but empirically, by conducting a membership categorization analysis (MCA) of some data emanating from a small organizational scoping study of older LGB adults. The ramifications of this for organizational research, policy making and practice are considered in the conclusion.

The lesbian and gay population is largely invisible in the gerontological literature and in planning and provision of aging services. A recent survey of providers of aging services in a large midwestern metropolitan area provides insight into providers{’} beliefs, preparation, and experience with serving old lesbian and gay people. Few agencies that participated in the study provided services targeted to this population, and some agencies were unwilling to consider their unique needs. Participating agencies generally recognized a need for greater knowledge and specific training in working with aging lesbian and gay people. Providers diverged over whether separate services should be established for the old lesbian and gay population. Providers consistently expressed values of care, inclusiveness, sensitivity, respect, and provision of service to everyone. The study results provide direction for future training and research with providers of aging services.

This study examines how married couples{’} age differences and gender dynamics influence retirement co- ordination in Sweden. High-quality longitudinal administrative registers allow us to study the labor market outcomes of all marital couples in Sweden. Using regression analysis, we find that the likelihood of couples retiring close in time decreases as their age difference increases but that age differences have a similar effect on retirement coordination for couples with larger age differences. Additionally, retirement coordination is largely gender-neutral in opposite-sex couples with age differences regardless of whether the male spouse is older. Additionally, male same-sex couples retire closer in time than both opposite-sex couples and female same-sex couples. The definition of retirement coordination as the number of years between retirements contributes to the literature on couples{’} retirement behavior and allows us to study the degree of retirement coordination among all couples, including those with larger age differences.

Conclusions. Resilience was a significant factor in how well older gay men aged even in an environment where homophobia and heterosexism were common. Having a strong social support network was an important factor that contributed to supporting the ageing process. These gay men were wary about having to go into residential care, preferring to age in their own homes. Relevance to clinical practice. Nurses and other healthcare professionals need to ensure healthcare services meet the needs of older gay men. Any interaction with older gay men should occur in a way that is open and respectful. The usage of best practice guidelines will assist organisations to deliver culturally safe and appropriate care to this group.

Available studies suggest that around 10 per cent of the population might self-identify as a lesbian woman or gay man (Davies and Neal, 1996). It follows that social workers will engage with older people who are homosexual. It does not follow that they will know who they are, as this is a group often characterized by its invisibility. This paper reports the results of a small-scale, exploratory study which examined how older les- bian women and gay men perceived their needs should they become ill or disabled as they age (Langley, 1997). Their concerns were viewed in the context of their past as well as present lives, and oppression was a unifying theme. Some of the findings are examined in order to highlight key challenges for social work practice. These include: (i) working with invisibility and fear of oppression; (ii) developing awareness and recog- nition of lesbian and gay relationships and supportive networks; (iii) the need for anti- oppressive empowering services which match the needs and circumstances of older lesbian women and gay men; (iv) importantly, the need for greater awareness of the heterosexist assumptions which influence institutional responses and individual prac- tice.

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Claudia Krell Alter und Altern bei Homosexuellen Claudia Krell Alter und Altern bei Homosexuellen Claudia Krell Alter und Altern bei Homosexuellen Die Autorin Claudia Krell, Jg. 1979, Dr. phil., ist Leiterin

it is estimated that up to 10 percent of the american population is lesbian, gay, bisexual, ort ransgender (lgBt) and that up to 7 million members of this population are elderly. Both the institute of Medicine and healthy People 2020 have addressed the health disparities that affect elderly members of the lgBt community. nurses are well positioned to bridge health disparities and provide culturally sensitive care across the lifespan, but compared with that of other disciplines, the nursing literature is lacking in content addressing lgBt health. eliminating health disparities in the care of lgBt elders should be a priority in nursing education.the authors review the issues lgBt elders face and rec- ommend how content related to lgBt aging can be integrated into nursing curricula.

