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.

As lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities age, many individuals expect a need to enter the long-term care system toward the end of life. Not unlike most aging Canadians, this anticipation is met with concern and fear. However, previous research suggests that older LGBTQ + individuals have unique fears often related to personal safety and discrimination. This qualitative study examined the hopes and fears of older LGBTQ + adults considering long-term care as they face end of life. Data were collected from three focus groups in Ontario, Canada, and analyzed using inductive thematic analysis. Specific and frequent reference to fear of entering long-term care homes was common across all focus groups, as participants anticipated: social isolation, decreased independence and capacity for decision-making, increased vulnerability to LGBTQ+-related stigma as well as exposure to unsafe social and physical environments. The results from this study, therefore, emphasize the need for palliative care specialists and long-term care home staff to address the unique health needs of older LGBTQ + adults nearing the end of life in order to work toward allaying fears and creating supportive and inclusive long-term care environments.

Objective: The purpose of the study was to explore age differences in attentional demand in response to driving situations of varying complexity within the context of a simulated assessment protocol. It was hypothesized that as road complexity increased, an indicator of attentional demand (i.e., latency to respond to a secondary task) would increase and, independent of the road complexity, older adults would exhibit greater attentional demand in comparison with younger and middle-aged drivers. Methods: Drivers from 3 age categories (i.e., young, middle-aged, and older) completed an assessment protocol in a STISIM driving simulator (Systems Technology, Inc., Hawthorne, CA) during which participants responded to a series of strategically placed secondary tasks (i.e., peripheral detection tasks, PDTs). Situations where secondary tasks occurred were grouped according to whether they were straight-road, crossing-path, or lane-change events. Two global indices of driving safety as well as several cognitive measures external to the driving simulator were also collected. Results: The results supported the hypothesis in that complex driving situations elicited greater attentional demand among drivers of all ages. Older adults showed greater attentional demand in comparison to young and middle-aged adults even after controlling for baseline response time. Older drivers also scored poorer on a global measure of driving safety. Conclusions: The findings are highly consistent with the literature on road complexity and attention that show that increased driving complexity is associated with poorer performance on tasks designed to concurrently assess attention, an effect that is more pronounced for older drivers. The results point to intrinsic and extrinsic factors that contribute to motor vehicle collisions (MVCs) among older drivers. The relevance of these findings is discussed in relation to interventions and future research aimed at improving road safety.

This article shares key focus group findings from a national study focused on the housing needs of older (55+) lesbian, gay, bisexual, and transgender (LGBT) Canadians. LGBT populations have and continue to face systemic discrimination and barriers to appropriate housing across the life course, and yet little attention has been given to solutions. Many older LGBT adults live alone, face poverty, and have limited familial supports which impact on their housing options. The purpose of this research was to examine how the housing needs of older LGBT Canadians are addressed at community, organizational, and policy levels. Focus group participants in five Canadian provinces were asked to describe their experiences and perceptions of safe, affordable, affirming housing for older LGBT people. Five themes from the data help guide housing providers and policymakers in improving housing for older LGBT Canadians: (a) understanding lifelong and evolving fears of discrimination among older LGBT populations, (b) recognizing diversity among older LGBT populations, (c) operationalizing LGBT-inclusive housing philosophies, (d) addressing isolation and exclusion through housing interventions, and (e) providing LGBT people with tools to access appropriate housing. These themes offer practical policy and programming approaches to address the housing needs and concerns of older LBGT Canadians.