Global Aging With Pride: International Perspectives on LGBT Aging

Introduction

This special issue is a testament that around the globe attention to LGBT (lesbian, gay, bisexual, and transgender) aging is growing. Building upon on the preconference, Global Aging with Pride (Fredriksen-Goldsen, 2017), held at the 21st International Association of Gerontology and Geriatrics World Congress, this special issue provides an unprecedented compilation of LGBT aging research from across the world. Participants from 16 countries and 5 continents attended the Global Aging with Pride preconference at the World Congress, and it was from this dynamic and interactive exchange of thoughts and experiences that the idea originated for this special issue. In addition to the preconference, multiple symposia and papers were presented on LGBT aging throughout the World Congress further highlighting the emerging nature of the field.

Worldwide, the number of older adults is increasing at a rate faster than other age groups with the aging and graying of the population of adults 60 years and older estimated to account for 12.7% of the world’s population (United Nations, 2017). By 2050, the number of older adults will more than double to 2.1 billion (21.4% of the global population), and more than triple by 2100 reaching more than 3 billion (27.7%). The oldest old, aged 80 years and older, is the fastest growing segment globally and is expected to increase almost seven fold to 909 million by 2100 (United Nations, 2017).

The definition of “old” varies from nation to nation based on a variety of economic, physical and social conditions, and circumstances. While most countries are trending in the same direction, there are some distinct characteristics across countries. Aging in Asia and Latin America is accelerating and will soon match Europe, which still remains as the oldest region (He, Goodkind, & Kowal, 2016). Asia is the leading region in the size of older populations as well as the speed of aging. Countries in Africa are still the youngest (He et al., 2016).

Countries have differing risk factors as well (Dans et al., 2011; Hosseinpoor et al., 2012; Lim et al., 2012; Wu et al., 2015), but the association of multimorbidity with age, being female, lower income level (Arokiasamy et al., 2015) and HIV-positive status (High et al., 2012) are quite similar around the globe. Continuous global surveillance and interventions are needed (Ng et al., 2006).

Along with population aging, we are also learning more about the diversity of older adults, including sexual orientation and gender identity and expression. As the older adult population becomes increasingly diverse, new challenges emerge in gerontological research and practice across the globe.

Shifting Landscape of LGBT Aging Research

Early pioneers in “the aging homosexual” field reinforced some but countered many common misconceptions of lesbian and gay aging. In a 25-year review of the literature on sexual orientation and aging, the first wave of published research dispelled negative stereotypes and myths regarding gay and lesbian aging (Adelman, 1987; Berger, 1984; Berger & Kelly, 1986; Gray & Dressel, 1985; Quam & Whitford, 1992) and was soon followed by three additional historical foci subsequently framing the field, including psychosocial adjustment to aging, identity development, and social and community-based support in the lives of LGBT older adults (Fredriksen-Goldsen & Muraco, 2010). In the early years, there was very limited international research on LGBT aging captured within the field.

Over the last decade, the landscape of LGBT aging literature has changed significantly as evidenced by the sheer volume of published work, increased application of theory, more varied research designs and methods, and the emergence of a new area of research investigating the health and well-being of LGBT older adults and the social determinants influencing their aging, health, and well-being (Fredriksen Goldsen, Jen, & Muraco, 2019). Another important trend in the literature emerged with an increasing number of international pieces published. While the majority of the studies reported on a U.S. sample (73.2%), 21.1% had samples exclusively from outside the United States; four studies reported on international samples (Fredriksen Goldsen et al., 2019). Although the field is growing at a rapid rate, there continues to be significant gaps and a lack of visibility and attention to sexual orientation (sexual identity, behavior, and romantic relationships) and gender identity and expression in most cross-cultural aging research.

