Abstract
The hostile environment that older lesbian, gay, bisexual and transgender (LGBT) people faced at younger ages in the United Kingdom (UK) may have a lasting negative impact on their health. This systematic scoping review adds to the current knowledge base through comprehensively synthesising evidence on what is known about the extent and nature of health and care inequalities, as well as highlighting gaps in the evidence which point the way towards future research priorities. We searched four databases, undertook manual searching, and included studies which presented empirical findings on LGBT people aged 50+ in the UK and their physical and mental health or social care status. From a total of 5,738 records, 48 papers from 42 studies were eligible and included for data extraction. The synthesis finds that inequities exist across physical and mental health, as well as in social care, exposure to violence and loneliness. Social care environments appeared as a focal point for inequities and formal care environments severely compromised the identity and relationships that older LGBT people developed over their lifecourse. Conversely, the literature demonstrated how some older LGBT people successfully negotiated age-related transitions, e.g. emphasising the important role of LGBT-focused social groups in offsetting social isolation and loneliness. While there exist clear policy implications around the requirement for formal care environments to change to accommodate an increasingly diverse older population, there is also a need to explore how to support older LGBT people to maintain their independence for longer, reducing the need for formal care.
Highlights
LGBT people’s health and health inequalitiesFor older lesbian, gay, bisexual and transgender (LGBT) people in the United Kingdom (UK), the legislative landscape has changed beyond recognition during their lifetime
This review finds evidence suggesting that health inequalities, or health inequities, exist in the health and care status of older LGBT people and, in particular, in the opportunities available for older LGBT people to plan and access health and social care that is stigma-free and accommodating of different health and care needs
A study that did include a heterosexual comparison group, and potentially is closest to providing evidence that is generalisable to a broader population due to the large sample size of LGB people included in analyses (1,036 LGB men and women) found that LGB people were more likely to be frequent drinkers of alcohol and to report poorer mental health than heterosexual people, but no overall differences were found in smoking rates, and one health advantage was uncovered with LGB older people reporting exercising more frequently than heterosexual people (Guasp, 2011)
Summary
LGBT people’s health and health inequalitiesFor older lesbian, gay, bisexual and transgender (LGBT) people in the United Kingdom (UK), the legislative landscape has changed beyond recognition during their lifetime. Most people who could conventionally be regarded as being on an ‘ageing trajectory’ (aged 50+), if not ‘older’ per se, were born at a time where male homosexuality was, in effect, criminalised, and where social and legislative conditions permitted discrimination across a wide spectrum of domains for men and women from sexual minorities. Even after advances in the 1960s and 1970s such as the decriminalisation of same-sex acts between men in 1967, the legislative and social landscape remained hostile. Compared to the legislative landscape, the pace of change across the social landscape has been more gradual, with a sizeable minority of the UK public continuing to regard same-sex relationships as ‘always or mostly wrong’ (Park and Rhead, 2013). The legislative and social landscape for transgender people in the UK has lagged further behind, with the right to change the gender assigned at birth only being recognised in UK law in 2004, despite the European Court of Human Rights recognising this as a fundamental human right 15 years earlier
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