A narrative review of literature on the use of health and social care by older trans adults: what can United Kingdom services learn?

Abstract

We carried out a narrative review and thematic analysis of literature on the physical health care, mental health care and social care of trans older adults to ascertain what is known about older trans adults’ contacts with and use of health and social care. Thirty papers were found: a majority originated in the United States of America. Five themes were identified: experience of discrimination/prejudice and disrespect; health inequalities; socio-economic inequalities; positive practice; and staff training and education. The first three themes present challenges for providers and service users. Experiences of discrimination/prejudice and disrespect over the course of their lives powerfully influence how older trans adults engage with care services and practitioners. Health and socio-economic inequalities suggest that older trans adults are likely to have greater need of services and care. The remaining two themes offer opportunities for service improvement. We conclude that more research is needed, that there is a strong argument for taking a lifecourse perspective in a spirit of cultural humility, and that contextual societal factors influence service users and providers. We identify positive trans-inclusive practices which we commend to services. More needs to be done now to make older adult services appropriate and welcoming for trans service users.

What Do We Know about an Invisible Issue? Results of a Scoping Review of Elder Abuse and Gender and Sexual Minorities

“…The context for many GSM older adults is a lifetime experience of violence, abuse, and hate crimes, extending from child abuse to end-of-life care [24,34,39]. Compared to their cisgender/straight counterparts, gender-diverse and LGBT older adults are more likely to experience socioeconomic barriers that prevent healthy aging and put them at risk of abuse [39,40].…”

“…In their narrative review of articles predominantly from the US, there were variations regarding the age categories in the LGBT community. Older adults' cut-off age was mostly 50+, while there was scant inclusion of 60+ and 65+ [39]. Also, in Westwood's commentary, age 60+ was the reference age for describing LGBT older adults [37].…”

“…LGBT seniors [32]. Additionally, Willis et al's UK study [38] and Benbow and colleagues' [39] study of Australia, Canada, UK, and the US have highlighted the issue of "othering," whereby phrases like "not on this floor" are used to make LGB older adults "invisible" within the facility. Not surprisingly, rejection and insensitivity have also been reported [39].…”

“…Additionally, Willis et al's UK study [38] and Benbow and colleagues' [39] study of Australia, Canada, UK, and the US have highlighted the issue of "othering," whereby phrases like "not on this floor" are used to make LGB older adults "invisible" within the facility. Not surprisingly, rejection and insensitivity have also been reported [39]. Moreover, Butler's US report has noted that older lesbians constitute the most invisible group within the LGBT community due to multiple assumptions about their social status [52].…”

Aging and late-life in Colombian Trans Women: A Grounded Theory Approach

“…Ageing is a heterogenous process, although trans individuals share unique challenges in their process of ageing and based on their gender identity (Witten & Eyler, 2011). For example, people with trans identities often live in a psychosocial context of violence and are frequently discriminated against and abused during their life course (Benbow et al, 2022;Finkenauer et al, 2012;Fredriksen-Goldsen et al, 2014). The risk of violence and discrimination increases in older adulthood since there are two stereotypes at play: ageism; and gender-based discrimination (Witten, 2017).…”