That heterosexual women caring for spouses living with dementia typically report greater stress than do men is often linked to empathic approaches to care, suggesting differences in identity-based stress appraisal. We examine this further, focusing on emotion work (manipulating one's own emotions to affect another's) versus feeling management (that targets the self) and gender and sexual orientation (GSO) identity. Using data from in-depth interviews with a nationwide sample (N = 69) of community-dwelling heterosexual, gay, and lesbian spousal/partner caregivers, we explore how GSO intersects to shape stress appraisal and emotion work provision. Thematic analysis reveals that identities centered around task completion resulted in feeling management engagement only (predominantly heterosexual men); emotion work was performed by those adopting an empathetic approach alone (mostly straight women) or combining this with a task orientation (typically gay and lesbian caregivers). These findings suggest how GSO might influence stress appraisal when challenges contradict caregivers' identities.

This study explores the impact of age and sexual and gender identity disclosure on health and quality of life among LGBT + individuals in Argentina, with a focus on the moderating role of age. A cross-sectional survey was conducted in 2022 with LGBT + adults residing in Argentina. Participants completed validated measures assessing quality of life, depressive symptoms, and identity disclosure. Bivariate and regression analyses were used to examine age-specific differences and interaction effects. Older adults (aged 50 and over) reported lower levels of depressive symptoms, though no significant differences were found in quality of life or identity disclosure when compared to younger participants (ages 19–49). Greater identity disclosure was associated with better quality of life and fewer depressive symptoms, with a particularly strong association observed among older adults. Transgender participants reported lower quality of life and higher levels of depressive symptoms compared to their cisgender peers. Identity disclosure plays a critical role in the well-being of LGBT + individuals, especially older adults. Age and identity-related factors should be carefully considered in the development of public health interventions and social policies targeting this community. These findings underscore the importance of promoting supportive environments for sexual and gender diversity in Argentina. Policies that reduce stigma—such as anti-discrimination legislation and public awareness campaigns—are essential to improving health outcomes for LGBT + populations.

We look “behind the scenes” of LGBTQ research across seven countries from the perspective of researchers exploring the type of research undertaken, the challenges of conducting research in these settings, and the direction of future research. Collaborators from the Global Pride pilot Study (from Argentina, Canada, India, Israel, New Zealand, Taiwan, and the UK) participated in an asynchronous roundtable in April, 2024, contributing word-limited written responses to the key areas above. Across nations, social sciences predominated with a focus on health and well-being and a marked recognition of diversity. There was a noted absence of national data across most countries, along with an absence of funding and other support with reference to varying cultural influences and heteronormativity. Addressing this diversity and inequalities were seen as future issues to consider, including issues of transgender and nonbinary experiences, housing, safety, and social connectedness, among others. The roundtable is an effective forum for gathering and sharing individual-level research experiences within countries and a window onto the international state of the field. Language (e.g., acronyms and terms) vary from country to country limiting both inclusion and comparison, with identified opportunities for curricular, programmatic and research innovation.

This paper examines differences in advanced care planning (ACP) discussions among Two Spirit, lesbian, gay, bisexual, transgender, queer, non-binary, and sexually or gender diverse (2SLGBTQ+) Canadians, focusing on subgroup differences in both the occurrence of these discussions and the individuals involved. This descriptive research is part of the Global Pride Study. The cross-sectional survey was conducted online in Canada in 2022, with a sample size of 106 2SLGBTQ + individuals aged 18 and older. Respondents were asked if they had discussions about the care and treatment they would prefer at the end of their life and with whom such discussions had taken in place. We also explored how demographic, social, and health factors predicted these discussions. Overall, 55.8

Research among heterosexual older adults finds that caring for a spouse/partner living with dementia is especially challenging. How this might vary by sexual orientation is less examined. Scholarship on older sexual and gender minoritized populations reveals the negative impacts of stigma and discrimination; we might expect this to exacerbate their caregiving challenges. But some scholars point to other, more positive outcomes: individuals untethered from heteronormativity can experience growth, value their identities, and form community. We explore these possibilities using in-depth interviews conducted nationally with 13 gay men and 16 lesbian women who cared for their spouses/partners living with dementia. We find that most expressed positive views of their identities and the characteristics that are often stigmatized; they also note the valuable lessons learned through their experiences of discrimination, particularly through the support and resources gleaned from their communities. They indicate that both of these influence their caregiving in positive ways.