We highlight the lessons learned across the varied international landscape from 6 continents, spanning 10 different countries, including Argentina, Australia, Canada, China, Israel, Portugal, South Africa, Sweden, United Kingdom, and United States as well as HIV across the globe. This special issue will be presented in two volumes, with authors sharing research and practices from their home countries describing the realities of older adulthood across diverse LGBT communities. The goal of this special issue is to present LGBT aging research from different areas of the world as well as to highlight the differing types of research on LGBT aging that are underway across distinct cultural settings. The special issue will allow readers to address the important similarities and differences in the experience of LGBT aging across diverse cultural settings, including variations in the definition and meaning of old age itself. Based on their work, authors share feasible strategies to move LGBT aging research, practice, policy and education forward within differing cultural, social, and political environments.

Based on the overwhelming response to our call for papers, this special issue represents many types of empirical work, as well as thought pieces, cutting across varied substantive areas. Across the papers, authors share their impressions and observations about LGBT aging and outline a blueprint for action in research, services, and policies to better equip us to understand LGBT aging and the lived lives of these older adults and their families, and communities in an international and global context. As we have considered the many contributions of the papers included, we have been impressed with issues that cut across papers as well as the distinct experiences within specific cultural settings.

Some of the themes upon which many papers touched concerned the well-being and physical health of LGBT older persons, including those living with HIV or AIDS, either directly or indirectly; emotional well-being was a correspondingly prominent theme, particularly depression. Relatedly, the risk of isolation and the experience of discrimination, on interpersonal as well as social or societal levels, were similarly frequently noted. Countering some of these life limiting circumstances and conditions were foci on social support and inclusion and especially the presence and even sustenance of friends and family—both chosen and the increasingly positive role of legal or biological kin. This support extended from superficial contacts to life-sustaining care provision. Health care and housing challenges were commonly mentioned highlighting issues of access and acceptance; end-of-life preparations and considerations appear as an emerging issue of concern—and research. Importantly, attention was paid to some of the many strengths LGBT people bring to their later lives, helping to partially mitigate and defy the stressors and strains of minority aging, The ways in which LGBT older persons weave into a coherent narrative these many demands and resources offered a compelling and encouraging glimpse into the lived worlds of LGBT older adults.

Culture and the Multidimensional Shaping of Sexuality, Gender, and Age

Profound changes are underway symbolized by the dynamic nature of culture and language in the constructions of sexuality, gender, and age across the globe, mirroring distinct historical, cultural, and social contexts. In this special issue, differing acronyms are used reflecting the varied language used in the papers. Some papers focus on subpopulations such as older adults who are bisexual, lesbian, gay, and transgender, as well as those that include queer and nonbinary. Age also differed by paper, with older adults within most studies aged 50 years or older, from aged 40 years in a developing cultural context, to those aged 80 years to over a century old in another study.

Cultural values as part of the fabric of any society provide a foundation upon which the experiences of LGBT older adults are situated. The papers illuminate a critical crossroads as the authors grapple with the multifaceted nature of gender, sexuality, and age within shifting historical, cultural, and social contexts. The papers within the issue explore the differing social and cultural meanings of sexuality, gender, and age as they relate to conducting research and developing culturally relevant practices and policies inclusive of LGBT older adults, and their families and communities.

While established researchers of sexual and gender minority persons may be accustomed to more tolerant academies and supportive research circles, potential government and private entity funding sources, and an emerging foundation of data from which to build, researchers from developing countries share that they encounter the absence of many of these backing structures and some additional barriers to their work, including human rights protections. These authors explicate how research can serve as an impetus to social change and through validating community voices and building visibility and a supportive environment, the process of research can sometimes be as meaningful as the results.

Theories and Methods

Theories and methods of investigation vary, often based on resources and cultural influences, and include conceptual, qualitative, quantitative, and multimethod approaches. There was a wide range of theories employed, including critical and social constructionist approaches (e.g., Queer and feminist theories), life course (e.g., Iridescent Life Course, ecological, Health Equity Promotion Model), stress (e.g., Minority Stress), and resilience theories, to name a few. Each theoretical approach provided a lens for investigating and understanding lived lives within both distinct cultures as well as cross-cutting contexts.