Geschlechtliche und sexuelle Vielfalt sind in der Alterns- und Pflegeforschung bislang eher randständig behandelt worden. Nicht-heterosexuelle Senior*innen und Pflegebedürftige berichten hinsichtlich der Gesundheitsversorgung im Alter von der Angst vor Ablehnung und der Abhängigkeit von Dritten, die ihre Lebenslage nicht in adäquater Weise erkennen.

This study examines the potential health-related impact of recent versus lifetime experi- ences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimin- ation uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological dis- tress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distin- guishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.

Peu de recherches ont porté sur les profils et les préoccupations de santé parmi les hommes homosexuels et bisexuels vieillissants. Dans le cadre d{’}une enquête en ligne pancanadienne, 411 répondants âgés de 55 ans et plus ont répondu à un questionnaire portant sur l{’}évaluation de ces deux problématiques. Les résultats montrent que les écarts avec la population hétérosexuelle du même groupe d{’}âge se situent en particulier dans le champ de la santé mentale, où les problèmes sont plus prononcés, des différences qui se retrouvent aussi entre les 55-64 ans et les 64 ans et plus dans notre échantillon. Ces résultats peuvent contribuer à développer des interventions mieux ciblées visant à favoriser le bien-vieillir parmi ces minorités sexuelles.

This article examines the literature relating to the attitudes of nurses currently practicing in nursing homes towards caring for gay men and lesbians in Ireland. Nurses{’} knowledge of and attitudes towards the sexuality of those in their care can potentially have an impact on the quality of care they deliver and the patient experience.There is a consensus in the literature regarding the expression of sexuality as a lifelong need and integral element of quality of life. Research to date focusing on the needs of older gay or lesbian individuals has been virtually non-existent, despite increases in life expectancy and increasing numbers of older people, and therefore older gay and lesbian people requiring nursing home care.

Conclusion: This review highlights key mental health-related issues that need to be taken into account in the creation and provision of appropriate, responsive and inclu- sive supports and services. Impact: What were the main findings? Some older people who identify as LGBTQ + have experienced stigma, discrimination, and minority stress. However, many have developed coping strategies and resilience while others have developed mental health issues. It is necessary to have in place appropriate interventions and supports to effectively meet the needs of this population. Where and on whom will the research have impact? The review has significant im- plications for health and nursing policy and inform developments in nursing practice and nurse education.

Background: Living alone is a risk factor for depressive symptoms among older adults, although it is unclear if it is a risk factor for older gay men. A sense of belonging to the gay community is protective and might compensate for living alone. This research investigated whether a sense of belonging with gay friends weakened the relationship between living alone and depressive symptoms among older gay men. Methods: A community sample of 160 Australian gay men aged 65{–}92 years completed the Center for Epidemiologic Studies Depression Scale and two visual analogue scales assessing a sense of belonging with gay friends. Results: Results supported the moderation model, with increasing levels of belonging with gay friends weakening the relationship between living alone and depressive symptoms. Conclusion: Results imply that enhancing a sense of belonging with gay friends among older gay men who live alone is likely to be a protective factor in relation to depressive symptoms.

Aims and objectives To synthesise and evaluate the extant literature investigating the psychosocial influences on ageing as a lesbian, gay or bisexual person, to develop understanding about these in…

