In November 2017, Prime Minister Justin Trudeau publicly apologized to LGBTQ2 members (lesbians, gays, bisexuals, trans, queers and two-spirited) about the systematic oppression and rejection the state has shown towards them. He pointed out that members of the LGBTQ2 community are, still today, the victims of violence and discrimination, as well as facing mental health problems and homelessness.(1)
Nationally available statistics on LGBTQ2 persons in Canada remain limited – previous census not including comprehensive questions on gender identity and sexual orientation. Current statistics allow us to estimate that LGBT people make up about 13% of the Canadian population (no such data being available to estimate the proportion of persons identifying as queer or two-spirited).(2) However, LGBTQ2 people seem invisible among older adults, many still being afraid to disclose their sexual orientation and gender identity. In addition, many fear moving to nursing homes where they may face discrimination, exclusion and prejudice.(3; 4)
To better support LGBTQ2 older adults, it is essential to better understand the challenges they face. Two systematic reviews, which included 34 and 41 studies respectively, provide some insights on the subject.(5; 6) These systematic reviews were conducted to better understand the psychosocial influences, needs, and experiences of aging experienced by non-heterosexual and transgender individuals.
What the research tells us
The first systematic review revealed that transgender and non-heterosexual people often experience more physical and sexual violence, as well as family and social isolation, discrimination, economic inequality and mental health issues.(5) Throughout their lives, these people also face barriers to accessing education, employment and housing, while having difficulty accessing adequate social support networks. In addition, some members of the transgender community appear to be confronted with discriminatory policies and practices in health and social services, and also with a lack of professional knowledge about their physiology or the long-term effects of treatments and hormones.
The second systematic review focuses on older adults from the lesbian, gay and bisexual communities.(6) The studies included in this review examine the psychosocial influences on aging among non-heterosexual individuals with respect to their identity (for example, their mental health and body image) and social factors (for example, intimate relationships, social support, discrimination, care received and delivered, access to healthcare services and housing). The findings suggest that lesbian, gay and bisexual older adults are doing well in managing their identity, as well as their mental and social health. That said, they still face different forms of discrimination in accessing health services, ranging from ageism to so-called "hetero-normative" discrimination (they may be confronted by norms and beliefs that impose heterosexuality as the only sexuality or legitimate way of life). A positive attitude towards oneself and one's sexuality seems to be the key to better mental health for lesbian, gay and bisexual older adults - just like being in a positive emotional or sexual relationship. A decrease in age-related cognitive skills (for example, decreased verbal skills, non-verbal reasoning, or memory) appears to exacerbate stigma and social isolation among lesbian, gay and bisexual older adults.
What can we do?
Although attitudes are changing and there is a growing recognition of the need to adapt the care provided to them, LGBTQ2 older adults still face negative experiences, including problems related to access to health and social services. Whether it is the prejudices or ignorance of a professional, or the impossibility of freely discussing their sexuality and their experiences, these and other factors tend to isolate them and prevent them from seeking care for fear of being treated differently or being ignored. Discrimination, exclusion and prejudice thus affect their mental and physical health, and lead to symptoms of anxiety or post-traumatic stress that may require specialized psychological interventions.
Health and social-service professionals can help LGBTQ2 older adults build on their resiliency in times of emotional turmoil, and to overcome the physical and cognitive challenges of aging. In addition, these professionals could become more sensitive to the fact that LGBTQ2 older adults have negative experiences related to access to services, and try to better engage their "chosen families" in care planning. Indeed, LGBTQ2 community members disproportionately experience rejection from their biological or adoptive families. As a result, many are building deep and lasting bonds with other members of their communities who will form their new and “chosen” families. Lastly, better training for professionals and implementing programs specifically designed for LGBTQ2 older adults may help them to remain healthy, active and engaged as long as possible.