Advance care planning among older LGBT Canadians: Heteronormative influences

Abstract

<jats:p> Advance care planning (ACP) in North America often takes place in a cultural context of great ambivalence about death and dying, challenging efforts to discuss end-of-life care desires and preparations for death. Such challenges are amplified for sexual and gender minority older adults who often lack connections to traditional heteronormative systems of support. The extent of ACP preparation (completed documents, discussions) and their predictors was examined among a national sample of 91 community-dwelling Canadian LGBT older adults (mean age 68). The sample was disproportionately single and lived alone; more trans participants had children and about half of all participants reported a chosen family. About two-thirds of participants had a will, while less than half had a living will and power of attorney for health care, and a quarter had made informal caregiving arrangements. Just over one-third of respondents reported having discussions about future care and end-of-life plans. The only significant predictors of both ACP documents completed and ACP discussions undertaken were relationship status (those in a relationship were more likely to have engaged in both) and number of children (those with children were less likely to have completed documents). Given that most LGBT older adults are single, efforts must be expanded to reach and engage these individuals in preparing for end of life. </jats:p>

LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

“…We also note that while our intention was to focus on aging, much of the literature we reviewed was not actually about aging experiences. Further, since the systematic search for this scoping review was conducted, there have been some important contributions to the Canadian literature that have helped to move the field along, e.g., [ 84 , 85 , 86 ].…”

Advance care planning among older Canadians amid the COVID-19 pandemic: a focus on sexual orientation

“…38 A choice must be made from the following list of the first person who is willing, available, and qualified: spouse, adult child, parent, sibling, grandparent, grandchild, anyone related by birth or adoption, a close friend, and a person immediately related to the individual by marriage; in the absence of such persons, a public guardian or trustee is appointed. 39 …”

Providing inclusive, person‐centred care for LGBT+ older adults: A discussion on health and social care design and delivery

“…Heteronormativity within health systems can be seen in service assessment forms, which fail to collect information on sexual orientation and gender identity. Knowing this information could influence care plans and prompt staff to involve ‘chosen family’; use preferred pronouns; include same‐sex partners; assist appropriate room placement in nursing home care; and ensure LGBT+ older adults are cared for in a way they would have chosen at the end of life (Cartwright et al., 2012; Daley et al., 2016; de Vries et al., 2020; Donaldson & Vacha‐Haase, 2016; Fredriksen Goldsen et al., 2019; MacDonnell & Daley, 2015; Roe et al., 2020). This information would also help staff clinically, for example managing age regression delusions in dementia, or ensuring transgender women are given proper screening for prostate cancer (Donaldson et al 2016).…”

“…This information would also help staff clinically, for example managing age regression delusions in dementia, or ensuring transgender women are given proper screening for prostate cancer (Donaldson et al 2016). The inclusion of details on gender identity and sexual orientation in assessment forms would make older LGBT+ people who are not connected to traditional heteronormative systems of support ‘visible’ to care providers (De Vries et al., 2020).…”