Study of the attitudes of the LGBT community toward aging and retirement

Der sich vollziehende demografische Wandel führt dazu, dass 2050 ca. 30 % der Schweizer Bevölkerung 65{&}nbsp;Jahre und älter sein werden. Diese Entwicklung führt auch dazu, dass die Anzahl älterer Menschen zunimmt, die sich als lesbisch oder schwul identifizieren und die ihr Leben auch im Alter mit einer/m gleichgeschlechtlichen Partner/in teilen. So werden in der Schweiz 2050 ca. 90.000{–}300.000 homosexuelle Personen 65{&}nbsp;Jahre und älter sein. Der vorliegende Beitrag zeigt auf, dass in der Gerontologie im Bereich der Homosexualität und in der Homosexualitätsforschung für die Lebensphase Alter Forschungslücken bestehen. Aufgrund dessen fokussiert der Beitrag auf das dritte und vierte Lebensalter bei Homosexuellen beiderlei Geschlechts. Er zeigt anhand aktueller internationaler Forschungsdaten auf, dass Homosexuelle in der Lebensphase Alter vor speziellen Herausforderungen stehen und besondere Bedürfnisse haben, die bei ambulanten und stationären Angeboten berücksichtigt werden sollten. Es zeigt sich in der bisherigen Forschung, dass Homosexuelle, bedingt durch ihre Lebensweise, häufig Single sind, keine biologischen Kinder haben, häufig allein leben und v.{&}nbsp;a. bei Pflegebedürftigkeit Angst vor Diskriminierung und Stigmatisierung haben. Erschwerend kommt hinzu, dass sich in Studien zeigt, dass der Gesundheitszustand schlechter ist als bei altersgleichen Heterosexuellen, was sich in einem frühzeitigen und erhöhten Pflegebedarf äußern kann.

Lesbian, gay, bisexual, and transgendered (LGBT) older adults have unique and varying physical and mental health needs. Yet their experiences have often been ignored in gerontological as well as LGBT studies. This book uses a life course perspective to investigate how LGBT older adults have been shaped by social stigma and systematic discrimination. The book explores not only the challenges and needs of this population but also their strengths and resilience. The intersection of cultural factors and personal attributes is emphasized.

This qualitative study explores the social lives of older gay men. In-depth interviews were conducted with 10 gay men over the age of 65 to elicit details about their relationships with other people. Findings paint a complex picture of older gay social life that is compounded by significant events affect- ing gay men from a particular socio-historical period. Three overarching themes emerged that capture the social lives of the participants: (1) coming of age as a gay man in the 20th century; (2) dealing with the aging body; and (3) enduring loss and the consequent impact on social life. The participants reported that being in a gay environment and closing the gay generational divide helped them adjust to their changing social lives in later life. This study adds to the ongoing discus- sion about the experiences of older gay men and makes suggestions for future research and practice considerations.

Human immunodeficiency virus (HIV) was once thought of as a condition predominately affecting the young. However, HIV among the older population is increasing. Older gay male adults living with HIV have received little attention from those who provide and commission services. However, with effective treatment, those gay men aged over 50 are the fastest growing group of people with HIV in the UK. Nurses will be required to offer care in a number of ways to this cohort of patients. In so doing, nurses will need to develop innovative and effective ways of supporting this growing group of people. This article provides an overview of the issues that can impact on the health and wellbeing of the older gay man living with HIV. The article discusses the epidemiology, the issue of HIV stigma, comorbidities and mental health and wellbeing needs.

Ageing brings about a number of challenges for heterosexual, lesbian, gay and bisexual people. It can be a time of anxiety and concern. The expectations that many lesbian, gay and bisexual people have of how they would like to be cared for if they were to enter sheltered housing or other forms of residential care can be very different from the expectations of heterosexual people. This article considers issues that older lesbian, gay and bisexual people may encounter with regard to their health-care needs.

The needs of LGBT people living with dementia are poorly recognised due, in part, to assumptions that all older people are heterosexual, together with persistent ageist stereotypes that older people are asexual. LGBT older adults are more likely to reside in care homes as a quarter of gay and bisexual men and half of lesbian and bisexual women have children, compared to 90% of heterosexual women and men. Older LGBT people may be unwilling to express their identity within care settings and this can have an impact on their ongoing care. Recognition of the members of an older person{’}s informal care network is crucial for their ongoing involvement in the life of a person resident in a care setting. However, healthcare professionals may not always appreciate that LGBT people may rely more on their family of choice, or their wider social network, than their family of origin. This article explores socio-legal issues that may be encountered when caring for older LGBT people living with dementia, including enabling autonomy, capacity and applying the legal frameworks in ways which support the identities and relationships of these older people in care.

Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwell- ing LGBT older adults{’} anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mis- treatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including sui- cide ideation. Discussion: This study adds to the existing litera- ture about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the pro- cedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for prac- tice, policy, and training.

ABSTRACT This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support. Data were gathered through seven groups with a sample of SGM-identified adults age 55 and over (N =~50) and analyzed using thematic analysis. The participants seek affordable and inclusive housing options. They identified that access to transportation is paramount in maintaining social support and accessing healthcare. Findings underscore the need for strategies to serve the housing needs of low-income SGM-identified older adults in a nondiscriminatory way, train housing providers in culturally responsive care, meet transportation needs, and provide SGM-inclusive community-based services that reduce isolation.

Like all spaces, concrete caring places both shape and are shaped by understandings and constructions of normativity and identity. The traditional understanding of care for older people, imagining clearly demarcated dyadic roles, is firmly embedded in heterosexual logics of relationships within families, the own (family) home and institutional support. Social and residential places for older people thus both assume particular gender and sexual identities and contribute to a (re)production of the very normativity. But how can this interlinkage between the construction of caring spaces and the normativity of identities be understood and, possibly, challenged? In this article we discuss the transformative potential of the social (and partly residential) space of La Fundación 26 de Diciembre, in Madrid, Spain, which opened up to specifically support older LGBT people. Drawing on an in-depth case study we explore a space that allows visibility of different forms of living and caring practices of people with different genders, sexual preferences, origins, classes or political backgrounds. Through the daily life narratives of the people who work, volunteer or simply use the centre we discuss the potential of challenging the restricted notions, assumptions and constructions through which particular places gain both social and political meaning. The article highlights the transformative power of the active and collective making of caring spaces through which narratives of care, collective sexual and gender recognition and practices of caring relationships can replace both traditional/informal forms of living together and institutional spaces that provide professional care.

We evaluate the association between emotional and instrumen- tal support and perceived health and depression symptoms in a sample of 182 gay/bisexual men age $\ge$ 55. Perceived health was positively correlated with number of sources of emotional sup- port and depression was negatively associated with instrumental support and health care providers{’} knowledge of patients{’} sexual orientation. Depression mediates the connection between providers{’} knowledge of patients{’} sexual orientation and perceived health. Number of sources of emotional support varied negatively with age and ethnic minority status, and positively with living with a part- ner. Instrumental support seemed to be dependent on living with a partner.

Older lesbian, gay, bisexual, and transgender (LGBT) adults face unique issues that can impede their well-being. Although many advances have helped address these issues, there is a need for education efforts that raise awareness of service providers about these issues. This study explores evaluation data of training panels provided by older LGBT adults and the views of training partici- pants on issues faced by the older LGBT community after attending the panels. Participants were 605 students and professionals from over 34 education and communication settings. Implications for trainings on participants and older LGBT trainers are discussed.

Studies of heteronormativity have emphasized its normative content and repressive functions, but few have considered the strategic use of heteronormative and homonorma- tive precepts to shape sexual selves, public identities, and social relations. Adopting an interactionist approach, this article analyzes interviews with homosexual elders to uncover their use of heteronormative premises (specifically, the presumption of hetero- sexuality, and the gender binary) to pass as heterosexual. Informants also used homonor- mative precepts, grounded in a postwar, pre-gay liberation assimilationist homosexual politics they adopted in their early years and maintained in later life, to justify passing and to frame their understanding and evaluation of past and present homosexual practices. Viewed through a homonormative lens, heteronormativity provided the tools for personal survival in a hostile society and for the collective production of a respectable homosexual culture. Informants{’} strategic use of heteronormativity can help explain heteronormativity{’}s survival despite the incoherence and fragility of its content.

