Far less, however, is known about how sexual identity-based inequalities shape the aging process (Barbee, 2022; Lytle et al
Acknowledgments
Special thanks go to my research participants-as this study would not have been possible without their time and support. I also thank Brian Powell, who helped inspire this project. I would also like to express appreciation for the feedback that Eliza Pavalko, Jaclyn Tabor, and Nichole Pena provided on the article. Finally, thank you to the anonymous reviewer and editor for their helpful feedback.
Scholars in recent years also investigate diversity in aging, emphasizing that gender, race, and social class shape aging experiences (Arber et al., 2003; Calasanti & Slevin, 2001; Mehrotra & Wagoner, 2019; Settersten & Trauten, 2009). Central to understanding variability in aging experiences is the cumulative inequality approach, which posits that the accumulation of inequality over the life course leads to worsened quality of life in late adulthood (Dannefer, 2003; Ferraro & Shippee, 2009). This theory also asserts that early life events shape outcomes in late adulthood, including health (Ferraro & Shippee, 2009; White et al., 2020). , 2018; Minkler & Estes, 2020).
Visions of End-of-Life Care
Transgender and nonbinary individuals were intentionally omitted from the study, as their experiences are qualitatively different from LGB people; gender-based concerns may instead drive their current aging experiences, which would have required that a different set of interview questions be asked. Simultaneously, there may also be overlap in cisgender LGB and transgender people’s visions of late life, an issue I return to in the discussion section.
Results
However, attitudes toward staying in long-term care homes are also driven by fears of facing institutional and attitudinal homophobia. For example, Bill (66, separated, gay man) expressed fears that predominately heterosexual nursing homes women swedish would be comprised of individuals who “lived in an era where it wasn’t cool to be gay.” He elaborated that LGB people were viewed as mentally ill during earlier periods, which he believed would affect the attitudes of older, heterosexual residents. In addition, Kathy (68, married, lesbian) remarked that “guys with AIDS have gone through absolute hell having to live in these facilities” when asked about her thoughts on staying in a paid care setting. She elaborated that they have been physically assaulted by nurses and expressed doubts that older LGB people would receive adequate care. Thus, the historical legacy of medical mistreatment of the LGBTQ community looms large and casts doubt on medical staff’s ability to provide equitable care and treatment. In short, participants wished to avoid retraumatization in medical settings (de Vries et al., 2019).
Aging in Place
As previously discussed, participants feared having to go back into “the closet” or facing abuse if staying in long-term care homes. Joe (60, married, queer-identified man) described LGB people’s experiences in medical facilities, noting that a number of staff “were abusive, and that a lot of the people who are residents are unaccepting.” Joe added that he is “not interested in that environment and if it gets to that point, I’d rather just kill myself.” Gloria (72, married, lesbian) also noted that she and her friends have decided that they will kill themselves before being willing to enter a nursing home. She described abusive conditions, remarking: “I’m not going to be out of it in a nursing home where you’d be drugged even more and maybe restrained and people not change you. I love life, but that’s not the life I want. That’s because they can extend life beyond what’s quality of life. And I don’t believe in that.” Here, we see that fears of ageist and homophobic abuse are prevalent among older LGB people, which push them to consider assisted suicide.
Queer aging also entails a uniquely interdependent approach to care as reflected in participants’ reported desires to “age in community”; that is, they wish to age in close proximity to similar others via LGBT-friendly retirement communities, gay neighborhoods, and cohousing. This interdependent approach to care departs from a tendency to want to preserve independence as long as possible, which is often found among heterosexuals (Black et al., 2015; Thomas & Blanchard, 2009). Similarly, participants push for a “cohousing movement,” which would allow individuals to pool their economic and social capital and, in turn, reduce the cost of housing (Black et al., 2015; Thomas & Blanchard, 2009). Such an approach to care would benefit the aging process of older LGB adults by offsetting some of the financial distress that is the result of life-long discrimination. Moreover, this interdependent approach to care may allow older LGB people to avoid poor mental and physical health that is often a consequence of isolation in late adulthood (Thomas & Blachard, 2009). Accordingly, “aging in community” can help facilitate successful and resilient aspects of aging for older LGB adults.
This article has broader implications for gerontological practice as it pertains to LGB people. It is important that staff in health care settings be educated on how to provide culturally competent care, use inclusive language, and the unique issues facing older LGBTQ patients (Lampe, 2022). This type of training is especially important in Southeastern and Midwestern regions of the United States, where it is likely that staff may harbor more homophobic attitudes and thus require greater education surrounding LGBT issues. The aforementioned cultural competency training would likely reduce homophobic discrimination in these settings, which could lead to greater utilization of these services by the LGBTQ population (Wilson et al., 2021). Greater attention to sexual diversity in end-of-life care experiences by gerontological researchers and practitioners alike would lead to enhanced quality of life for older LGBTQ people.
