The ABS data showed that almost half of all LBGTI Australians noted high or very high levels of psychological distress compared with one in seven heterosexual people. An alarming 47.8 per cent of LGBTI people had “seriously thought about taking their own life” at some point in their lifetime. The rate of self-harm among the LGBTI community is close to six times higher, with 41.2 per cent having self-harmed in their lifetime, compared with 7.4 per cent of heterosexual people.

Social isolation and marginalisation

One of the most pressing issues confronting older LGBTI Australians is social isolation. Many have lived through intense discrimination, and some were severely impacted by the HIV epidemic, having lost loved ones to AIDS / AIDS-related diseases, or themselves enduring life-long HIV. This has often led to estrangement from biological families and traditional support networks. Unlike their heterosexual counterparts, LGBTI elders are less likely to have children who might care for them in old age. According to LGBTIQ+ Health Australia, this social isolation is compounded by a fear of discrimination or lack of understanding within aged-care settings, leading many to “re-closet” themselves in their later years. This re-closeting is not merely a return to secrecy; it is a painful regression forced by an environment that still harbours remnants of the discrimination the LGBTI community has fought against for decades.

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The result is a community suffering enduring mental health conditions associated with their minority status and compounded by a higher risk of loneliness, with all the associated negative health outcomes that come with isolation. Indeed, loneliness among the older LGBTI community is not just a matter of emotional distress; it has tangible impacts on their physical health, such as increasing their risk of dementia twofold. Research consistently shows that social connection is vital for the wellbeing of older people, particularly those from marginalised communities. Inclusive services, especially in aged care, that recognise and respect the identities of LGBTI people are essential in combating this isolation. These services must go beyond mere tolerance and acceptance; they need to actively affirm the identities of LGBTI elders and create spaces where the LGBTI community feels safe and valued.

Health disparities in care

In addition to social challenges, members of the LGBTI community face significant health disparities, ABS data has found. Evidence from small-scale LGBTI-targeted studies and some larger population-based surveys indicate that LGBTI people experience higher rates of mental health issues, such as depression and anxiety, compared to the general population. The legacy of stigma and discrimination, coupled with the compounded effects of ageing, contributes to these elevated risks. For instance, LGBTI people are more likely to suffer from chronic conditions such as cardiovascular disease and are less likely to seek timely medical help, often due to negative past experiences with healthcare providers.

The health disparities do not end with physical conditions. Mental health issues are rampant among older LGBTI people, driven by years of societal rejection and internalised stigma. A 2019 study highlighted that many older LGBTI people have concerns about residential-care services, citing perceptions of a lack of inclusivity, potential for discrimination and hostility, loss of access to community and partners, decreased autonomy, and concerns about the quality of care and the potential for elder abuse.

These fears are not unfounded; they are grounded in lived experiences where LGBTI individuals have repeatedly faced violence, alienation, and neglect. The enduring heteronormativity in medical settings, along with a lack of LGBTI-friendly programs, reinforces a vicious cycle of disparities in care. Worse still, LGBTI elders are often treated as a monolithic group, leading to the unique needs of our subcommunities being overlooked or inadequately addressed.

The LGBTI community also faces specific challenges related to dementia care. The lack of understanding and tailored care for LGBTI individuals with dementia can lead to inadequate treatment and support. This is particularly concerning given that dementia rates are expected to rise as the population ages. Dementia care for LGBTI people requires a nuanced approach that considers the unique life experiences and identities of patients. Without this, there is a significant risk that the LGBTI community will be forced into environments that do not respect or recognise their identities, further exacerbating their vulnerability and risking premature death.

A call for inclusive policy and practice

Despite these challenges, there are avenues for improvement. Training aged-care staff to understand and respect the unique needs of LGBTI residents can help mitigate feelings of isolation and fear. It is not enough to simply train staff on the basics of care; they must be educated on the history of LGBTI rights, the struggles this community has faced, including criminalisation, discrimination, hate crimes and vilification, and the specific needs that arise from those experiences.

Furthermore, ensuring that health and support services are accessible and affirming for LGBTI seniors will go a long way in addressing the mental and physical health disparities they face. This includes everything from the language and programs employed in care settings, to the policies that govern those settings. Health services must be proactive in reaching out to the LGBTI community, consulting with us and developing frameworks that welcome us and care for us.

A more compassionate tomorrow for LGBTI elders

The unique challenges faced by LGBTI elders are a direct result of a lifetime of navigating a world that has often been hostile to their existence. As they age, these challenges do not disappear; they evolve, requiring targeted support and understanding. It is crucial that the voices and experiences of LGBTI elders are not just heard, but placed at the forefront of these discussions.

By doing so, we can ensure that all Australians, regardless of sexual orientation or gender identity, age with dignity and respect. The older LGBTI community has fought for the rights that many now take for granted. It is our responsibility to ensure that their needs are met as they enter their golden years.

Nicholas Stewart is a partner at Dowson Turco Lawyers. He is also an adjunct fellow at UTS, chair of the women’s advancement subcommittee for the Law Society of NSW’s D&I committee, and vice president of Australian Lawyers for Human Rights.