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nature outlook article

OUTLOOK 19 January 2022

Support for LGBTQ+ people in later

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The COVID-19 pandemic highlights the importance of tailoring health-care Ageing

services to older lesbian, gay and trans people as they age.

Trish Hafford-Letchfield Does the human lifespan have a limit?

How the COVID-19 pandemic might

In 2020, during the first COVID-19 lockdown in the United Kingdom, my colleagues and I age us
carried out a study of older people from sexual and gender minorities (LGBTQ+ people) about
their experiences during the pandemic1. One comment from an older trans women stays with
me: “I would much rather kill myself than go in a care home. I have written ‘Do Not Robots rise to meet the challenge of
Resuscitate’ on the wall above my bed so the ambulance people know what I want.” caring for old people

Our survey revealed many positives, including examples of informal care offered by the
LGBTQ+ community to its older members. But that comment was not a one-off. Along with Tackling the crisis of care for older
the findings of other studies I have led as an educator and social-work professional, it shows people: lessons from India and Japan
how far we still need to go for older LGBTQ+ people to feel confident and safe in the services
we provide.
The biological clean-ups that could
Our 2020 survey found social distancing meant that many older combat age-related disease
RELATED
LGBTQ+ people had to rely on health care and public services
that, in their gendered and normative fashion, were not tuned to
their needs. Many advocacy organizations who adapted their Research round-up: Ageing

services during lockdowns reported older LGBTQ+ people

hiding to avoid unwanted attention from neighbours and
community volunteers.
Turning back time with epigenetic
clocks
As the size of the ageing population grows, so does its diversity.
In the United Kingdom, for example, more than 120,000 people
over the age of 65 identify as LGBTQ+.
Part of Nature Outlook: Partner content: Recent research into nicotinamide
Ageing mononucleotide and ageing
Older LGBTQ+ people in various countries have witnessed
transformative legal, political and social changes during their
lives — although it is important to remember that in 69 countries, diverse sexual and gender Partner content: Viewing challenges as
identities remain illegal, some with dire consequences. springboards for innovation

In the United Kingdom, positive changes include the freedom to adopt as a same-sex couple
(in 2002), the introduction of civil partnerships (2005), and the legalization of same-sex Subjects
marriage (2014), alongside measures to tackle discrimination in employment, crime and
Society Ageing
health care. Today’s older LGBTQ+ people came of age as homosexuality was partly
decriminalized (1967). In the 1970s, many engaged in political and social movements such as
radical feminism, and they lived through the global AIDS crisis in the 1980s. Even so, many
older LGBTQ+ adults still face rejection from family members who refuse to accept their life
choices.
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Some cultivate alternative support structures, known as ‘friendship families’ or ‘families of
opinion and analysis, delivered to your inbox
choice’. Maintaining these networks can become more difficult as LGBTQ+ people age, owing
every weekday.
to the loss of roles in retirement, the death of loved ones, the onset of chronic health
conditions, and threats to their independence. As a result, lesbians and gay men are more
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likely than the general population to live alone in their later years, without a partner or
e.g. jo.smith@university.ac.uk
children. This deprives them of a source of support that care systems in the United Kingdom
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An older lesbian couple in the Gay Pride Parade in New York City, 2016
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As LGBTQ+ people age, maintaining support networks can become more difficult. Credit: Brigette
Supernova/ Alamy Stock Photo

Having confidence in health and social care services is important. Our 2020 review of health
inequalities in LGBTQ+ ageing found evidence of poorer health and health-care provision
compared with the general population, particularly with regard to cancer, dementia,
palliative care and mental-health services2.

In the United Kingdom, trans people report some of the highest rates of dissatisfaction with
health care. There is, on average, a four-year wait to access gender-identity services, which is a
problem for those who have waited until retirement to transition, perhaps to avoid the
trauma of doing so in the public arena of a workplace, or until their children have grown up.

In 2003, the psychiatric epidemiologist Ilan Meyer coined the

RELATED
term ‘minority stress’ to refer to lifelong exposure to prejudice
and discrimination3. Pressure to conform to stereotypical sex
and gender roles, and the sanctions people face when they don’t
conform, can lead to increased smoking, substance use and
obesity. These sources of stress often intersect with other
factors arising from power and privilege around race, culture,
More from Nature Outlooks
ethnicity, dis/ability, social class and geographical location.

Adverse experiences can lead LGBTQ+ people to develop resources such as social skills,
emotional resilience and political awareness. All of these can be crucial in later life as these
people continue to live a diverse lifestyle, either at home or in a care setting, and we should
take account of these life skills in our interactions with them.

I use education to address a growing appetite among health-care professionals to improve

services for older LGBTQ+ people. In 2018, for example, alongside academic colleagues, we
recruited eight LGBTQ+ older people who were trained during the study as community
advisers across six sites run by a large care-home provider4. The advisers used their own lived
experiences, expertise, patience and resilience to educate and challenge others to adopt a
more person-centred approach in the face of some common responses such as “we don’t have
people like that in here” and “we treat everyone the same”.

The project developed seven areas of good practice in LGBTQ+ inclusion in care homes:
policies and procedures; consultation; risk management; end-of-life support; cultural safety;
transgender-specific issues; and workforce development. Other schemes have since been
designed for the LGBTQ+ community, highlighting the need for inclusive spaces and
supportive environments where people can get what they expect as they age, such as respect
for their relationships, accessible health care and support.

Nature 601, S11 (2022)

doi: https://doi.org/10.1038/d41586-022-00073-y

This article is part of Nature Outlook: Ageing, an editorially independent supplement produced
with the financial support of third parties. About this content.

References

1. Hafford-Letchfield, T., Toze, M. & Westwood, S. Health Soc. Care Commun.

https://doi.org/10.1111/hsc.13531 (2021).
Article  Google Scholar 

2. Westwood, S. et al. J. Epidemiol. Commun. Health 74, 408–411 (2020).

Article  Google Scholar 

3. Meyer, I. H. Psychol. Bull. 129, 674–697 (2003).

PubMed  Article  Google Scholar 

4. Hafford-Letchfield, T., Simpson, P., Willis, P. B. & Almack, K. Health Soc. Care Commun. 26,
e312–e320 (2018).
Article  Google Scholar 

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COMPETING INTERESTS

The author declares no competing interests.

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