Abstract
Objectives
The number of sexual and gender minority older adults who require long-term care is
steadily increasing. The purpose of this systematic review and meta-analysis was to
synthesize the evidence related to preference for long-term care with regard to sexual
orientation and gender identity.
Design
Systematic review and meta-analysis.
Setting and Participants
We searched PubMed/MEDLINE, Ovid/PsycINFO, and Web of Science from inception to July
2020 (updated in July 2021). Search terms embraced 3 themes (1) sexual and gender
minorities, (2) long-term care, and (3) preferences. Quantitative studies of the adult
population were included.
Methods
Screening, data extraction, and quality assessment followed the National Institutes
of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
The proportions were pooled using meta-analysis and random effects models.
Results
A total of 17 articles were included out of 5944 studies of potential relevance. The
perception of nursing homes (NHs) that emerges from these studies is predominantly
negative for heterosexuals and lesbian, gay, bisexual and trans (LGBT) individuals
(n = 11). Across 6 studies (10 outcomes), the pooled estimate for the proportion of
individuals with a preference to move into a NH was 10.6% [95% confidence interval
(CI) 7.88%‒13.22%, I2 = 97.4%]; 13.7% (95% CI 8.6%‒18.7%) for LGBT individuals and 7.3% (95% CI 3.14%‒11.50%)
for heterosexuals. LGBT-friendly NHs were preferred by between 55% and 98% of LGBT
respondents. Informal care provided by partner or family was one of the preferred
options (n = 6). It was preferred by 33% to 70% of various groups of LGBT respondents.
Conclusions and Implications
The preference to move into a NH is relatively low among both heterosexuals and sexual
and gender minority adults. Findings showed negligible differences in preferences
to move into a NH between heterosexuals and sexual and gender minorities. LGBT-friendly
long-term care facilities where every member feels welcomed and not discriminated
against seem to be one of the favorable long-term care choices among LGBT individuals.
This knowledge is important to inform nursing services and policy makers about the
preferred long-term care options. Providing LGBT-friendly facilities is usually less
expensive than providing care in newly created LGBT-only facilities.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Care preferences among middle-aged and older adults with chronic disease in Europe: individual health care needs and national health care infrastructure.Gerontologist. 2015; 56: 687-701
- Stated preferences for long-term care: a literature review.Ageing Soc. 2019; 39: 1873-1913
- Recipients of long-term care.Health at a Glance 2019: OECD Indicators. OECD Publishing, Paris2019
- Modernisation and ageing theory revisted: current explanations of recent developing world and historical Western shifts in material family support for older people.Ageing Soc. 2004; 24: 29
- Do individuals in old age prepare for the risk of long-term care? Results of a population-based survey in Germany.Int J Environ Res Public Health. 2018; 15: 2189
- [Long-term care preferences among individuals of advanced age in Germany: results of a population-based study].Gesundheitswesen. 2018; 80: 685-692
- Social care networks and older LGBT adults: challenges for the future.J Homosex. 2014; 61: 21-52
- Differences by sexual orientation in expectations about future long-term care needs among adults 40 to 65 years old.Am J Public Health. 2015; 105: 2359-2365
- [The proportion of sexual minorities (LGB) among community-dwelling older individuals in germany and the potential association between sexual orientation and depressive symptoms].Psychiatr Prax. 2021; 48: 92-98
- Sexual orientation and sex differences in socioeconomic status: a population-based investigation in the National Longitudinal Study of Adolescent to Adult Health.J Epidemiol Community Health. 2018; 72: 1016-1026
- The health and wellbeing of Australian lesbian, gay and bisexual people: a systematic assessment using a longitudinal national sample.Aust N Z J Publ Health. 2019; 43: 281-287
