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This final chapter revisits the ‘big takeaway messages’ for health, community and social care practitioners that are woven across the book and identifies future directions in research for supporting trans people in later life and developing trans-inclusive research and practice. In relation to improving care experiences across health and social care systems, a resounding message is the importance of developing and delivering a person-centred, person-led approach to care that is collaborative and centred on the wishes and preferences of older trans people as the experts on their lives. The chapter concludes by setting out key dimensions for enabling trans-inclusive and affirming practice and services.
This chapter highlights nuanced considerations facing older trans people at the end of life to inform current thinking and promote further research. Research evidence suggests that trans people often face additional barriers and vulnerabilities at the end of life, including the handling of memorialisation. Trans people also report anxieties related to past experiences of exclusion and discrimination, around points of disclosure and over becoming dependent on others to meet their care needs. LGBT end-of-life care research has grown significantly in recent years. However, this has involved few trans participants and even fewer non-binary people. This lacuna in research evidence also means we have scant knowledge about positive end-of-life care experiences of this population. More research is needed to enhance inclusion of trans and non-binary participants and explore intersectionality to expand our understandings in this area. In turn, this will help to inform evidence-based practice to ensure services are accessible and safe for this population.
This chapter is about the perceptions and attitudes of health and social care professionals towards older trans people in the United Kingdom. Findings from the Trans Ageing and Care study highlighted the obstacles and discrimination trans people in mid to later life encounter when seeking to access medical transition services (Willis et al, 2020, 2021). We present descriptive survey findings from the same study. A total of 165 health and social care professionals across Wales completed an online questionnaire that assessed their knowledge about trans’ legal and medical issues in later life, and familiarity with trans individuals, among other knowledge domains. Findings indicate respondents are familiar with trans issues – with the media being the most popular source – and are generally supportive of trans civil rights. However, we also identified gaps. We conclude by outlining core components essential to developing a trans-inclusive training curriculum for health and social care professionals.
Pre- and postoperative considerations for older transgender and gender diverse (TGD) people seeking gender-affirming surgery are often overlooked. In this chapter, we examine how older age impacts pathways to gender-affirming surgery, the experience of surgery and postoperative surgical and psychosocial outcomes. We address perceptions of older adults’ appropriateness for surgical candidacy based on assumptions about sexuality in older adults, patient preferences and postoperative outcomes, resulting in both inequitable access to surgical procedures and minimal outcomes data for this population. Financial resources, adequate health education and information specific to healthcare and sexuality for older TGD individuals present additional factors influencing equitable access. We also explore how insufficient trans competency in various care-based settings can impede access to surgery and compromise postoperative care. Finally, we examine the role of social support for older TGD individuals and identify best practices for supporting older gender-affirming surgical candidates before, during and after gender-affirming surgery.
This chapter will discuss the healthcare needs and experiences of older trans and gender diverse (including non-binary) people in the UK, drawing upon empirical qualitative data collected through the Integrating Care for Trans Adults project, conducted at the Open University from 2019 to 2021. This project included an exploration of the unique health challenges faced by older trans people with transition-related and non-transition-related healthcare. These data comprise 33 semi-structured interviews with participants ranging in age from 51 to 82 years old. A major theme we unpacked was the concept of waiting – especially waiting for gender-affirming care and managing a sense of ‘time running out’. A wide range of overlapping and specific considerations for the healthcare of trans elders were explored, including hormone replacement therapy, healthcare screening programmes, hair removal limitations, surgery later in life and plans and concerns about social care. Consideration of trans elders requires a nuanced consideration of time, as an individual trans elder may have transitioned historically, or recently, such that one is young in ‘trans time’. Most of the participants in this study transitioned relatively recently and so reflected on the mental, physical and social challenges transition as an elder specifically created. The participants in this study discussed the factors posing barriers to transition earlier in life and lack of access to information. All participants reported transition as a positive life step, and although many wished they had transitioned sooner, this was not a universal sentiment.