Regardless of the setting, LGBT older adults remain a relatively hard to reach population necessitating innovative techniques. Given the emerging nature of the research, many of the papers describe the methods they used to fully engage with the community and to carefully listen, hear, and document the stories of lived lives, including one-on-one in-depth interviews, focus groups, and community meetings. Other authors describe the ways in which they are moving research initiatives to scale through community-based and online and web-based surveys and other interactive resources and techniques to reach both the larger population of LGBT older adults as well as hidden within hidden subpopulations. Still others noted that they chose a method such as a focus group not only to learn from the discussions, including cross-talk and nonbehavioral interactions, but also to provide an initial vehicle for the groups to develop community (or realize its potential) and create support or other group sharing experiences.

Across the papers, researchers were cognizant of community norms and characteristics in order to design robust and meaningful measures and to develop and test effective methods of data collection practices. Across all projects and at multiple stages of the research process, authors articulated the ways in which community engagement and collaboration were essential, including the use of participatory action research.

Disparities and Challenges Experienced

Both historical and environmental context frame the experiences of marginalization of LGBT people. Across the papers, the marginalization of LGBT older adults is identified, while the countries varied in their histories and some authors identified historical periods when sexual and gender minority people held a coveted place in society—and some where current conditions are relatively favorable. At the same time, many identified the health, economic, or social disparities of LGBT older adults and the risks they encounter.

Many of the findings in the special issue reveal that LGBT older adults are underserved, health disparate populations, largely invisible, shunned, or even disparaged. Structural constraints are identified as adversely impacting the aging, health, and well-being of LGBT older adults. In some of the countries, where cultural and social stigma reign, antidiscrimination laws and other human rights protections are lacking, and in some cases, same-sex sexual activity is forbidden altogether. A few potential authors contacted us and wanted to contribute to the special issue but because of their government’s regressive position on same-sex sexuality and related human rights abuses in their home country, could not use their name in a publication with an LGBT focus without severe risk of harm to themselves, their colleagues, and their families. Such structural constraints are identified as casting a long shadow of fear as a representation of severe repression enveloping the lives of LGBT older adults. Even in other countries where protections are constitutionalized and explicit, practice and public opinion still lag behind, and older LGBT adults note and experience the disparities that impact their lives.

Strengths and Resilience

Much of the research identified the strengths and resources, either implicitly or explicitly, of the LGBT older adult population, giving voice to shared community experiences and support through resilience and resistance. The papers explore myriad resources evidenced by LGBT older adults such as mastery and a kind of crisis competence as well as their social relationships and networks of support. The role of community was central to exploring the nature of support and engagement and the impact on their lives. Some papers further explored how historically oppressive regimes gave way to progressive political policies embracing the diversity of experience and lives, although the implementation of such novel legislation often trailed behind the enactment of legislative policies. The structural protections that exist for LGBT older adults ranged considerably from no protections to a growing increase in legislation that was codified in the constitutions of countries, to those that were enacted in national policies (such as increasing numbers of countries with same-sex marriage) or protections only at the local level.

Another theme emerged regarding the important role that research and community collaborations and partnerships can have for building infrastructure and providing a foundation as a catalyst for action to improve the lives of the LGBT older adults and their communities. By examining the risk and resilience of these older adults around the world, a new light may shine on ways in which innovative research can strengthen our understanding of aging and our practices in our increasingly diverse society.

Services

Several papers identified the lack of attention to sexual orientation and gender identity and expression by governments and social and health service agencies as significant gaps in designing culturally relevant aging services and supports. The importance of organizations and service providers to be responsive to the needs of LGBT older adults was exemplified, and how the development of best practices and evidence-based services are needed to address the distinct needs. Reaching all levels of organizations as well as providing on-going training given potentially high staff turnover were identified as important steps forward to addressing the needs of LGBT older adults.

