Golden queers

Sometimes you can’t see what is staring you right in the face, even if someone else points it out to you. At least, that’s the excuse I’ll give my husband for failing to take his advice, years back, to look at the intersection between geriatric medicine and Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) people’s needs. Having worked in geriatric medicine for nearly twenty years and been gay for as long as I can remember, I never thought to ask what we were doing for older LGBTQ+ people, or what I might want when I get old. Perhaps it was my own realisation that I was getting older that finally made the penny drop? This made me wonder what life and healthcare would be like for us, as cisgender gay men, when we become eligible for older people’s services.

Thinking about receiving healthcare is difficult, because most of us never believe we will need it, no matter how many people we treat. It’s sobering as it illuminates gaps in knowledge or practice and exposes biases and prejudices. Often, I am as scared as I am delighted about what I imagine will happen. Much of the focus around healthcare provision and education for people like me is around sexual health. Other health outcomes for members of my communities make for grim reading, as we experience a high burden of mental and psychological illness, not to mention suicidal ideation and suicide. We are also more likely to delay or avoid seeking medical care and medication, and we engage in unhealthy lifestyles, like smoking or drinking to excess. If you think that is bad, the statistics are even worse for older LGBTQ+ people.

As geriatricians, we are faced with the problem that older people are an invisible part of our society. Older LGBTQ+ people are even more invisible. It would be wrong to assume that this is only due to HIV/AIDS causing the death of a generation. Older LGBTQ+ people lived much of their lives criminalised and exposed to significant societal prejudice. These experiences are good reasons why some continue to be circumspect about their sexual orientation and identity, but that’s not the end of the story. We might be complicit in perpetuating their invisibility. If we never ask older people if they are LGBTQ+, how would we know that they are and why would they bother to tell us? Perhaps it is because we don’t see older people as sexual, so we don’t think to ask about their sexuality?

Five to 5.5% of the population in the London Boroughs of Lambeth and Southwark, the catchment areas for my Trust, are members of the LGBTQ+ communities. This is higher than the 3.1% national rate. Despite this, I cannot tell anyone how many older LGBTQ+ patients we have in our service. We are in the process of implementing sexual orientation and gender identity (SOGI) monitoring, but we are likely to see a high proportion of “prefer not to say” responses, unless it is accompanied by education, training, and inclusive care. LGBTQ+ people make daily choices about coming out to people they meet and can quickly judge when it is safe to do so, based on our lived experience. When we don’t feel seen, or when we feel that there is an assumption that we are heterosexual, we may judge that it is better to keep quiet. This could deny us the opportunity to get help that allows us to have a great old age.

When my husband and I become old men, I want care to include all parts of our lives so that if one of us develops dementia and forgets everything, it helps remind us how we lived out and proud. I don’t want either of us to be asked about “our wife” so we are left scared that the people looking after us, or the service they work in, are homophobic or prejudiced. I want people to understand that we might need extra support, if one of us becomes unwell, as otherwise we can only rely on each other. I want to know that if we need help from formal services the providers will not judge us for who we are.

These are great aspirations, and I am saddened that we have not achieved them already yet I am spurred on to try to ensure we do. Times are challenging for LGBTQ+ people of all ages, especially for trans people. This may be more than familiar to older members of our communities. I want to do more to help the generation that first lived in silence, that then raised the cry for rights and equality, and that survived the first pandemic of my lifetime. I’m happy to know I am not alone in wanting this, as the first sparks are already starting the fire of change. Now, there are many opportunities to educate, disseminate, iterate, and innovate. I believe that healthcare professionals don’t go into work to discriminate against people, even unintentionally. We are the problem solvers that enable people to live their lives. We can both lead and be part of change.