Research into Practice
Edited by
Michael Toze, Paul Willis and Trish Hafford-Letchfield
With forewords by
Shanna K. Kattari and Pauline Smith
Policy Press, an imprint of
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Thanks to all those older people and allies who have shared their insights, knowledge and skills with us – we are still and always listening and learning.
List of figures and tables vii
Notes on contributors viii
Acknowledgements xiii
Foreword
Shanna K. Kattari xiv
Foreword: Trans ageing
Pauline Smith xvi
Introduction: Trans ageing and care – a review of the terrain
Michael Toze, Paul Willis and Trish Hafford-Letchfield 1
- PART IWhat do we know about older trans people’s lives and care needs? Messages from research
- 1Trans and gender diverse ageing and the life course: what can evidence from quantitative studies tell us about how trans people age?
Dylan Kneale, Evangeline Tabor and Laia Bécares 15
- 2“I need to get on with it”: experiences of older trans people navigating healthcare
Evelyn Callahan, Ben Vincent and Richard Holti 41
- 1Trans and gender diverse ageing and the life course: what can evidence from quantitative studies tell us about how trans people age?
Over to you 55
- PART IIPerspectives from practice: views, attitudes and practices of healthcare and welfare professionals
- 3“You know what? I’m not agreeing”: older trans people’s experiences of navigating, building and refusing care
Michael Toze 61
- 4Not in the family: trans people’s experiences of family relationships and the implications for support in later life
Trish Hafford-Letchfield, Christine Cocker, Keira McCormack and Rebecca Manning 77
- 5“What happened to my body over the past decade?” Trans masculine ageing and embodiment in a cisgenderist and ageist society
Alexandre Baril 91
- 6Examining the views and attitudes of health and social care professionals towards older trans people: findings from the Trans Ageing and Care study
Deborah Morgan, Paul Willis and Christine Dobbs 107
- 7
Professional preparedness for supporting older transgender adults when working in social services in Sweden Sofia Smolle 120
- 8Gender-affirming surgery in later life: centring older adults’ perspectives to promote equitable access and person-centred surgical care
Elijah R. Castle and Laura L. Kimberly 134
- 9What is being done to support trans older people facing intimate and domestic abuse?
Trish Hafford-Letchfield and Keira McCormack 152
- 3“You know what? I’m not agreeing”: older trans people’s experiences of navigating, building and refusing care
Over to you 173
- PART IIIMaking care practices more inclusive: perspectives on improving care and support for trans people in later life
Over to you 215
Conclusion: Looking ahead for enabling trans-inclusive and affirming practice
Paul Willis, Michael Toze and Trish Hafford-Letchfield 221
Index 226
Figures
Kathryn Almack (she/her) is Professor of Family Lives and Care (School of Health and Social Work, University of Hertfordshire) and Honorary Professor of Inclusive Health and Social Care at the University of Nottingham. Kathryn is a sociologist, and her research addresses relationships of care in people’s lives. This includes a substantial focus on lesbian, gay, bisexual and trans (LGBT+) older people’s experiences of ageing and end-of-life care. She has published widely in this area and has an effective sustained track record of her research being used to shape and influence policy and professional practice. ORCID ID: 0000-0002-4342-241X
Alexandre Baril (he/him) is Associate Professor at the University of Ottawa. His work is situated at the crossroads of gender, queer, trans, disability/crip/Mad studies, critical gerontology and critical suicidology. His commitment to equity has earned him awards for his involvement in queer, trans and disabled communities, including the Canadian Disability Studies Association Tanis Doe Francophone Award (2020) and the Equity, Diversity and Inclusion President’s Award at the University of Ottawa (2021). A prolific author, he has given over 200 presentations and has 80 publications. He is the author of Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide (2023). ORCID ID: 0000-0003-4833-1979
Laia Bécares (she/her) is Professor of Social Science and Health at King’s College London. Her work examines the mechanisms by which structural oppression, including heterosexism and cisgenderism, leads to health and social inequities over the life course. ORCID ID: 0000-0002-4207-074X
Evelyn Callahan (they/them) is a research fellow at University College London working with older people living in almshouses. Their other research interests include trans healthcare, healthcare in resource-limited settings and applied qualitative research methods. They have a PhD in sociology from Brunel University London, an MSc in medical anthropology from University College London and a BA in anthropology from the University of Connecticut. ORCID-ID: 0000-0002-0360-4657
Elijah R. Castle (he/him) is a study coordinator with the Hunter Alliance for Research and Translation, working on projects related to trauma-informed approaches to healthcare and research, sexual health for trans men and trans masculine people, health education and knowledge dissemination and community engagement. For over five years, Elijah has provided peer and community support and education on topics related to trans healthcare
