Updated on September 8, 2015
With 4.9 million Canadians aged 65 and older in 2011 and close to 6,000 centenarians, Canada – like many countries – is facing an aging population.((Statistics Canada, “Age and Sex Highlight Tables, 2011 Census,” 2011 Data Products, page last updated November 23, 2016. Link: http://bit.ly/2xdzb01.)) Many older Canadians are managing chronic or episodic illnesses, disabilities or conditions that make for frequent encounters with the health care system. When seeking medical attention, LGBTQ+ seniors face discrimination that can act as barriers to care. The main hurdles for LGBTQ+ seniors include identifying oneself as gay, lesbian, bisexual, transgender or queer, and experiencing discrimination.((Shari Brotman, Bill Ryan and Robert Cormier, “The Health and Social Service Needs of Gay and Lesbian Elders and Their Families in Canada,” The Gerontologist 43:2 (2003). Link: http://bit.ly/1ggcMmo.))
According to Statistics Canada, the use of the health care system (e.g. having a regular doctor, consultations with health care professionals and receiving preventive screening tests) by gay, lesbian and bisexual Canadians varies by sexual identity, and their health care choices differ from those of heterosexual seniors.((Michael Tjepkema, “Health Care Use Among Gay, Lesbian, and Bisexual Canadians,” Health Reports 19:1, Statistics Canada catalogue no. 82-003-X (March 2008). Link: http://bit.ly/1iZMGYN.)) Many seniors only discuss their sexual orientation in relation to their care, and many service providers avoid discussing issues relating to sexual orientation when making care plans. Research performed at McGill University revealed a “don’t ask, don’t tell” passive approach toward revealing sexual orientation in the health care system.((Brotman, Ryan and Cormier.))
Many seniors only discuss their sexual orientation in relation to their care, and many service providers avoid discussing issues relating to sexual orientation when making care plans.
Many gay and lesbian seniors have support from their biological families and children and grandchildren; others rely on friends considered as family, also known as “chosen families” or “fictive kin.”((Brotman, Ryan and Cormier.)) Health care providers do not always understand this broad definition of family and therefore it is common for same-sex partners to identify themselves as friends or roommates in order to avoid being treated differently. This can often make it difficult for LGBTQ+ partners to show affection or be acknowledged as the patient’s spouse.
A number of studies on gay and lesbian seniors and their caregivers have found that they may experience both actual and anticipated discrimination via homophobic or heterosexist attitudes or policies in the health care system. Actual discrimination has been reported in hospital practices surrounding visiting hours, such as LGBTQ+ caregivers being denied acknowledgement as family members when seeking to visit their partners. Anticipated discrimination could affect seniors’ willingness to reveal their sexual orientation or even access services due to prior negative experiences. Both forms of discrimination pose a challenge to both the possibilities of self-identifying as a gay or lesbian senior and receiving appropriate care.((Shari Brotman et al., “Coming Out to Care: Caregivers of Gay and Lesbian Seniors in Canada,” The Gerontologist 47:4 (2007). Link: http://bit.ly/2guIer6.))
In order to address the biases within the health care system, current research has suggested that specialized services designed to engage dialogue between gay and lesbian community health professionals and enhance integration would have a significant impact on the health care experiences of LGBTQ+ seniors in Canada.((Brotman et al.)) Such services would include training sessions for health care workers on the needs of gay and lesbian seniors; hiring gay and lesbian health care workers; using gender-neutral language in discussions about identity and relationships; ensuring confidentiality; specialized facilities (e.g. Kipling Acres, a long-term care facility and gay-positive environment that provides services to seniors in Toronto), support groups or telephone support lines; and community outreach programs. These services aim to reduce the barriers between LGBTQ+ seniors and their health care providers and improve health care interactions for both the care provider and the patient.
Laura Zuccaro is a second-year medical student at the University of Ottawa.
Originally published in Transition, Vol. 44, No. 3, in July 2014.
Updated on September 8, 2015