- Understanding SAFE Housing - putting older LGBT people's concerns, preferences and experiences of housing in England in a sociological context.Hous Care Support. 2017; 20: 89-99
- Sexual orientation and psychosocial factors in terms of loneliness and subjective well-being in later life.Gerontologist. 2022; : gnac088
- Diversity in social communication and support: implications for loneliness among LGB adults.Gerontologist. 2022; : gnac10
- Swimming upstream: the provision of inclusive care to older lesbian, gay and bisexual (LGB) adults in residential and nursing environments in Wales.Ageing Soc. 2016; 36: 282-306
- "Could we hold hands?" Older lesbian and gay couples' perceptions of long-term care homes and home care.Can J Aging. 2016; 35: 432-446
- Long-term planning and decision-making among midlife and older gay men and lesbians.J Soc Work End Life Palliat Care. 2007; 3: 59-77
- Perceptions of ageing as an older gay man: a qualitative study.J Clin Nurs. 2013; 22: 3388-3395
- Canadians who care: social networks and informal caregiving among lesbian, gay, and bisexual older adults in the canadian longitudinal study on aging.Int J Aging Hum Dev. 2020; 91: 299-316
- “I will die if I have to go into an old age home”: Afrocentric options for care of older LGBT people in South Africa.Agenda. 2020; 34: 94-107
- Older lesbians receiving home care: formal and informal dimensions of caregiving.J Women Aging. 2018; 30: 91-110
- Successful aging among LGBT older adults: physical and mental health-related quality of life by age group.Gerontologist. 2015; 55: 154-168
- Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual older people.Soc J Br Soc Assoc. 2010; 44: 908-924
- Investigating the needs and concerns of lesbian, gay, bisexual, and transgender older adults: the use of qualitative and quantitative methodology.J Homosex. 2014; 61: 53-78
- Staying out of the closet: LGBT older adults' hopes and fears in considering end-of-life.Can J Aging. 2018; 37: 22-31
- Later life care planning and concerns of transgender older adults in Canada.Int J Aging Hum Dev. 2019; 89: 39-56
- Perspectives of LGBTQ older adults on aging in place: a qualitative investigation.J Homosex. 2016; 64: 1539-1560
- Planning for future care and the end of life: a qualitative analysis of gay, lesbian, and heterosexual couples.J Health Soc Behav. 2017; 58: 473-487
- Lesbian and gay people's concerns about ageing and accessing services.Aust Soc Work. 2009; 62: 186-201
- How do community-dwelling LGBT people perceive sexuality in residential aged care? A systematic literature review.Aging Ment Health. 2019; 23: 529-540
- Provider and LGBT individuals' perspectives on LGBT issues in long-term care: a systematic review.Gerontologist. 2020; 60: e169-e183
- End-of-life and advance care planning considerations for lesbian, gay, bisexual, and transgender patients #275.J Palliat Med. 2013; 17: 106-108
- Silent voices and invisible walls: exploring end of life care with lesbians and gay men.J Psychosoc Oncol. 2006; 24: 51-64
- LGBT∗ ageing in the UK: spatial inequalities in older age housing/care provision.J Poverty Soc Justice. 2016; 24: 63-76
- Hidden and ignored: older sexual and gender minorities in New Zealand.Soc Work Soc Sci Rev. 2019; 18: 15-30
- Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.Health Soc Care Community. 2019; 27: 1251-1259
- Dying in long-term care: perspectives from sexual and gender minority older adults about their fears and hopes for end of life..J Soc Work End Life Palliat Care. 2018; 14: 209-224
- Are services inclusive? A review of the experiences of older GSD women in accessing health, social and aged care services.Int J Environ Res Public Health. 2020; 17: 3861
- 'We see it as being heterosexualised, being put into a care home': gender, sexuality and housing/care preferences among older LGB individuals in the UK.Health Soc Care Community. 2015; 24: e155-e163
- Lesbian and gay elders and long-term care: identifying the unique psychosocial perspectives and challenges.J Gerontol Soc Work. 2010; 53: 421-435
