Introduction

In recent decades the situation for LGBTI people has changed radically in large parts of the world, including the Nordic countries. This has meant increased access to social and legal rights, stronger protections against discrimination, greater visibility and more places to gather. Despite this, public health surveys illustrate how a gender identity or sexuality that that does not conform to conventional norms still matters. LGBTI people, especially bisexual and transgender people, experience a greater degree of vulnerability and impaired mental and physical health than the majority population over the life cycle (Nordic Council of Ministers, 2021, Eggebø, Stubberud & Andersen 2020, FHI 2015; Johansen Laursen & Juel, 2015).

Older LGBTI people are a heterogeneous group with different conditions when it comes to ageing, but they also have two things in common.

How do these conditions affect older LGBTI persons’ prospects as they age and what happens in their contacts with health and social care?

The research on older LGBTI people comes mainly from an English-speaking context. The patterns in these studies show that the life experiences in close relationships of older lesbians, gays, bisexuals, trans and intersex people strongly affect their living conditions, health, and healthcare and social care needs in various ways (Kneale et al., 2021). The majority are living good lives and report to be in good health. But the studies also indicate that older LGBTI people are at significantly higher risk of impaired mental health than their peers, have an increased risk of social isolation, and retain a palpable concern about being treated negatively and with ignorance when they need healthcare and social care (Fredriksen Goldsen et al., 2011). This is especially true of older adults with trans experiences, and older gay and bisexual men with HIV (ibid).  Fredriksen Goldsen, Jen, och Muraco (2019) conclude in their latest literature review of key international publications on LGBTI ageing and life course perspectives between 2009 and 2016 that this field of research has grown rapidly. They also identify greater breadth in the methodologies used as well as a stronger theoretical foundation. But there is also a lack of intersectional perspectives and a greater focus on differences within the LGBTI group. Few studies address the very oldest bisexual or non-binary people, people with intersex variations, older racialised individuals, and LGBTI people with low income.

International studies also show that people working in elder care service providers have little knowledge and competence about LGBTI people’s life experiences and special needs, although attitudes are more positive than before (Leyerzapf, Visse & Abma. 2018; Hafford-Letchfield, Simpson, Willis and Almack, 2018; Willis 2013). Thus, there is also good reason for their low expectations and their concerns about not being responded to with knowledge and understanding. The ultimate consequence is that older LGBTI people, like other marginalised groups, simply do not seek help when needed. Another consequence is that it does not feel safe to be open about one’s gender identity or sexual orientation in contacts with the healthcare system, or prior to moving into a nursing home for older people or short-term housing – despite having been open earlier in life (Leyerzapf et al., 2018; Pijpers, 2022; Siverskog, 2021a; Rainbow Project and Age Northern Ireland, 2011). On the one hand, not being open about one’s gender identity or sexual orientation can protect the person from discrimination, but on the other hand, make it impossible to access understanding and positive affirmation of one’s identity, life experiences and relationships.

Living conditions and prospects for ageing are strongly associated with the local context, and the legislation and welfare structure that feature there. In order to create better  ageing conditions for older LGBTI people in the Nordic countries, as well as the Faroe Islands, Greenland and Åland, a knowledge base of the situation  from this geographical area is needed. This report therefore brings together knowledge about older LGBTI people’s prospects for, as well as experiences of, healthcare and social care in the Nordic countries from two points of departure: older LGBTI people’s living conditions and experiences from encounters with healthcare and social care; and knowledge and the need for knowledge concerning gender, sexuality, norms and older LGBTI people in professional qualification study programmes and CPD initiatives after graduation.

In January 2020, Nordic co-operation within the Nordic Council of Ministers was extended to include work for equal rights, treatment and opportunities for LGBTI people in the Nordic countries. One of the strategic policy areas for Nordic co-operation concerns quality of life and living conditions and has the aim of reducing the significant differences in both physical and mental health between LGBTI people and the rest of the population. In particular, it emphasises the importance of knowledge about the situations of older LGBTI people as the basis for promoting fair and just health and medical care services.

The Norwegian Presidency of the Nordic Council of Ministers in 2022 therefore initiated a project that aims to increase knowledge about the living conditions and quality of life of older LGBTI people, especially in relation to their interactions with healthcare and social care. The Nordic Council of Ministers co-operation body Nordic Information on Gender (NIKK), located at the Swedish Secretariat for Gender Research at the University of Gothenburg has carried out the project, which has resulted in this report among other things.

The report has two parts:

The research overview has been written by Anna Siverskog, PhD, project researcher at the School of Culture and Education, Södertörn University, and senior lecturer at the School of Health and Welfare, Jönköping University. The knowledge inventory was written by Janne Bromseth, PhD, researcher at Eastern Norway Research Institute, Innland Norway University of Applied Sciences and is translated from Swedish to English by Katherine Stuart.