Summary This chapter contains section titled: Gay Life and Historical Change (Homo)Sexual identity Careers Identity and Family Being Old and Gay Future Cohorts

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospi- talizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services net- work. This article provides exemplars from empirical data on older les- bians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.

Cet article interroge le vieillissement d{’}hommes gays en bonne santé en France. Il met en perspective les représentations et les expressions du vécu de l{’}avancée en âge en s{’}appuyant sur les apports des recherches sur l{’}homosexualité, le gen- re et la vieillesse. Deux approches méthodologiques sont mobilisées. La pre- mière s{’}appuie sur une littérature scientifique en mettant en perspective diffé- rents modèles du vieillissement. La seconde se fonde sur l{’}analyse de données recueillies entre 2013 et 2015 au moyen d{’}une enquête quantitative et qualita- tive. L{’}analyse montre que les modèles du vieillissement LGBT ont changé en raison de la plus grande acceptation de l{’}homosexualité comme mode de vie et en raison d{’}une plus grande sociabilité homosexuelle des personnes âgées favo- risée par les réseaux sociaux et Internet. Ainsi, pour bon nombre d{’}homo- sexuels âgés, vivre leur identité gay s{’}avère plus aisé désormais que durant leur jeunesse.

Les résultats d{’}enquêtes menées en Allemagne sur la sexualité et la conjugalité chez les personnes âgées montrent que, quelle que soit l{’}orientation sexuelle, les variations de l{’}activité sexuelle sont bien plus liées au statut conjugal qu{’}à l{’}âge. 50% des hommes et femmes de soixante ans qui se déclarent en couple disent avoir une activité sexuelle élevée ! Aussi, c{’}est avant tout la perte du partenaire (mort, séparation) qui est le facteur principal empêchant les personnes âgées de continuer à avoir des relations sexuelles (72% des célibataires de 60 ans disent n{’}avoir plus eu de relations sexuelles depuis un an). Or, que ces personnes soient en couple ou célibataires, ils et elles considèrent que la sexualité est quelque chose d{’}important qui participe de la bonne santé individuelle et de celle d{’}un couple. Cependant, en Allemagne comme en France, hommes et femmes ne sont pas égaux sur le marché de la sexualité, ni sur celui du couple et encore moins sur celui de la rencontre… Et les choses semblent encore se complexifier lorsque l{’}on est gay ou lesbienne et âgé-e. En croisant les résultats d{’}enquêtes menées auprès de personnes hétérosexuelles et de personnes homosexuelles, il est possible de voir qu{’}en vieillissant les aspirations ne sont pas les mêmes selon que l{’}on est homme ou femmes, hétéro ou homo. Cependant, une chose semble commune à tous, avec l{’}âge être en couple est un plus, le ou la partenaire devenant la ressource sociale la plus importante (suivi des enfants et petits-enfants) et cela quelle que soit l{’}orientation sexuelle.

The purpose of this article is to describe how heterosexism impedes the provision of culturally competent care for lesbian, gay, bisexual, transgender, and queer (LGBTQ) residents in long-term care (LTC) facilities. LTC facilities continue to employ staff members who lack an understanding of sexuality and sexual diversity in the elderly. In this article, we identify the heterosexual assumption, namely heterosexism, as the primary issue surrounding the holistic care of the LGBTQ elder in LTC. We first review the literature related to LGBTQ elders in LTC facilities, identifying the themes that emerged from the review, specifically the definitions of homophobia and heterosexism; perceptions of LGBTQ elders as they consider placement in LTC facilities; and staff knowledge of and biases toward sexuality and sexual diversity in LTC settings. Then, we suggest approaches for changing the culture of LTC to one in which LGBTQ elders feel safe and valued, and conclude by considering how facility leaders are in a unique position to enable LGBTQ elders to flourish in what may be their last home.