Such recommendations were forthcoming from the LGBT participants in research studies as well as authors of the papers. There was the echo of “nothing about us without us” in some of the narrative materials with suggestions of organic, ground-up efforts of educational intervention designs. It was suggested that strategies are needed to advance the planning and implementation of support services for LGBT older adults designed to address the heterogeneity of the population as well as differing needs at varying life stages. Human agency apparent in these suggestions and recommendations, was a hopeful, action-oriented sign.

Attention to Subpopulations

The heterogeneity of LGBT older adults across populations, countries, and cultures highlights the important role of intersectionality in the lives of LGBT older adults. This was a point noted by many of the authors as they attempted and called for clearer distinctions among sexualities, orientations, identities, and expressions. While in some papers, sexual minority groups were collapsed generally due to methodological considerations and small-sample sizes, one paper addressed how bisexuality is conceptualized and operationalized across two differing Western cultural contexts. Others moved beyond the dominant Western notion of gender as binary to explore more nuanced models of gender within cultural contexts, including those nonbinary. In addition, differences by sexual orientation and gender identity and expression, and distinct experiences by age cohort, economic status, education, housing stability, geographic region, and disability status all presented as critical considerations in the lives of LGBT older adults. It is also important to recognize additional differences within the population, such as the legacy and the realities of living with HIV for LGBT older adults and the increasing challenges that may co-occur with increasing age, such as multimorbidity and disability, across differing regions of the world. Concomitant with the continued increasing longevity of older adults, we should all be encouraged to give more attention and an expanded intersectional research focus on LGBT aging, rooted in a strength-based approach, one that takes into consideration culture, region, infrastructure, and available resources.

Conclusion

By drawing upon international, interdisciplinary experts, this special issue addresses the unique cultural influences, dimensions, and dynamic nature of conducting research with LGBT older adults and presents cutting-edge findings, conceptual frameworks and practices, as well as a nuanced perspective on the strengths and challenges facing LGBT older adults in countries around the world.

As we move forward in aging-related research, services, and policies, there is a critical need for increased attention to the societal and cultural contexts in which aging occurs—especially if we are to understand the realities of older adulthood across diverse communities. Future research must be responsive to the changing contexts of aging and the increasing diversity worldwide. The insights we glean from the study of aging among LGBT older adults can deepen an awareness of the diversity of lives across the life course (Fredriksen Goldsen, et al., 2019), particularly among those living in less traditional or heteronormative environments (de Vries & Blando, 2004). with important and potentially paradigm-changing contributions to the understanding of the richness, challenges, and heterogeneity of ageing in general. This special issue provides a unique opportunity through international collaborations to share and generate knowledge of differing strategies and best practices for conducting global research inclusive of LGBT older adults, their families and communities.

Biographies

Author Biographies

Karen Fredriksen Goldsen, PhD, is a professor and Director of Healthy Generations at the University of Washington. Dr. Goldsen is a nationally and internationally recognized scholar addressing equity and the intersections of aging, health, and well-being in resilient, at-risk communities. She is Principal Investigator of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NIH/NIA, R01), the first national longitudinal study of LGBTQ midlife and older adult health assessing trajectories; Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action) (NIH/NIA, R01) the first federally-funded study of cognitive impairment in LGBTQ communities; Socially Isolated Older Adults Living with Dementia (P30); Sexual and Gender Minority Health Disparities; and Investigator of Rainbow Ageing: The 1st National Survey of the Health and Well-Being of LGBTI Older Australians. Dr. Goldsen is the author of more than 100 publications, three books, and numerous invitational presentations including U.S. White House conferences and Congressional Briefings. Her research has been cited by the New York Times, U.S. News & World Report, NBC News, Washington Post, and more than 50 international news outlets.

Brian de Vries, PhD, is professor Emeritus of Gerontology at San Franĉisco State University and Adjunct Professor at Simon Fraser University (in Vancouver). Dr. de Vries has co-edited several professional journals and acclaimed academic books as well as authored or co-authored over 100 journal articles and book chapters (based on research funded by national agencies, associations and organizations) and has given over 150 presentations to local, national and international professional audiences on the social and psychological well-being of midlife and older LGBT persons, life review and reminiscence, among other topics.