OBJECTIVES:Despite the importance of spousal caregiving, and the increase in same-sex marriages concomitant to its legalization in 2015, few studies have examined the experiences of same-sex spousal caregivers. We use an intersectional approach to explore how gender and sexual orientation shape gay men's particular caregiving approaches for their spouses living with dementia. METHODS:We focused on a subsample of gay (N = 13) contrasted with straight husbands (N = 15) from a national study of spousal dementia caregivers. Data were obtained through in-depth interviews and analyzed thematically by a team. RESULTS:We find that sexual minority status and gender interact to shape gay men's caregiving approaches. Gay men's broader division of labor in households combines with experiences of discrimination based on sexuality and HIV/AIDS, as well as being a part of a same-sex couple to influence their caregiving approaches in unique ways. Specifically, they combine a task-oriented approach with concern for the personhood of the care receiver; bring strength and empathy borne of struggle; and what they feel is a deeper understanding of the care receiver given their shared status as gay men. DISCUSSION:Our findings indicate that gay men's flexibility in divisions of labor results in variable sets of skills, resources, and identities they bring to and approach their caregiving. In addition, some of the many negative experiences borne of HIV/AIDS and discrimination are reframed as sources of strength and guide caregiving efforts. Together, these findings highlight the intersecting effects of gender and sexual orientation on spousal caregiving.

Social sciences research has linked the experiences of caregivers to gendered experiences over the life course; a few studies have crossed these findings with sexual orientation, often introducing stigma and other social impacts. We directly asked caregivers themselves about the perceived influences of gender and sexual orientation on their caregiving experiences. Twenty-three straight women, 15 straight men, 14 lesbian women, and 13 gay men spousal/partner dementia caregivers were interviewed about their caregiving experiences, including the advantages and disadvantages of their gender and sexual orientation in caring for their spouse/partner; these interviews were recorded, transcribed, and content analyzed. Four superordinate themes accounted for advantages, and the same number of comparable themes were found for disadvantages; together, these represent: empathy and emotional expression; bridging household management and relationship tasks; societal factors; and reference to bodies. The synthesis of these findings is illustrative; for example, straight women reported their emotional facility and household management histories as advantages; they also felt burdened and somewhat weighed down by both. Straight men similarly spoke of their emotional reserve as both an advantage and disadvantage—and similarly referencing household management (not trained in the former case, not prepared in the latter). Gay men and lesbians noted the stigma and discrimination that colored their caregiving experiences; they also saw how these struggles became strengths. These data help reinforce and animate existing interpretations of caregiver behaviors, add new nuance and perspective, and offer detail for policy and practice interventions rooted in gender and sexual orientation identities.

Few older adults discuss their end-of-life care wishes with their physician, and even fewer minorities do this. We explored physicians' experience with advance care planning (ACP) including the barriers/facilitating factors encountered when initiating/conducting ACP discussions with South Asians (SA), one of Canada's largest minorities. Eleven primary care physicians (PC) and 11 hospitalists with >= 15 per cent SA patients >= 55 years of age were interviewed: 10 in 2020, 12 in 2021. Thematic analysis of transcripts indicated that cultural and communication barriers, physician's specialization, SA older adults' lack of ACP awareness, and decision-making deference to family and physicians were barriers to ACP discussions. Although the COVID-19 pandemic impacted physicians' practices, contrary to our hypothesis most reported no change in frequency of ACP discussions. Although ACP discussions were viewed as best conducted by PC physicians, only 55 per cent had ACP training and only 64 per cent had used ACP tools. Training in ACP facilitation, concerning ACP tool usage, and training in patient-physician communication are recommended. Peu de personnes agees discutent de leurs volontes de fin de vie avec leur medecin, et encore moins parmi celles issues de minorites. Nous avons examine l'experience des medecins liee a la planification prealable des soins (PPS), y compris les obstacles/facteurs de facilitation rencontres lorsqu'ils abordent le sujet de la PPS avec des personnes d'origine sud-asiatique, l'une des plus importantes minorites au Canada. Onze medecins exercant en soins primaires et 11 en milieu hospitalier, dont la clientele comprenait 15 % ou plus de patients d'origine sud-asiatique ages de 55 ans et plus ont ete interviewes (10 en 2020 et 12 en 2021). L'analyse thematique des transcriptions a indique que les barrieres culturelles et communicationnelles, la specialisation en soins primaires par rapport aux soins hospitaliers, le manque de sensibilisation a la PPS parmi les personnes agees d'origine sud-asiatique et la deference a l'egard de la famille et des medecins pour la prise de decisions etaient des obstacles aux discussions sur la PPS. Bien que la pandemie de COVID-19 ait eu un impact sur la pratique des medecins, contrairement a notre hypothese, la plupart n'ont declare aucun changement a la frequence des discussions sur la PPS. Les medecins en soins primaires etaient consideres comme etant les mieux places pour mener des discussions sur la PPS, toutefois seulement 55 % d'entre eux avaient suivi une formation en PPS et 64 % avaient utilise des outils de PPS. La formation en facilitation de la PPS, aux outils pertinents et a la communication patient-medecin est recommandee.

