Lesbian, gay, bisexual, and transgender (LGBT) older adults face a number of challenges with respect to access to healthcare especially towards end-of-life. Through a systematic search and scoping review of the literature, we sought to answer two related research questions. In particular, the purpose of this scoping review was to determine the healthcare needs of LGBT older adults nearing end-of-life as well as the factors that contribute to a good death experience among older adults who identify as LGBT. A systematic search of electronic databases for articles published between 2005 and 2016 as well as screening for relevance resulted in 25 results. The data were charted and grouped according to the themes of: social support and chosen family, intimacy, health status, fear of discrimination and lack of trust, lack of knowledge and preparedness, and cultural competence in the healthcare system. The results suggest a role for health and social service workers in contributing to a positive care experience for LGBT older adults by becoming knowledgeable about the unique needs of this population and being unassuming and accepting of individuals’ sexuality. Many of the articles reviewed collected data outside of Canada, limiting generalizability and highlighting a need for Canadian data on LGBT aging and end-of-life.

RÉSUMÉ: Le vieillissement de la population canadienne et l’hétérogéneité des aînés 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.

Canada is experiencing population aging and evidence on the provision of care is based on data collected from majority populations. This analysis compared social networks and patterns of care provision between heterosexual and lesbian, gay, and bisexual (LGB) Canadians between the age of 45 and 85 years. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a large national study of health and aging. The results from analysis of baseline data showed that LGB participants were less likely to have children and reported seeing their friends more recently than heterosexual participants. Gay and bisexual men were more likely to provide care support in comparison to heterosexual men. LGB participants were more likely to provide care to friends. The results highlight the importance of considering distinct social networks in the development of policy and practice approaches to support a diverse aging population.

This research investigated the health and aging experiences of 21 lesbian, gay, bisexual, trans, and queer (LGBTQ) adults, aged 60 to 79 years, to identify their service and support needs. Participants engaged in focus groups in four locations in Ontario, Canada. Data were analyzed using inductive thematic approach. Participants anticipated age-related losses and expected a greater use of and dependence on health/social care services. Despite greater LGBTQ visibility and inclusive care, participants perceived care services and facilities as unsafe and without competent support. Participants described employing positive strategies to overcome discrimination, contributing to participants’ health and aging experiences.

Age-friendly initiatives have grown in popularity in their efforts to promote active aging among older adults in Canada and other countries worldwide. However, these initiatives often overlook underrepresented populations, such as lesbian, gay, bisexual, trans, queer, and two-spirit (LGBTQ2S+) older adults, who have unique social and historical contexts which impact their aging experiences. The study involved a survey and key-informant interviews with local leaders, volunteers, staff, and/or LGBTQ2S+ older adults involved in initiatives that were both age and LGBTQ2S+ friendly to explore what it means for a community to be age and LGBTQ2S+ friendly and learn what can further be done to promote these communities. Through a qualitative template analysis, our findings suggest that safety within the social environment should be at the forefront of age-friendly policy initiatives. Considerations and avenues to create this safety and an overall culture of acceptance for all older adults include recognizing generational differences among aging cohorts, increasing LGBTQ2S+ visibility and involvement and highlighting the importance of policy and cultural humility. These considerations and the voices of LGBTQ2S+ older adults need to be integrated into age-friendly community planning and policies to ensure they are inclusive and that all older adults feel safe and can thrive within their communities.

Within Canada, there has been increased Federal recognition and support for lesbian, gay, bisexual, transgender, queer, Two-Spirit (LGBTQ2+) individuals and communities. The recognition of previous systemic discrimination helps to illustrate the unique social and historical contexts those current older adults faced as they aged as members of LGBTQ2+ communities. Addressing the diverse and unique needs of LGBTQ2+ older adults is crucial to ensuring safety and well-being within formal and informal care settings yet, due to a lack of research evidence, this remains a challenge. In order to advance research and action on LGBTQ2+ aging in Canada, stakeholders were convened at a research-policy forum to establish a community of interest and catalyze activities to support a diverse aging population. Immediate concerns that were raised included: social isolation, healthcare, education and training needs for providers, stigma and discrimination, and housing. Other knowledge gaps included dementia care and the effects of cognitive impairment on sexual and gender identity, lived realities of older LGBTQ2+ ethnic minorities, and the experiences of older Two-Spirit Canadians. Attendees highlighted the importance of showcasing success stories of aging among LGBTQ2+ communities in addition to describing experienced challenges. Considering that members of LGBTQ2+ communities who experienced systemic discrimination and in or approaching old age, action on these fronts is urgently needed.