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Summer 2008 | Vol 11 No 4

Focus

Over the rainbow

Meeting the needs of older LGBT adults

By Anne Ptasznik

During the late 1960s and 70s, Chris Morrissey felt so alone in her conflicted feelings about her sexual orientation that she sometimes felt suicidal. Yet the therapist she saw for more than four years never once indicated that it would be OK to talk about this issue. Morrissey, now 65, is the programs manager for the Generations Project, which provides resources and support for lesbian, gay, bisexual and transgender (LGBT) older adults in Vancouver, British Columbia, so they do not have to endure the silence she faced.

This silence pervades health services for all age groups, where clinicians often don’t ask, or may treat gender identity and sexual orientation as irrelevant, forcing clients to essentially hide their identity or to not seek help in the first place. Yet sexuality and sexual orientation remain important parts of who people are as they age.

Gens Hellquist, executive director of the Canadian Rainbow Health Coalition in Saskatoon, Saskatchewan, says that it is difficult to determine what percentage of older adults are LGBT, due to fears of disclosure and varying definitions of sexual orientation; but he estimates the number to be around 10 per cent.

What we do know is that with the aging of the general population, the unique needs of older LGBT adults cannot be ignored. Yet in a 2006 McGill School of Social Work national study of the needs of LGBT older adults and their caregivers and service providers, most service providers indicated that they had no clients they could identify as lesbian or gay. They also reported that they were not trained to deal with LGBT issues. Results also showed that service providers lacked awareness that ignoring issues of identity and sexuality limits the ability to support older LGBT adults.

Similarly, a 2002 study in the Journal of Gay and Lesbian Social Services advocated that substance use treatment must address social and psychological factors related to sexual orientation, including “coming out,” societal and internalized homophobia and family and support systems. Yet 40 to 50 per cent of substance abuse counsellors received no formal training about these issues.

But addressing these issues is crucial. Older LGBT adults may have faced a lifetime of discrimination or secrecy. Dick Moore, manager of the Older LGBT Programme at the 519 Community Centre in Toronto, says that many older LGBT adults grew up in a time when being gay or lesbian was considered a mental disorder. While some became involved in the gay liberation movement, others grew up when the only way to cope was to pass as straight.

As a result of this history and ongoing discrimination, Moore says some older people simply will not seek help unless they are in crisis. But this isolation can affect mental health. A 2001 Aging and Mental Health study of 416 lesbian, gay and bisexual adults aged 60 to 91 found less suicidal ideation among older adults who were open about their sexual orientation. Some researchers have found that the “coming out” experience of older adults can help them cope with some of the stresses of aging, what researcher Douglas Kimmel has referred to as “crisis competence.”

Morrissey says that there are more visible LGBT practitioners working in services today and services for specific groups within the LGBT demographic. Her program offers a weekly Golden Oldies group for older LGBT adults with drug and other alcohol problems in partnership with gay and lesbian addiction counsellors from the local community health centre.

Angela Johnston, a master’s candidate in gerontology at Vancouver’s Simon Fraser University who is studying the needs of the older LGBT community, says that it is difficult to recommend one overarching strategy for health care professionals for more appropriate care because there is a lot of diversity within the LGBTcommunity. Some older adults she interviewed for her research were open about their sexuality, while others were not out in all areas of their lives. Johnston says that counsellors need to ask clients what they need and want and should assess how their sexual orientation influences them because its influence may vary. Key to providing appropriate care is to visibly demonstrate openness to serving LGBT communities.

Moore agrees, adding that professionals need to be aware of heterosexism, even in language. “It provides a whole different opening for a conversation if you use the word ‘partner’ or ask ‘Could you tell me about the people who are close to you in your life’ rather than ‘Were you married?’” he says. “If there is a place where older adults know that gay and lesbian people are accepted, it will be a more comfortable environment, even if they choose not to come out.”

A more comfortable environment would have helped Morrissey years ago: “I was going through so much torment and anguish; it would have been much more helpful if the therapist had taken the initiative to somehow allow me to feel safe in those sessions.”