Improving healthcare for older LGBTQ+ people

Although we are both in our seventh decade, different identities and intersecting factors have led to very different experiences of healthcare. Some have been very positive; others less so. We reflected on the diversity within LGBTQ+ communities and the importance of recognising that experiences are not uniform.

It is clear though, that some common themes affecting older LGBTQ+ people do exist within health and social care, which have led to persistent health inequalities. For example, older LGBTQ+ people report poorer physical and mental health than the general population and worse experiences of healthcare particularly relating to cancer, palliative/end-of-life care, dementia and mental health provision.

There are growing numbers of older LGBTQ+ people because we have an ageing population, and more older people are identifying as LGBTQ+ later in life. Health and social care systems should plan how to identify the range of different needs, to gain a deeper understanding of health inequalities. For examples, less is known about the distinct physical and mental health needs of older transgender (*) adults in the UK.

Why do health inequalities persist?

The reasons will be complex and likely due to many interacting factors and experiences, including the often poorly understood impact of wider social determinants of health.

It is not uncommon for older LGBTQ+ people to have experienced a lifetime of discrimination, stigma and social exclusion. The impact can be profound and long-lasting, affecting almost every facet of life. They may fear accessing health and social care, because of perceived, and sometimes real, bias and misunderstanding of gender identity and sexual orientation, and the intersection with advancing age.

Transgender (trans) people face multiple barriers and prejudices when accessing healthcare, both in terms of access to gender services and healthcare more generally. A national Healthwatch report published in 2025 showed that trans and non-binary people face hurdles at every stage of primary care.

Avoiding, delaying or delayed assessments can result in delayed diagnosis and treatment, with much poorer health outcomes, and social inequalities, loneliness and isolation, and engaging in health risk behaviours such as excessive alcohol use, may all contribute to the unique health challenges associated with ageing as an LGBTQ+ person.

It feels important to emphasise that the health and wellbeing outcomes and inequalities experienced by older LGBTQ+ people are the result of societal structure and models of health and social care, rather than intrinsic characteristics of people, or their behaviours. It took us a very long time to truly understand that ‘we’ are not the problem.

It may feel as though this paints a gloomy picture, but paradoxically, it became very apparent during our conversations and wider experience, just how extraordinarily resilient LGBTQ+ people can be in adapting and creating communities of care. 

A lifetime of stigma and discrimination can create wisdom and a wealth of understanding on which to draw, to support others, of all generations and identities, with an abundance of empathy and compassion.

This adaptability, resilience, knowledge and wisdom give us a glimpse into why it is so important to work with communities in codesigning, coproducing and codelivering inclusive services in health and social care.

Hope for the future

In July 2025, the NHS launched a ‘first ever’ review to tackle LGBT+ health inequalities.

The LGBT+ health evidence review aims to identify barriers to healthcare access and areas where LGBT+ communities experience poorer healthcare experience and outcomes.

The review, to be published shortly, promises to describe best practice approaches and make recommendations for change that align with the commitments and the three big shifts in the 10 Year Health Plan: hospital to community, analogue to digital, and sickness to prevention.

Older LGBTQ+ people have been consulted as part of gathering evidence, which has included literature reviews, submission of evidence, analysis of existing datasets and surveys, and stakeholder engagement.

Engagement sessions have explored key questions such as what more do we need to know, why have we not made progress in the past, and how do we make things better?

I am hopeful that the review will build on previous evidence to inform future research, policy and public interventions.

We need to shine a light on the way that health differs between LGBTQ+ people and better understand the impact of many intersecting experiences of inequality. To address health inequalities at a population level, there needs to be a better understanding of the underlying social mechanisms that influence LGBTQ+ health inequality.

Very recent research examining the experiences of people from “minoritised groups” who report healthcare-related harm, suggests that focusing on improving the quality of interpersonal, relational care, is unlikely to have a significant impact on safety improvement “without addressing the structural and institutionalised processes that drive discrimination and exclusion”.

The study highlighted the common factors driving healthcare safety in “minoritised groups” across individual, interpersonal, community, organisational and societal levels, and the importance of addressing disparities in safety at a national level. NHS frameworks, such as the Patient Safety Healthcare Inequalities Reduction Framework, that support the National Patient Safety Strategy, are crucial in this respect.

The need for further research is clear, however, and the authors acknowledge the limitations of their study such as sampling from a limited number of minority groups and participants being predominantly under 60 years old.

As our conversation drew to a close (still without cake!), we reflected on the pivotal role that organisations supporting LGBTQ+ communities have played in shaping history and healthcare. A fascinating article from the Kings Fund, “What can be learnt from the past 75 years of LGBTQ+ healthcare?”, gives a very powerful perspective on the influence of LGBTQ+ communities. May this long continue and we will certainly be playing our part.