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

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.

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.

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.

Background: Lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) adults face challenges accessing end-of-life care. Understanding the experiences of LGBTQ+ persons within the end-of-life context is crucial in addressing their needs and supporting equity at end of life. Aim: Review recent literature documenting the experiences of LGBTQ+ adults nearing end-of-life, identifying needs, barriers to care, and translating this into clinical recommendations. Design: A rapid review design was chosen for prompt results. The process was streamlined by limiting the literature search to peer-reviewed articles, dissertations, theses, by date and language. Data collection used a predetermined set of items based on Meyer’s Minority Stress and Bronfenbrenner’s Ecological Models including participants’ voices, needs, and barriers. Thematic analysis of collected data was conducted and presented results in a narrative summary. Data Sources: We searched six electronic databases (PubMed, Medline, ProQuest Dissertations and Theses A&I, ProQuest Dissertations and Theses, Open Access Theses and Dissertations, CINAHL, and Google Scholar) for articles published from 2016 to 2020. Results: We included and appraised for quality 33 articles. We uncovered three latent themes: systemic barriers, a lack of lived experience within the literature, and treatment of LGBTQ+ as one homogeneous group. Conclusions: The hybrid Meyer’s Minority Stress and Bronfenbrenner Ecological model elucidated how stressors and social contexts may impact LGBTQ+ adults when accessing end-of-life care. Incorporating LGBTQ+ cultural competence training into continuing education and ensuring that LGBTQ+ individuals participate in the development of end-of-life care programming may better attend to the needs of this population.

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 Within days of obtaining ethics approval for a qualitative study “Optimizing LGBTQ Engagement with Hospice and Palliative Care in the Island Health Region” our local Covid-19 lockdown began. It took several months to have new Covid-19 research protocols (Zoom Town Hall meetings/Zoom or telephone interviews) approved. Being impatient, I teamed with another group of researchers to launch “Covid-19: Your Current Experiences and Planning for the Future,” an online survey with a large qualitative component where we planned to oversample LGBTQ respondents. In time both projects were approved, and here I reflect on recruitment lessons learned. These include my perceptions how Zoom Town Hall meetings and interviews differ from those I’ve conducted in-person, reflections on how to use social media (including targeted Facebook advertising) to recruit participants, and sadly, how to manage anti-LGBTQ sentiment that resulted from even the most targeted advertising.

Abstract Child abuse and intimate partner violence rates are known to increase during and in the aftermath of disasters. Research on elder abuse during disasters, including the current pandemic, is limited. As part of an online survey that explored older Canadians’ current experiences and future care plans during the COVID-19 pandemic, we aimed to determine the prevalence, contributing factors and potential outcomes of frequent family discord involving physical violence (FFD/PV) as a proxy for elder abuse. The survey was conducted between Aug 10 and Oct 10, 2021. Respondents (n=4380) were recruited using social media, direct email, Facebook advertising and with the assistance of 85 local community, regional and national organizations. The sub-sample reporting FFD/PV (n=76, 1.8%) was compared with other survey respondents regarding socio-demographic characteristics, negative and positive emotions, difficulty accessing basic needs, food, health care and support. Respondents experiencing FFD/PV were found to be significantly younger and less educated and were more likely to be non-white and not working than other respondents. The subgroup sustaining FFD/PV reported significantly higher rates of feeling depressed, lonely, isolated, anxious, sad, and judged/shamed and felt less happy, relaxed and accepted in their community. They also reported higher rates of challenges in accessing basic material needs such as food, support, medical care, mental health treatment and experienced more changes in life routines. Although only a small percentage reported FFD/PV, our results highlight a disturbing pattern that merits serious attention of adult protection agencies, seniors' advocates and disaster response organizations.

OBJECTIVES:The COVID-19 pandemic has led to death and hardship around the world, and increased popular discourse about end-of-life circumstances and conditions. The extent to which this discourse and related pandemic experiences have precipitated advance care planning (ACP) activities was the focus of this study with a particular emphasis on sexual orientation.METHODS:A large, national online survey was conducted between 10 August and 10 October 2020 in Canada. The final sample of 3923 persons aged 55 and older was recruited using social media, direct email, and Facebook advertising and in conjunction with community groups. Women comprised almost 78% of the sample; just more than 7% of the sample identified as lesbian, gay, and bisexual (LGB). Measures included demographic variables and a series of questions on ACP, including documents and discussions undertaken prior to the pandemic and since its onset.RESULTS:Descriptive analyses revealed few gender or sexual orientation differences on documents and discussions prior to the pandemic; since its onset, LGB persons have completed or initiated wills, powers of attorney, advance directives, representation agreements, and have engaged in ACP discussions in greater proportion than heterosexuals. Logistic regressions reveal the increased likelihood of pre-pandemic ACP engagement by age, gender (women), and education; since the pandemic onset, gender, education, and sexual orientation were predictive of greater ACP engagement. Care discussions were more likely undertaken by women and LGB persons since the pandemic most often with spouses, family, and friends, especially among LGB persons.DISCUSSION:Gender roles and previous pandemic experiences (HIV/AIDS, in particular) are implicated in this pattern of results; opportunities for educational interventions are considered.