The COVID-19 pandemic's impact on older adults (55+) living at the mid-point of the shelter-care continuum, in seniors housing (SH) and assisted living (AL), remains largely unexplored. This study compares survey responses of SH and AL residents with those of age peers living in private conventional community-based dwellings (CD) in British Columbia, Canada. Despite more SH/AL residents reporting feelings of isolation and changes to social support access, the pandemic appears to have had a greater negative impact on the routines of CD older adults. AL residents were more likely to engage in advance care planning discussions before and since the COVID-19 outbreak. These data are important for improving response to current and future disasters across the shelter-care continuum, particularly in ways to reduce the psychosocial effects of isolation or routine disruption, and strategies to increase advance care planning engagement.

Abstract Most research has speculated that discrimination would influence the experiences of gay and lesbian spousal caregivers (e.g., Fredriksen-Goldsen, et al, 2016), but to date little research has revealed the actual impacts of discrimination and where and how it matters. The present study of 13 gay and 16 lesbian spousal dementia caregivers finds that both past experiences and present discrimination influence how they give care. On the one hand, past experiences of discrimination have taught these caregivers to be cautious, even when they have been out for many years and even when they live in what are typically considered to be supportive areas. Further, and even though many respondents reported no accounts of discrimination presently, some reported discriminatory experiences with social service or medical providers; and one gay husband had experienced violence in a care setting. At the same time, and what is less documented, are the ways that our respondents feel that what they learned to do to respond to discrimination prepared them for the challenges of spousal dementia care. This included all that lesbians and gay men faced during the HIV/AIDs epidemic. Having been “othered,” they feel they are more empathetic and sensitive to the stigma that comes with cognitive decline; they have greater self-reliance borne of the struggle with HIV/AIDs or in the face of estrangement from families or broader society; and they rely upon the resources provided by their communities. These results highlight areas both for subsequent novel research and interventions to support same-sex spousal dementia caregivers.

This study focused on the effects of the COVID-19 pandemic on the marginalized populations-specifically Black and Indigenous people as well as People of Color (BIPOC) compared to White older adults and LGBT individuals compared to heterosexual older adults. Data were derived from our national online survey of Canadians aged 55+, conducted from 10 August to 10 October 2020. The survey explored the influence of COVID-19 on lifestyle changes, well-being, and planning for the future. Our sample comprised 4292 respondents. We compared sets of dichotomous variables with White vs. BIPOC, LGBT vs. heterosexual, and LGBT White vs. LGBT BIPOC respondents. Significantly more BIPOC than White individuals reported changes in accessing food (44.3% vs. 33.2%) and in family income (53.9% vs. 38.9%) and fewer reported feeling accepted and happy, and more felt isolated and judged. Significantly more LGBT than heterosexual respondents reported changes in routines and in accessing social support, medical and mental health care and more feeling depressed, lonely, anxious, and sad. More LGBT-BIPOC than LGBT-White respondents reported changes in access to food (66.7 vs. 30.6, p < 0.001); in family income (66.7 vs. 41.5, p < 0.005); and in access to mental health care (38.5 vs. 24.0, p < 0.05). The only difference in emotional response to COVID-19 was that more BIPOC-LGBT than White-LGBT respondents reported feeling judged (25.9 vs. 14.5, p < 0.05). These findings reflect a complex mix of the effects of marginalization upon BIPOC and LGBT older adults, revealing both hardship and hardiness and warranting further research.