Conclusions: Irish healthcare services need to reflect on how they currently engage with older LGBT persons at both an organisational and practitioner level. Consideration needs to be given to the specific concerns of ageing LGBT persons, particularly in relation to long- term residential care. Implications for practice: Healthcare practitioners need to be knowledgeable of, and sensitive to, LGBT issues.

Mental health providers in LTC facilities would benefit from more training in LGBT-specific mental health problems and evidence-based treatments, and efforts to destigmatize LGBT identities in these settings might improve access to mental health care

Résultats : les recommandations ont été regroupées en cinq axes : se sensibiliser à l{’}existence des PADSG, à leur contexte historique et à leurs problèmes de santé ; s{’}abstenir de préconceptions hétérocissexistes et hétérocisnormatives en adoptant un langage inclusif et une attitude ouverte ; soutenir les PADSG et leurs proches aidants ou leur famille de choix ; créer un environnement sécuritaire et confidentiel ; et promouvoir l{’}inclusion des PADSG dans le système de soins de santé. Conclusion : les infirmières et autres professionnels de la santé pourraient utiliser les résultats obtenus pour optimiser la qualité des soins dispensés aux personnes âgées issues des minorités sexuelles et de genre.

Fifty-three staff members currently working in residential aged care facilities located in Barcelona, Spain, were asked about the way they would react if a resident told them that he or she felt sexually attracted and had maintained sexual relationships with another resident of the same gender. Acceptance of non-heterosexual sex- ual orientation was a frequent answer, and around one in four professionals stated that they would try helping the resident in question, by offering a private space or giving some emotional sup- port. However, some reactions were not consistent with a respectful approach toward sexual diversity, as, for instance, informing the resident{’}s family or advising the resident to keep his or her sexual orientation hidden. We highlight the importance of developing for- mal policies and offering formal training to staff in order to address the specific needs of older LGB people living in RACFs.

Aim: This article provides an overview of how gender and historical contexts influence the well-being of old lesbians. It aims to inform the practice of aged care providers in addressing the needs of these women. Methods: The lived experience of old lesbians is examined using feminist methodology with a focus on hegemonic femininity, social structures and cultural life. Results: Old lesbians being selectively {‘}open{’}, their use of health services and desire for lesbian-specific aged care are all influenced by lesbophobia, a complex of discriminations. The age women began living as lesbian and fluidity of orientation, are central to understanding their particular needs. Many old lesbians have created social groups and intentional communities where there is support and freedom. Conclusion: The current {‘}inclusivity{’} approach is insufficient for culturally appropriate aged care for old lesbians. Developing practices that meet their needs requires better understanding of lesbians{’} different life courses and why they created lesbian cultures.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and expe- riences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential- care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential- care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings sug- gest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experi- ences of services, whether these are needed presently or in the future.

Despite sensationalized media attention, transgender individuals are the most marginalized and misunderstood group in the lesbian, gay, bisexual, and transgender (LGBT) community. The current article presents a case study of one woman{’}s quest for identity. Narrative inquiry was used to ana- lyze data from interview transcripts and four themes emerged during analysis: (a) naming the ambiguity, (b) revealing{–} concealing the authentic self, (c) discovering the transgender community, and (d) embracing the {\textquotedblleft}T{\textquotedblright} identity. Lifespan and empowerment theories were used to harvest meanings from these themes. Implications for nursing practice and research were examined based on study findings. Participatory ac- tion research offers an approach for future studies in which researchers advocate for transgender individuals and remove obstacles to their health care access

