Gen Silent (2010)

Gen Silent (2010) [Kanopy] . S. Maddux (Director) and P. Cornwell, S. Gruber, J. Applebaum (Producers), United States: Interrobang Productions and Stu Maddux Films. Free with Kanopy subscription through select libraries or institutional packages available for purchase, free screenings available.

Stu Maddux's Gen Silent, released in 2010, resonates even more today. It chronicles a year in the lives of six older Lesbian, Gay, Bisexual, Transgender, and Queer (or Questioning) and others (LGBTQ+) Bostonians to bring attention to the plight of aging LGBTQ+ Americans. The film highlights concerns that “the generation that fought hardest to come out of the closet is going back in [the closet] to survive,” and urges the audience to consider our ability to impact this trend and the factors contributing to it. The filmmakers show that LGBTQ+ elders have many of the same concerns about aging as their cisgender heterosexual counterparts, such as losing independence and financing long-term care. Gender and sexual minority elders also carry the weight of additional issues such as ongoing discrimination by family, caregivers, and peers, an increased likelihood of dying alone, the need to ensure respectful remembrance, and an overwhelming lack of culturally competent care teams. The elders portrayed become more relatable to viewers as they convey these concerns that likely resemble the concerns of the audience or their loved ones.

The current cohort of LGBTQ+ elders was crucial in generating the ongoing trend toward LGBTQ+ acceptance. However, Gen Silent profiles Mel, a gay man who lived closeted for many years, and feels that many people still harbor fears that “the pendulum might swing the other way.” For a generation that witnessed and fought substantial prejudice, they still fear discrimination in the aging process. In the documentary, Sheri and Lois, a lesbian couple, reflect on their advocacy work in early LGBTQ+ organizations. Although they express their worry that younger generations are oblivious to their contributions, they voice their hope that the local community of “gay people” will provide the support they need later in life as they do not have children to assist them. Although it is common for elders to want to remain in their homes through old age, Gen Silent shows that LGBTQ+ elders may have additional obstacles. As executive director of a Boston-based nonprofit, Dale Mitchell, shares that for LGBTQ+ people, “our home is the safest environment, it is the one place where the closet no longer exists.”

In 2013, three years after Gen Silent was released, Obergefell v. Hodges extended marriage equality to LGBTQ+ couples nationwide, and there continues to be a general trend toward acceptance of LGBTQ+ individuals. Despite this progress, prejudice and the fear of discrimination persist. In a touching segment of the film, Lawrence reflects on the guilt he felt leaving his partner of 38 years, Alexandre, in a facility where he may experience discrimination. Lawrence shares that “If I wasn't the only person responsible for Alexandre, I would have ended my life.” Fortunately, involvement in local LGBTQ+ senior services provided support and socialization that prevented his suicide.

Although I was disappointed that the documentary does not explicitly acknowledge the heterogeneity of experiences of people under the LGBTQ+ umbrella, the story of KrysAnne, a veteran who underwent gender transition in her 50s, highlights that transgender elders often face more challenges than their cisgender counterparts. Her story also highlights the topic of chosen family. KrysAnne is estranged from her family due to her transition and is suffering the isolation of navigating the complexities of terminal lung cancer. She navigates end-of-life care alone until an affirming case manager rallies the local LGBTQ+ community to provide in-home support. Unfortunately, the film does not specifically address her goals of care, even as we see her symptom burden increasing, nor does it discuss hospice care as an option for additional support. Despite these omissions, the suffering depicted in the last clip of KrysAnne's life actualizes the disturbing ramifications of her living alone. After her death, she is honored by her support network and viewers see the headstone depicting her name and acknowledging her military service.

Many transgender people take extra care to complete documents to ensure their gender identity is respected after death, especially in the face of an unaccepting family. Although the filmmakers briefly show KrysAnne completing advanced care planning documents, they missed an opportunity to explicitly describe the need for additional documents to ensure respectful remembrance. I also wish the film highlighted the importance of advanced care planning in general.

The film not only depicts the unique needs of LGBTQ+ elders, but it also calls viewers to action, especially health care workers and organizations. The film also features practical solutions. For example, the LGBT Aging Project provides training that enhances the ability of caregivers to provide LGBTQ+ inclusive care. Given the paucity of formal training on the subject matter, there is an incredible need for this type of programming. The film also depicts social services and events that cater to LGBTQ+ individuals, such as tea parties, dances, and meal services. As evidenced by Lawrence's story, these programs can be not only life affirming, but also lifesaving. Unfortunately, these programs are less likely to be available in rural areas and the success shown in this film may not be as feasible outside of large population centers.

Gen Silent portrays the unique aging concerns of LGBTQ+ elders and viewers will be emotionally invested in the lives of these individuals. The film is a must-see for anyone in health care, and it is imperative that its message is heard by those providing care to elders. We in health care are responsible for removing barriers and guaranteeing the safety of these trailblazing elders. As a field dedicated to understanding and aligning with patients' wishes, palliative medicine professionals especially carry the weight of this responsibility. The film urges viewers to do what we can to ensure that LGBTQ+ elders can age authentically and with pride.