Context: While policies may promote Advance Care Planning (ACP) discussions in long-term care (LTC) settings, practices often result in outcomes different from residents’ wishes. We attribute this to a confluence of cultures: healthcare; LTC settings; mainstream societal; and individuals’ ethno-cultures. This research explores these cultures as reflected in focus group discussions conducted with residents and family-of-residents in two LTC homes: one exclusively Chinese (EC); one multicultural (MC). Method: Fourteen residents and 13 family members participated in the four focus groups. Discussions were audio-recorded, transcribed, and themes were extracted and compared. Results: Four themes characterized residents’ discussions: 1-Variations in Range/Type of ACP Discussions/Actions; 2-Care of Family; 3-Reliance on Staff; and 4-Quality-of-Life at End-of-Life. Exclusively Chinese residents expressed reluctance to speak about ACP, were more likely to state “family would handle it,” less likely to call upon staff, and more acquiescent concerning death. Multicultural residents were more likely to pejoratively mention pull or absence of family and reliance upon staff; also, wanting personal awareness and control at end-of-life. Family themes were 1-Timing/Focus of ACP Discussions, 2-Communication with Family, 3-Care Home and Staff Influences, and 4-Cultural and Religious Issues. Exclusively Chinese families spoke of need to involve family in ACP discussions inclusive of residents and of Chinese cultural influences on ACP. Multicultural families reported being “taken by surprise” and feeling “overwhelmed” by requests to engage in ACP and document completion on behalf of residents. Conclusion: Findings provide evidence of multiple cultural influences on ACP in LTC but existing institutional policies and practices offer little direction and support on how to balance/prioritize them. Our analyses may provide a starting point.

This paper examines how experiences with a previous pandemic, particularly HIV/AIDS, may have informed approaches to COVID-19, with a focus on sexual orientation. Method: The sample was drawn from an online survey of Canadians 55+ conducted in 2020, comprising 1143 persons (mean age = 67; 88 gay or bisexual (GB) men, 65 lesbian or bisexual (LB) women, 818 heterosexual women, and 172 heterosexual men). Respondents reported if they, or someone close to them, "had been affected by" one or more pandemics and whether COVID-19 led them to "think more about their prior epidemic/pandemic experiences" and/or feel they "couldn't handle it again". Correlated items reflecting feeling "they have been here before"; "prepared for what is happening"; and "like they needed to act or do something" formed a scale named "agentic familiarity". Results: About half of respondents reported thinking about their previous pandemic experience; about 5% reporting feeling like "they couldn't handle it again" with no gender or sexual orientation differences. Higher agentic familiarity scores were found for GB men and for those with experience with HIV/AIDS vs. other pandemics. Discussion: These outcomes speak to resilience and growth experienced by LGBT (and especially GB) persons through shared stigma and trauma-with implications for current pandemic experiences and future actions, like advance care planning.

Advance care planning (ACP) in North America often takes place in a cultural context of great ambivalence about death and dying, challenging efforts to discuss end-of-life care desires and preparations for death. Such challenges are amplified for sexual and gender minority older adults who often lack connections to traditional heteronormative systems of support. The extent of ACP preparation (completed documents, discussions) and their predictors was examined among a national sample of 91 community-dwelling Canadian LGBT older adults (mean age 68). The sample was disproportionately single and lived alone; more trans participants had children and about half of all participants reported a chosen family. About two-thirds of participants had a will, while less than half had a living will and power of attorney for health care, and a quarter had made informal caregiving arrangements. Just over one-third of respondents reported having discussions about future care and end-of-life plans. The only significant predictors of both ACP documents completed and ACP discussions undertaken were relationship status (those in a relationship were more likely to have engaged in both) and number of children (those with children were less likely to have completed documents). Given that most LGBT older adults are single, efforts must be expanded to reach and engage these individuals in preparing for end of life.