This qualitative Canadian study explores advance care planning among LGBTQ older adults living in non-metropolitan regions in the province of British Columbia. We examined the level of engagement in advance care planning (ACP) among LGBTQ persons and introduced a region-specific ACP Tool to our participants. Six focus groups were held with 32 participants with ages ranging from 55 to 84 years (M = 67.3 years). The focus group transcripts were audio recorded, transcribed and manually coded for themes. The four overarching themes were information uncertainty; the planning tool; the temporary substitute decision maker; and the LGBTQ perspective. Implications of these findings are discussed.

Abstract In an online survey exploring older Canadians’ experiences during the COVID-19 pandemic, 3989 respondents aged 55-99 indicated whether they had discussed their future care preferences and with whom, prior to and since the outbreak. Pre-pandemic, 62% had held such discussions; since the pandemic 43% did so, 11% for the first time. Rates were significantly higher among white respondents than among persons of color, women than men, and those 65+ than younger respondents. Respondents were most likely to have talked, respectively, with their spouse (58% before; 40% since), family (35%; 22%), and friends (12%; 10%)—with higher rates for white, women and older respondents. Surprisingly, only 4% before and 2% since the pandemic had discussed their care preferences with a doctor. Initiation of some new discussions was encouraging but there were fewer than expected, perhaps due to denial, superstition, or disbelief of pandemic severity. Advance care planning remains an under-utilized resource.

Abstract The COVID-19 virus has caused millions of deaths and impaired physical and mental health and social disconnection for countless persons around the world; concomitantly, the pandemic has exposed and exacerbated the pervasive effects of racism and stigma experienced by Black, Indigenous, or People of Color (BIPOC) and other marginalized/stigmatized groups. This study adopts an intersectional perspective examining multiple marginalized identities (i.e., the combination of LGBTQ and BIPOC status) and COVID-19 pandemic health stressors. We report on data from an online survey (conducted between Aug 10 and Oct. 10, 2020) focusing on current experiences and future planning during the COVID-19 pandemic in Canada. LGBTQ respondents (n=415) indicated significantly higher levels of depression, loneliness, sadness, and isolation in comparison to heterosexuals (n=3916). Heterosexual white respondents (n=3446) reported significantly higher levels of acceptance in their community and reported greater happiness but also higher rates of feeling of isolation than heterosexual BIPOC heterosexuals (n=470) who reported significantly higher rates of feeling judged/shamed by others than the heterosexual white respondents. In contrast to our expectations, white LGBTQ respondents (n=366) reported significantly more depression, loneliness, anxiety, and sadness than their BIPOC LGBTQ peers (n=49). These findings are interpreted as reflecting a complex mix of the effects of marginalization (as experienced by LGBTQ persons in general), and privilege and relative deprivation (as experienced by heterosexual and LGBTQ white persons) along with resilience and the moderated expectations and experiences of BIPOC LGBTQ persons.

Abstract The cultural appropriateness of two ACP tools, My Wishes, My Care, and Conversation Starter Kit, are examined. In development by the BC Centre for Palliative Care, My Wishes, My Care was reviewed with: LGBT Non-Metropolitan Older Adults (6 focus groups, N=32); English/Chinese Speaking Older Adults (1 focus group, N=9); and English/Punjabi or Hindi Speaking South Asian Older Adults (1 focus group, N=5). The Conversation Starter Kit, developed by Ariadne Labs, was reviewed with focus groups of people whose loved one was/is in a Care Home: one LGBT group (N = 5); one South Asian group (N = 5). General feedback on both tools included: concerns over level of understanding required to use the tool; the role of family in ACP planning; cultural inclusivity (e.g., images and text) and design elements. The feedback will inform revision of these tools and assist organizations in developing inclusive ACP planning guides or educational materials.

Background: A myth persists that seniors do not use the Internet, are ambivalent toward information and communication technologies (ICT's), and that a technological divide exists between older and younger generations. Aims: To explore the role of ICT's in the lives of seniors, in particular, those outliers who are thriving and fully engaged in the use of these technologies. Method(s): This study employed a quasi-ethnographic methodology. In-depth semi-structured interviews were held with research participants in an effort to capture their context-dependent lived experience and deeply explore the role of these technologies in their lives. Results: Four themes emerged from the analysis of the data: social connectivity; face-to-face contact remains; positive addiction; and back to the future. Conclusion: This research is an exploratory study and provides a glimpse into the level to which some older adults are engaged with ICT's, in particular social media such as Facebook and video-conferencing technologies such as Facetime. The research findings are contrary to the persistent myth that seniors do not use these technologies.

New surveillance technologies like those included in ambient assisted living - such as body-worn and passive environmental sensors, smart interfaces, and communications networks - are being developed to improve the security and safety of "at risk" older people, but ethical questions have been raised about the extent to which they compromise the rights and privacy of the people being monitored. The qualitative study we conducted was designed to help us understand the ways these novel surveillance technologies would influence individuals' everyday experiences of home. Participants felt new forms of surveillance would influence their sense of security, autonomy, and self-confidence, and would alter perceptions of home. The findings emphasize the need to improve our understanding of how ambient assisted living will affect the lives of those being monitored.