- "Fear Runs Deep:" The anticipated needs of LGBT older adults in long-term care.J Gerontol Soc Work. 2018; 61: 887-907
- Older LGB&T housing in the UK: challenges and solutions.Hous Care Support. 2017; 20: 128-136
- Housing for ageing LGBTQ people in Sweden: a descriptive study of needs, preferences, and concerns.Scand J Occup Ther. 2015; 23: 337-346
- 'I don't want to go back into the closet just because I need care': recognition of older LGBTQ adults in relation to future care needs.Eur J Soc Work. 2020; 23: 253-264
- Gay and lesbian perceptions of discrimination in retirement care facilities.J Homosex. 2005; 49: 83-102
- Well-being among older gay and bisexual men and women in England: a cross-sectional population study.J Am Med Dir Assoc. 2019; 20: 1080-1085.e1
- Sexual health and its linkages to reproductive health: an operational approach.World Health Organization, 2017https://apps.who.int/iris/handle/10665/258738(Lizenz: CC BY-NC-SA 3.0 IGO)Date accessed: December 28, 2022
- Advancing LGBTQI health research.Lancet. 2021; 397: 2031-2033
- The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors.Gerontologist. 2013; 53: 664-675
- Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Psychol Bull. 2003; 129: 674
- Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.PLoS Med. 2009; 6: e1000097
- Long-term care preferences and sexual orientation: protocol for a systematic review.Healthcare. 2020; 8: 572
- Quality assessment tool for observational cohort and cross-sectional studies.National Institutes of Health, Department of Health and Human Services, 2014
- Metaprop: a Stata command to perform meta-analysis of binomial data.Arch Public Health. 2014; 72: 1-10
- Adaptation and age-related expectations of older gay and lesbian adults.Gerontologist. 1992; 32: 367-374
- Who can I turn to? Social networks and the housing, care and support preferences of older lesbian and gay people in the UK.Sexualities. 2020; 25: 9-24
- Friends, family, and caregiving among midlife and older lesbian, gay, bisexual, and transgender adults.J Homosex. 2014; 61: 79-102
- Planning to move into a nursing home in old age: does sexual orientation matter?.Age Ageing. 2021; 50: 974-979
- End of life, chronic illness, and trans-identities.J Soc Work End Life Palliat Care. 2014; 10: 34-58
- Elder transgender lesbians: exploring the intersection of age, lesbian sexual identity, and transgender identity.J Lesbian Stud. 2015; 19: 73-89
- Aging and transgender bisexuals: exploring the intersection of age, bisexual sexual identity, and transgender identity.J Bisex. 2016; 16: 58-80
- Older lesbians: experiences of aging, discrimination and resilience.J Women Aging. 2011; 23: 216-232
- Older lesbian experiences of homophobia and ageism.J Soc Serv Res. 2013; 39: 3-15
- Advance care planning among older LGBT Canadians: heteronormative influences.Sexualities. 2020; 25: 79-98
- The potential impact of discrimination fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care.J Homosex. 2008; 54: 325-339
- 'Lavender retirement': a questionnaire survey of lesbian, gay and bisexual people's accommodation plans for old age.Int J Nurs Pract. 2010; 16: 586-594
- Transgender and gender non-conforming adult preparedness for aging: concerns for aging, and familiarity with and engagement in planning behaviors.Int J Transgenderism. 2020; 21: 58-69
- Planning for future care needs: experiences of unmarried heterosexual and sexual minority women.Women Health. 2010; 50: 599-617
- Planned retirement housing preferences of older homosexuals.J Homosex. 1987; 14: 35-56
- Older LGBT people's experiences and concerns with healthcare professionals and services in Ireland.Int J Older People Nurs. 2014; 10: 230-240
- “Who are these people?” Evaluating the demographic characteristics and political preferences of MTurk survey respondents.Res Polit. 2015; 2 (2053168015604648)
Article info
Publication history
Published online: December 28, 2022
Publication stage
In Press Corrected ProofFootnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