This introductory chapter provides an overview of the contemporary issues and topics in trans ageing and care and outlines the book’s contribution to enhancing understanding, navigating more confidently and improving practice with trans older adults. The chapter includes an overview of the trans and gender diverse ageing population in the context of the social and political landscape and introduces common terminology along with some of the themes and concepts that are followed through in subsequent chapters such as intimacy, family, community, accessing and using care and support services, and health disparities. It also provides an understanding of trans life trajectories, including the diversity and intersectionalities of the population, and the emerging emphasis on non-binary identities and what this means for later life.
Gender diversity is becoming increasingly visible within society, with more trans, non-binary and gender diverse people coming forward throughout the life course. In settings such as social care, welfare services, housing and associated health disciplines, practitioners and service providers will see an increasing number of trans and non-binary service users as more trans people ‘come out’ and existing trans populations age.
Drawing upon theoretical perspectives from social gerontology, as well as contemporary research and the direct lived experience of older trans and gender diverse people, the book focuses on practical support for ageing trans, non-binary and gender diverse people, with an emphasis on person-centred care. Expertise is contributed by scholars from a range of disciplines, with particular attention to the scholarship of trans, non-binary and gender diverse people.
The book is aimed at professionals and practitioners working internationally in a range of public and social welfare services for older people, as well as students training for such roles, and educators involved in delivering professional training. Each section concludes with practical learning activities, designed to support professional practice.
This chapter revisits findings from a systematic review on trans parenting which contained limited findings on grandparenting (Hafford-Letchfield et al, 2019). The authors expand the themes to examine the potential implications for trans people in accessing and developing support in later life, particularly where conflict and transgression impact on future care planning. The authors draw on two case studies from empirical research which illustrate barriers and enablers in developing support networks with birth and chosen family. Honest and respectful communication between individuals is a key factor in building and sustaining relationships. Messages for professional practice with trans people in later life include: the importance of professionals addressing their own transphobia; acknowledging the individuality of trans people’s lives; supporting trans people’s relationships with family members; including trans people in developing and improving all family services; and helping trans people build links with social and community networks that understand their needs.
Gender diversity is becoming increasingly visible within society, with more trans, non-binary and gender diverse people coming forward throughout the life course. In settings such as social care, welfare services, housing and associated health disciplines, practitioners and service providers will see an increasing number of trans and non-binary service users as more trans people ‘come out’ and existing trans populations age.
Drawing upon theoretical perspectives from social gerontology, as well as contemporary research and the direct lived experience of older trans and gender diverse people, the book focuses on practical support for ageing trans, non-binary and gender diverse people, with an emphasis on person-centred care. Expertise is contributed by scholars from a range of disciplines, with particular attention to the scholarship of trans, non-binary and gender diverse people.
The book is aimed at professionals and practitioners working internationally in a range of public and social welfare services for older people, as well as students training for such roles, and educators involved in delivering professional training. Each section concludes with practical learning activities, designed to support professional practice.
Gender diversity is becoming increasingly visible within society, with more trans, non-binary and gender diverse people coming forward throughout the life course. In settings such as social care, welfare services, housing and associated health disciplines, practitioners and service providers will see an increasing number of trans and non-binary service users as more trans people ‘come out’ and existing trans populations age.
Drawing upon theoretical perspectives from social gerontology, as well as contemporary research and the direct lived experience of older trans and gender diverse people, the book focuses on practical support for ageing trans, non-binary and gender diverse people, with an emphasis on person-centred care. Expertise is contributed by scholars from a range of disciplines, with particular attention to the scholarship of trans, non-binary and gender diverse people.
The book is aimed at professionals and practitioners working internationally in a range of public and social welfare services for older people, as well as students training for such roles, and educators involved in delivering professional training. Each section concludes with practical learning activities, designed to support professional practice.
