Not so long ago, the general perception of lesbian, gay, bisexual, trans, intersex and queer persons (LGBTIQ+) was associated with many things, among them being young, colourful and “out there”. But as the world’s population is becoming older, so are LGBTIQ+ persons, bringing with them a new understanding of older persons.

Up until 1974, homosexuality was still classified as a pathological condition by the world’s leading Psychiatric Association (the APA). This meant openly lesbian and gay men were institutionalised, stripped away from their right to work and treated as criminals. Trans persons were treated with greater oppression, even from the gay community. Fast forward to today, the queer community has made great strides in being recognised as equals but, unfortunately, it is still criminalised in over 70 countries, with the death penalty present in at least 11.

The cohort that has lived their prime years during this revolution are now reaching older age. While millions of gay men died during the peak of the AIDS pandemic (1980s), wiping away an entire generation, the ones who survived and have been “out and proud” are now reaching a life passage where the “closet” is now resurfacing as they face a number of factors, including a history of stigma, discrimination and persecution, their relationship with institutions, especially that of healthcare and service provision.

The same basic needs may apply across the elderly population but one should not forget that people are dependent on others to gain access to a number of services. Service providers may be unaware that LGBTIQ+ persons are also potential users of their services and this notion has resulted in older LGBTIQ+ persons becoming medically underserved and at a higher risk of health problems than their heterosexual counterparts, thus calling for a much-needed enquiry into making these services accessible.

Research demonstrates that LGBTIQ persons report poorer health than the general population, with inferior healthcare in relation to cancer, dementia, palliative and mental health provision. Poorer health outcomes may be attributed to social inequalities, including minority stress as a result of the accumulation of discrimination and prejudice across one’s lifetime. Such stress may cause health-risk behaviours such as excessive alcohol/drug use, smoking and obesity. Loneliness and isolation also place a person at risk of a poorer health outcome, affecting one’s physical/mental health and mortality.

 How is ageing experienced differently?

In comparison to the majority of the ageing population, older LGBTIQ are more likely to be living alone, estranged from their biological families and to be child-free. Many would have established ‘chosen families’ composed of peers coming from the same generation, thus developing increased care needs over time and decreased ability to provide reciprocal care, especially as the circle begins to diminish.

Older gay and bisexual persons are deeply affected by HIV/AIDS after experiencing loss of friends in previous decades and due to increasing numbers living longer on HIV treatments.

Older cisgender lesbians and bisexual women live longer than men, however, with greater age-related health conditions and disabilities and are considered as an ignored and invisible sub-population, placing them at a triple threat of marginalisation and oppression. Older transgendered persons are concerned with the need to attend to their personal care if their bodies do not match a binary gender identity and that of being misgendered if they lose mental capacity.

Older LGBTIQ are more likely to be living alone

Granted, some LGBTIQ+ persons are more successful than others in adapting and ageing well and hold strong psychological and social ties/resources while being more likely to enjoy better health when in older age. Research further shows how minority stress may have brought about a sense of resiliency across the years, allowing some older LGBTIQ+ persons to be better equipped to face ageing problems, mastering a sense of ‘crisis competence’.

Over the past years, older LGBTIQ+ persons have brought to light stories containing narratives of hope while confronted with oppression, thus gaining visibility and building communities while challenging the myths of being lonely and depressed and championing the right to age successfully while battling social stigma. The reality is that the very notion of “successful ageing” is often seen through the heteronormative lens, with images of happy older heterosexual couples, with grandchildren, who supposedly make their lives positive and meaningful.

Such narratives make the life stories, relationships positive and culture of older LGBTIQ+ people invisible and overlooked by those responsible to promote well-being in later life and responsible for service provision. Hence, older LGBTIQ+ persons are apprehensive about who would take care of them once they are unable to lead independent lives. Indeed, falling in the hands of a long-term care setting is greatly feared, with the realisation that they would have to succumb back into the heteronormative straight-jacket.

In Malta, a vast array of community care, and services, is offered to promote the well-being of its older citizens and, despite pockets of initiatives and LGBTIQ+ affirmative policies at national and grassroots level with the aim to raise visibility and awareness, the voice of the older LGBTIQ+ community in Malta still seems to be missing. With Malta retaining its top position among European countries by the ILGA Rainbow Index, this sense of invisibility does not only manifest within the wider social community but within the LGBTIQ community itself.

If we have to look at demography, it is being estimated that, conservatively, around 5,000 persons out of the 97,000 senior citizens in Malta (as at 2020 according to NSO) are LGBTIQ+. A significant percentage of these are bound to be service users, both living in the community and in residential care. Having, throughout their life, experienced a lack of understanding towards their lifestyle and in being different to the norm, the majority of older LGBTIQ+ persons don’t feel safe and confident with current healthcare provision and tend to rely mostly on their support network.

Assumption is the mother of all mistakes; with more awareness, we can reach a step closer towards inclusivity.

Christian Vella is a doctoral candidate with the Department of Gerontology and Dementia Studies, Faculty for Social Well-being, University of Malta. He is also a member of the Maltese Association of Gerontology and Geriatrics (MAGG).

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