International human rights movements have improved the visibility and equality of lesbian, gay, bisexual and transgender+ (LGBT+) communities and their members. Health outcomes for LGBT+ people remain, however, worse than for their non-LGBT+ peers. Older LGBT+ people have experienced fewer positive changes, in part due to their lived experience of discrimination and their ongoing, unintentional invisibility in medical and social care. This article highlights the impacts of societal structure, health and social care on the lives of older LGBT+ people including physical and mental health, End of Life, Dementia, Housing and Care Settings, and a focus on the experiences of trans-people. We look at the existing improvements developed by LGBT+ communities (and their allies) and propose refreshing Person-Centred Care to improve inclusivity. Finally, we provide a framework for looking at the areas in which service challenges arise and suggest ways to address these to make health and social care services more ready to meet the needs of older LGBT+ people.

This roundtable discussion is a creative contribution to this special issue on 'aging masculinities' based on questions posed by editor Stephen Katz to three leading senior scholars in the critical gerontological field in the United States. W. Andrew Achenbaum is a renowned historian who has devoted his career to writing about the relevance of past politics, cultures, and knowledges of aging to comprehending our current dilemmas. Thomas R. Cole is an acclaimed historical scholar and mentor to generations of Humanities researchers across the globe. His work also includes film, literature, ethics, and spirituality. Brian de Vries is a social gerontologist whose bold research on LGBTQ aging is a powerful voice in critiquing the multiple forms of discrimination, violence and hardships, and denied rights and life-chances imposed by hetero-patriarchal regimes in later life. That these men have shaped and been shaped by their work and advocacy is the key theme that inspires our conversation.

Disasters such as the COVID-19 pandemic exact a toll on vulnerable populations in terms of morbidity and mortality, but they also provide opportunities for personal growth and development and demonstration of personal and collective resiliency. This inductive thematic analysis explores self-perceived negative and positive impacts of the COVID-19 pandemic on 2994 Canadians aged 55+. Data derive from response to two open-ended questions included in a national online survey (View Survey (sfu.ca)) conducted between August-October 2020. Respondents were recruited using Facebook, and a widespread email campaign to organizations serving older adults. 4260 of the 6573 coded comments (66%) addressed negative impacts of COVID-19. Fewer but still a considerable number (n = 2313) addressed positive impacts. The negative comments had a mean of 24.5 words per response (SD = 31.7, range: 1-560), while the positive comments had a mean of 21.3 words (SD = 27, range: 1-448). Five overarching themes characterized negative impacts of the virus in the lives of these older adults: disruption in daily life and plans; disruption in social relations; impact on health and wellness; healthcare and caregiving; and views on the pandemic. An additional five themes identified positive impacts: personal development; relationships; simpler life; benefits in work and finance; and introvert’s dream. Gender differences are consistent with expectations based on gender roles and activities: men were more likely to mention disrupted daily lives in particular as related to work, women were more likely to mention disrupted social relations, while health was mentioned to a comparable extent by both men and women. The negative themes illuminate the deep impact and disruption caused by the pandemic. The positive themes highlight adaptability and successful coping strategies which may be useful in the development of recovery plans and programming to help mitigate the negative effects of future pandemics.

Abstract Our presentation adopts a lens of intersecting inequalities based on gender and sexual orientation in exploring caregiving for a spouse or partner with dementia. How the division of labor shapes caregiving approaches is sometimes examined, but how this might differ by sexual orientation has not been explored. Previous research has often examined physical tasks and, to a lesser degree, emotion work. Here, we focus on cognitive labor (Daminger, 2019): the mental labor involved in managing the household and social relationships, including anticipating needs, identifying ways to address these, making decisions, and monitoring outcomes. This theoretical backdrop informs our analysis of data garnered from in-depth interviews conducted among gay/lesbian and heterosexual older adults (N=57) who care for their spouses with dementia. However couples may have divided these cognitive steps previously, caregivers must perform them all alone, given care receivers’ cognitive losses. Our analyses reveal that caregivers find being responsible for everything exhausting, but this manifests differently based on gender and sexual orientation. Heterosexual women, for instance, found making all the decisions problematic, whereas heterosexual men reported difficulty in anticipating needs. For the most part, the challenging issues for gay and lesbian caregivers were more varied, as their previous division of labor had been negotiated differently, without a reliance on traditional gender roles. Finally, we uncover a novel domain for cognitive labor: being the “memory keeper.” Predominantly undertaken by women, this work involved maintaining important memories and markers of the care receiver’s (and couple’s) past.