and surgery navigation (especially genital surgeries). He has also worked in gender-affirming surgery research and medical case management. He is particularly interested in research related to patient–provider relationships as well as the relationship between trans surgeries and embodiment. ORCID ID: 0000-0003-0894-2214 Christine Cocker (she/her) is Professor in Social Work and Head of School at the University of East Anglia, Norwich, UK, and a qualified social worker. Prior to academia, Christine practised in child and family social work. She continues to have strong links with practice as an independent member of a Local Authority Fostering Permanence Panel and as Independent Chair for a Local Authority’s Children’s Academy and as an author of Safeguarding Adult Reviews. Her research and publications are in the area of social work with looked-after children, LGBT+ issues in social work and transitional safeguarding. ORCID ID: 0000-0002-4188-2316
Christine Dobbs (she/her) is based at the Centre for Innovative Ageing, Swansea University. As a Chartered Psychologist, joined the Centre for Innovative Ageing after completing her PhD in 2008 and worked here almost continuously until taking on her current position as Honorary Research Fellow in December 2020. Prior to this, she was Postgraduate Programme Director for Gerontology and Ageing Studies. She has held a number of roles in research, teaching and student supervision. Research has included end-of-life care for older people, as well as intra- and intergenerational relationships in black and minority ethnic elders elders, and, more recently, looking at dignified and inclusive health and social care for older trans people living in Wales. ORCID ID: 0000-0002-4320-6709
Trish Hafford-Letchfield (she/her) is Professor of Social Work at the University of Strathclyde, Scotland, UK. She is a qualified nurse and social worker. Her research interests are in the experiences of ageing of people in marginalised communities, and much of her research uses participatory methods. She has published extensively on LGBTQ+ ageing and care; on suicide thought and behaviour and problematic substance use in later life; educational gerontology; leadership and management; and organisational development in social work and social care. Trish has over 150 publications including 20 books which more recently have included Rethinking Feminist Theories for Social Work Practice for Palgrave with Christine Cocker, and she is also series and volume editor on the series on Sex and Intimacy in Later Life with Paul Simpson and Paul Reynolds for Policy Press. Orchid ID: 0000-0003-0105-0678
Phil Harper (they/them) is Senior Lecturer in Health and Social Care at Birmingham Newman University. Phil is currently studying for a
doctorate, where they aim to explore care staff’s understanding of the needs of non-binary individuals living with dementia. Phil has also been involved in research projects looking at transgender individuals’ experiences of healthcare and personal care for people living with dementia. Phil is also an advisor/LGBTQ+ consultant for the Association for Dementia Studies and external member of the Northampton Dementia Research Centre. Phil is also part of Alzheimer’s Europe’s working group on Sexuality and Gender, where they helped to develop resources around LGBTQ+ inclusion in policy and practice. Phil is currently Chair of the conference subgroup in the LGBTQ+ Dementia Advisory group. ORCID ID: 0000-0003-0933-005X Kit Heyam (they/he) is a writer, researcher, heritage practitioner and trans awareness trainer who has supported a wide variety of professionals across the UK to develop trans inclusivity. Their research investigates the history of gender and sexual non-conformity, and their 2022 book Before We Were Trans: A New History of Gender – which argues for the importance of understanding gender-non-conforming people on their own historical and cultural terms – was a finalist for the 2023 Lambda Literary Award in Transgender Nonfiction. They are currently working with the Royal Armouries Museum and University of Plymouth to illuminate gendered aspects of the museum’s collection. ORCID ID: 0000-0001-7541-7001
Richard Holti (he/him) is Professor of Professional Learning at the Open University. He recently led the research team funded by the UK National Institute for Health and Care Research on the project ‘Improving the integration of care for trans adults’ (ICTA). Learning also from the experiences of his trans son, he is committed to improving the healthcare that trans people receive. ORCID ID: 0000-0003-4769-8621
Eloise Kane (she/her) is Consultant in Palliative Medicine, Marie Curie Hospice Bradford, caring for patients with life-limiting illness. She has a passion for inequalities work including developing local services for prisoners, chairing her local palliative care network’s equity, diversity and inclusion committee. She has a particular focus on LGBTQ+ communities, especially the trans community, and provides education sessions on this topic. She was also involved in supporting the Hospice UK ‘I just want to be me’ report in 2023. ORCID ID: 0000-0003-3241-6054
Laura L. Kimberly (she/her) is Assistant Professor in the Hansjörg Wyss Department of Plastic Surgery and in the Division of Medical Ethics in the Department of Population Health at New York University Grossman School of Medicine in New York City, USA. Her research examines