Journal of Elder Abuse {&} Neglect, 2018. doi:10.1080/08946566.2018.1543624

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This paper is a conceptual discussion of the ways in which the diverse lives, identities and collective politics of lesbian, gay and bisexual (LGB) people can be made visible, and how they are made visible, in long-term care environments for older people. The purpose of this paper is to problematise strategies of visibility as methods for promoting social inclusion in care environments.,This is a conceptual discussion that draws on several social theorists that have previously discussed the politics of visibility, knowledge and sexuality.,Promoting increased visibility in itself does not fully grapple with the ways in which older LGB can be represented and known as particular kinds of sexual citizens. This potentially curtails a more holistic recognition of their needs, interests and wishes, inclusive of their sexual lives and histories. Making LGB lives visible in care environments may not always be a productive or affirmative strategy for dismantling homophobic views and beliefs.,The theoretical implications of a politics of visibility warrant a deeper consideration of strategies for promoting visibility. The paper concludes with a discussion of some of the practical implications for rethinking strategies of visibility in care environments.,Critical discussions about the application of visibility strategies, and the problematic assumptions contained within such strategies, are lacking in relation to mainstream housing and social care provision for older LGB people. This paper seeks to initiate this important discussion.

This paper centres on a neglected area of social work with older people{—}the social inclusion of older lesbian, gay and bisexual (LGB) adults in long-term care environments. The translation of equality law into the delivery of adult care services is a challenging endeavour for organisations, even more so in the morally-contested terrain of sexual wellbeing. In this paper we report findings from a mixed method study into the provision of long-term care for older adults who identify as LGB. Herein we present findings from a survey of care workers and managers (n=121) and from focus groups with equality and LGB stakeholder representatives (n=20) in Wales. Focussing on the current knowledge and understanding of staff, we suggest that affirmative beliefs and practices with sexual minorities are evident amongst care workers and managers, however the inclusion of LGB residents needs to be advanced systemically at structural, cultural and individual levels of provision. There is a need for enhancing awareness of the legacy of enduring discrimination for older LGB people, for cultural acceptance in care environments of older people{’}s sexual desires and relationships, and for a more explicit implementation of equality legislation. Social workers in adult care can advance this agenda.

This paper examines the ways in which older people{’}s residential and nursing homes can constitute heteronormative environments {–} social spaces in which the same-sex attractions and desires of residents are disregarded in the provision of everyday care. The aim of this discussion is to examine the synergies and differences between older lesbian, gay and bisexual (LGB) adults{’} expectations for future care home provision and the expectations of care staff and managers in providing residential services to older people with diverse sexual backgrounds. We present qualitative evidence from research into the provision of care environments in Wales. In this paper, we present findings from two cohorts: first, from five focus groups with care and nursing staff and managers; and second, from 29 semi-structured interviews with older LGB adults (50{–}76 years) residing in urban and rural locations across Wales. We argue that residential care environments can constitute heterosexualised spaces in which LGB identities are neglected in comparison to the needs and preferences of other residents. To this extent, we discuss how care staff and managers can be more attentive and responsive to the sexual biographies of all residents and argue against the separation of care and sexual orientation in practice.

Le vieillissement de la population canadienne et l{’}hétérogéneité des a{\^\i}nés amène une diversité accrue en fin de vie. L{’}objectif de cette étude était d{’}aider à combler les lacunes présentes dans la recherche du vieillissement et la fin de vie des personnes LGBT. À l{’}aide des groupes de discussion, nous avons tenté de mieux comprendre les expériences vécues des individus LGBT plus âgés, afin de mettre en évidence leurs inquiétudes associés aux dernières phases de la vie. Notre analyse démontre que l{’}identité LGBT est déterminante lorsqu{’}on considère le vieillissement et les soins en fin de vie. En particulier, l{’}identité de genre et l{’}orientation sexuelle sont des facteurs importants par rapport aux liens sociaux, influençant les attentes des individus envers les soins qu{’}ils reçoivent, à la crainte unique associée à la révélation de son homosexualité et le maintien de l{’}identité tout au long du vieillissement et des dernières phases de la vie. Cette étude souligne le besoin de considérer l{’}identité du genre et l{’}orientation sexuelle en fin de vie. En particulier, la reconnaissance de l{’}intersectionnalité et des lieux sociaux est essentielle afin de faciliter des expériences positives par rapport au vieillissement et des soins en fin de vie.

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