Growing old without fear

Every year, May 17 marks the International Day Against Homophobia, Biphobia, Intersexism and Transphobia (IDAHOBIT). The theme for IDAHOBIT 2026 was ‘At the heart of justice and freedom for everyone’.

When we talk about justice and freedom, it is vital that we do not leave anyone behind, especially our older generations. For the first time in human history, the majority of the global population can expect to live into their 60s and beyond. While this increased lifespan is a triumph of modern public health and medicine, the experience of growing older brings complex biological, psychological and social challenges. These challenges are often magnified for lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) persons.

To truly understand an older LGBTIQ+ person today, we must recognise the unique historical journey they have lived through.

The “Baby Boomer” generation entered adulthood in a society where their identities were frequently met with deep-rooted institutional homophobia. For many years, homosexuality was heavily criminalised and treated as a mental illness by the medical community. To survive, many individuals had to endure a constant fear of exposure, risking the loss of their employment, housing and family connections. Furthermore, they lived through the immense trauma of the HIV/AIDS pandemic in the 1980s, an era that tragically shortened lifespans and devastated their friendship networks.

Because of these harsh experiences, many older LGBTIQ+ adults carry what researchers call “minority stress”. This refers to the chronic, daily stress caused by a lifetime of navigating stigma and prejudice within a society that naturally assumes everyone is heterosexual.

Over a lifetime, this stress takes a physical and mental toll, often leading to higher rates of depression, cardiovascular issues and other chronic conditions compared to their heterosexual peers. However, this adversity has also forged an incredible generation defined by political agency, activism and a unique “crisis competence” that helps them adapt and survive against the odds.

It is also important to understand that the LGBTIQ+ community is incredibly diverse. The experience of ageing is heavily influenced by other intersecting factors, such as a person’s social class, gender, ethnicity, and whether they have a disability. For example, a person’s social class often dictates their financial resources and pension in later life.

Economic security is a major issue and transgender individuals face poverty rates that are double those of cisgender individuals. Older women generally live longer than men, meaning they are more prone to facing age-related disabilities and poverty as they grow older. Furthermore, when a person is an older, LGBTIQ+ individual who also belongs to an ethnic minority, they can face a “triple jeopardy” of ageism, racism and homophobia.

As people age, there is a high likelihood they will require long-term care, either through community-based support or within residential facilities. While society has generally become more liberal and accepting, the transition into a care home remains a terrifying prospect for many LGBTIQ+ older adults. In fact, residential aged care is sometimes described as a “geography of fear,” where the care home becomes a place where residents feel they might be “outed” against their will or have their true identities erased.

The fear of being misgendered or losing personal dignity [in care homes] takes a significant toll on the well-being of transgender persons

Because of the fear of discrimination from care staff and fellow residents, many older LGBTIQ+ adults feel forced to take a heartbreaking step: they go back “into the closet”. To ensure their safety, they may hide their sexual orientation or gender identity entirely. Some even introduce their lifelong same-sex partners as “siblings” or “friends” to avoid prejudice. The fear of being misgendered or losing personal dignity takes a significant toll on the well-being of transgender persons.

Looking closer to home, Malta is actively working to address these realities. Data from 2021 indicated that 0.50% of the Maltese population over the age of 60 identified as LGB or having other sexualities. To support this growing demographic, Malta has introduced intersecting frameworks, such as the National Strategic Policy for Active Ageing 2023-2030, which explicitly outlines the specific challenges faced by LGBTIQ+ older adults.

This is complemented by the LGBTIQ+ Equality Strategy & Action Plan 2023-2027, which aims to mainstream equality across a person’s entire lifespan. However, while these national policies are strong, there is still a significant gap in translating these laws into daily, culturally safe practices within local care homes.

Another major hurdle in long-term care is society’s traditional definition of “family”. Because many older LGBTIQ+ persons experienced rejection from their biological families, they built “chosen families” (de facto families) − networks of close peers who provide crucial emotional and physical support. Unfortunately, formal healthcare systems and legal policies often fail to recognise these chosen families. In end-of-life situations, policies that prioritise biological relatives can leave LGBTIQ+ persons vulnerable to estranged family members taking control of their care and overriding their final wishes.

These issues become even more complicated when dealing with cognitive decline. If an older LGBTIQ+ person develops dementia, they may lose the ability to manage who knows about their identity. For transgender persons living with dementia, there is a very high risk of being misgendered or treated according to the sex they were assigned at birth by care staff who do not understand their personal history.

A phrase frequently heard from well-meaning care provi­ders is: “We treat everyone the same.” While this may sound fair, it often means treating everyone as if they were heterosexual and cisgender. This “one-size-fits-all” approach ignores the rich, diverse histories of LGBTIQ+ residents and effectively makes them invisible within the care system. Older LGBTIQ+ people want to be understood, recognised and fully integrated into their communities.

To move beyond basic tolerance and build truly affirming environments, care providers must embrace a higher standard. This isn’t just about “being nice”; it’s about a fundamental right to dignity. We can achieve this by ensuring carers receive mandatory training on LGBTIQ+ histories, using language that doesn’t assume everyone is heterosexual, and displaying visible symbols of welcome that say: “You are safe here.”

Returning to the IDAHOBIT 2026 theme of “justice and freedom for everyone”, we must recognise that true freedom includes the right to grow old authentically. The older LGBTIQ+ generation fought the intense battles that secured the civil rights many enjoy today. They should not have to spend their twilight years hiding who they are or who they love. By acknowledging their histories, recognising their chosen families and creating genuinely inclusive care systems, we can ensure that dignity in later life is a reality for all. Only then will justice and freedom truly be for everyone.

Christian Vella is a member of the Maltese Association of Gerontology and Geriatrics (MAGG).