ethical and psychosocial considerations in innovative surgical interventions, including gender-affirming surgery. Her work seeks to centre patients’ lived experiences of embodied identity over the life course. ORCID ID: 0000-0001-6873-6266 Dylan Kneale (he/him) is a principal research fellow at the EPPI-Centre, UCL Social Research Institute, University College London. He is particularly interested in ageing, LGBTQ+ health, social exclusion and evidence-informed decision making, as well methods involving evidence synthesis and secondary data analysis. ORCID ID: 0000-0002-7016-978X
Rebecca Manning (she/her) is a registered mental health nurse and manager of a community mental health team in Suffolk at the Norfolk and Suffolk Foundation NHS Trust and has experience in the gender field, through personal experience, founding and running a social enterprise to support the trans community and working with people in both the health and charity sectors, and was recently part of the Clinical Reference Group for NHS England. ORCID ID: 0000-0003-0076-9103
Keira McCormack (she/they) is a senior independent domestic violence advisor (IDVA), having working intensely within both the domestic abuse and sexual abuse fields and previously spending 15 years as a counsellor in rape crisis settings. Keira set up and ran a counselling charity in Belfast aimed at the trans, non-binary and intersex community. She is also on the board of an LGBT charity in Belfast, Northern Ireland. ORCID ID: 0009-0002-8509-6904
Deborah Morgan (she/her) is a senior research officer in the Centre for Innovative Ageing, Swansea University. Her main research interests are loneliness and social isolation in later life and she has a PhD. She sits on the Welsh government Loneliness and Social Isolation Strategy Board and is a member of the Cross Party Intergenerational Solidarity Group. Deborah’s research has led to several invited national and international presentations, and she has made several appearances on radio and television. She is also a TEDx Swansea speaker. ORCID ID: 0000-0002-3107-3945
Sofia Smolle (they/them) is a PhD student in social work at the Department of Psychology and Social Work at Mid Sweden University. Areas of interest are transgender and queer perspectives including queer ageing, intersectionality, norm-critical approaches, empowerment, social welfare, knowledge-enhancing initiatives regarding critical and radical social work and LGBTQ+-related activism. ORCID ID: 0000-0003- 0960-8832
Evangeline Tabor (they/them) is a final-year PhD candidate at University College London funded through the Soc-B CDT (ESRC/BBSRC). Their work examines LGBTQ+ health disparities and inequities across the life course. Their current interests include queer data ethics, the measurement of sexuality in large population surveys, LGBTQ+ physical health inequities, LGBTQ+ ageing and queer joy. ORCID ID: 0000-0002-5485-8817 Michael Toze (he/him) is Senior Lecturer in Public Health and Social Determinants of Health at Lincoln Medical School, UK. Prior to academia, Michael worked in local government policy. Michael has been involved in running trans masculine support groups for over 15 years and has published on topics relating to trans health, ageing and LGBT+ communities. ORCID ID: 0000-0003-4699-9190
Ben Vincent (they/them) is an independent scholar and author of the books Transgender Health (2018) and Non-binary Genders (2020). They are a co-editor of the collections Non-binary Lives (2020) and TERF Wars (2020). Ben was also a co-author of the eighth edition of the WPATH Standards of Care and recently worked as Research Coordinator of the Trans Learning Partnership, based at the charity Spectra. ORCID ID: 0000-0002-3110-3008
Olivia Warnes (she/her) is Policy and Advocacy Officer at Hospice UK. Following a masters in global governance, Olivia joined Hospice UK in 2021. Since then, she has worked closely with Gender Identity Research and Education Society (GIRES)and Stonewall on a programme of work examining trans and gender diverse communities’ access to and experiences of palliative and end-of-life care, resulting in the publication of the 2023 report ‘I just want to be me’. Olivia has a longstanding interest in human rights and health inequalities. Her work in the trans healthcare space continues with further research and advocacy projects. ORCID ID: 0009-0004-5072-6536
Paul Willis (he/him) (PhD) is Professor of Social Care in the School of Social Sciences, Cardiff University, and a registered social worker. His research areas include: older men’s experiences of loneliness and social isolation; sexuality, care and ageing; trans ageing and gender identity; inclusive housing and care provision for diverse groups of older people; and social work practice with older people. Paul has a longstanding interest in the ageing experiences of people from sexual and gender minoritised groups. He has recently co-edited a new international volume entitled Ageing, Men and Social Relations (2023) (published by Policy Press as part of their Ageing in a Global Context series). ORCID ID: 0000-0002-9774-0130
Thanks to SafeLives for their kind permission to reproduce the DASH checklist in Chapter 9. This checklist was developed and published by SafeLives and can be freely downloaded from: https://safelives.org.uk/sites/default/files/resources/Dash%20without%20guidance.pdf. SafeLives are a UK registered charity (no 1106864).
