Canadians Who Care: Social Networks and Informal Caregiving Among Lesbian,Gay,and Bisexual Older Adults in the Canadian Longitudinal Study on Aging

Abstract

Canada is experiencing population aging and evidence on the provision of care is based on data collected from majority populations. This analysis compared social networks and patterns of care provision between heterosexual and lesbian, gay, and bisexual (LGB) Canadians between the age of 45 and 85 years. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a large national study of health and aging. The results from analysis of baseline data showed that LGB participants were less likely to have children and reported seeing their friends more recently than heterosexual participants. Gay and bisexual men were more likely to provide care support in comparison to heterosexual men. LGB participants were more likely to provide care to friends. The results highlight the importance of considering distinct social networks in the development of policy and practice approaches to support a diverse aging population.

Keywords

aging sexuality caregiving social networks lesbian gay bisexual older adults Canadian Longitudinal Study on Aging

Canada is experiencing population aging. By 2031, all baby boomers (i.e., individuals born between 1946 and 1964) will have reached the age of 65 years, and by 2036, approximately a quarter of the Canadian population will comprise older adults (Statistics Canada, 2015a). As these individuals age and experience age-associated changes in health, the role of social networks in the receipt and provision of informal care (e.g., uncompensated and ongoing assistance with another’s personal care needs) becomes increasingly important (Lee & Penning, 2018).

To date, much of our understanding of the role of social networks and informal care among older adults is based on data collected from majority populations. Canadian data show that caregiving is gendered such that women are more likely to provide care and that informal care is often provided by women who are either adult children or romantic partners (Statistics Canada, 2015b). While these data are consistent with dominant narratives in caregiving literature (e.g., Williams, Giddings, Bellamy, & Gott, 2017), they are inconsistent with what is known about the social networks and informal care among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults.

Research shows that LGBTQ+ men and women report similar levels of caregiving behaviors toward their partners as they age (e.g., Cantor, Brennan-Ing, & Shippy, 2004; MetLife Mature Market Institute, 2010). Caregiving within LGBTQ+ communities is often provided by spouses or partners (MetLife Mature Market Institute, 2010), as sexual minority adults have fewer children than their heterosexual peers (Espinoza, 2011). LGBTQ+ older adults are also less likely to be partnered and more likely to be living alone (Croghan, Moone, & Olson, 2014). These findings are aligned with other studies which have demonstrated that LGBTQ+ older adults exhibit more friend-centered networks than the majority population (Kim, Fredriksen-Goldsen, Bryan, & Muraco, 2017); patterns of social contact occur more frequently with friends than members of their family of origin (i.e., a family one is born or adopted into).

This pattern of relationships has also been attributed to the sociohistorical context in which aging members of these communities lived much of their lives, including potential rejection from their family of origin, negative societal messages related to nonnormative identities, and the need to care for those affected by HIV/AIDS in the 1980’s and early 1990’s (Cohen & Murray, 2007). While Canada maintains a single-payer universal health-care system through the Canada Health Act (Government of Canada, 2019), older LGBTQ+ Canadians have experiences of stigma and discrimination that may prevent health-care utilization. Members of these communities were affected by federal laws that criminalized homosexuality until 1969 and they had no legal rights to marry someone of the same sex until 2005. Considering these lived experiences and the impacts of policy legacies, care responsibilities are often placed onto members of their family of choice (i.e., nonkin social ties selected based on mutual care and support), such as friends or neighbors (Brennan-Ing, Seidel, Larson, & Karpiak, 2014).

Among LGBTQ+ caregivers, challenges stemming from sexual and gender identities are presented within these relationships. Caregivers may face ongoing heteronormative¹ and cisnormative² assumptions in health-care settings (Westwood, 2016). Such assumptions continue to permeate social support services for primary caregivers (i.e., individuals responsible for others’ care), as these systems were not designed with sexual minority caregiving or family of choice relationships in mind (Brotman et al., 2007). Discrimination and lack of acknowledgement of LGBTQ+ families of choice in health-care facilities continue to be harmful to caregivers and care-recipients’ end-of-life needs (Orel, 2017). Some LGBTQ+ caregivers have also reported expectations from members of their family of origin to be involved in care due to the assumption that they have fewer responsibilities (e.g., less often responsible for childcare) than heterosexual members of their family (Cantor et al., 2004). These increased social stressors contribute to additional health costs for LGBTQ+ individuals involved in the provision of care (Fredriksen-Goldsen et al., 2011).

Availability of social networks has been linked to caregiving among LGBTQ+ people. An American study found that 78.3% of LGBTQ+ individuals aged 48 years and older reported caregiver availability within their social network; individuals with fewer friends were less likely to report caregiver availability (Croghan et al., 2014). Engagement with social care networks (i.e., webs of individuals providing emotional and physical assistance; Hughes & Kentlyn, 2011) has also been shown to play a role in promoting positive aging experiences for LGBTQ+ older adults (Erosheva, Kim, Emlet, & Fredriksen-Goldsen, 2016). Recent data also highlight the importance of companion animals, such that LGBTQ+ older adults who own companion animals show high levels of perceived social support (Muraco, Putney, Shiu, & Fredriksen-Goldsen, 2018).

Understanding the composition of care networks involved in the well-being of LGBTQ+ older adults is critical to providing effective person-centered health and social care. The purpose of this analysis was to contrast the social networks and patterns of caregiving among lesbian, gay, and bisexual (LGB) and heterosexual participants in the Canadian Longitudinal Study on Aging (CLSA). At baseline, the CLSA did not ask about gender identity, precluding analysis of transgender participants. This study aims to identify differences in social networks and caregiving experiences of older LGB Canadians relative to heterosexual peers of the same sex or gender. Comparing sexual minority older Canadians with majority peers allows us to uniquely identify strengths exhibited by members of this subpopulation and explore opportunities for social intervention that promote equity among Canadian older adults. To this end, we compared patterns of social networks (including pet ownership) as well as frequency and types of caregiving, and the nature of the caregiving relationship between LGB and heterosexual participants in the CLSA. Given the gendered nature of care and the life course (Feinberg, Reinhard, Houser, & Choula, 2011; Williams et al., 2017), sexual minority participants were compared with heterosexual peers of the same sex or gender. Understanding the social networks and the provision of informal care among older LGB Canadians are important considerations for supporting a diverse aging population. These uniquely Canadian data offer new insight into the experiences of sexual minority adults within a diverse and aging population and can inform inclusive policy and practice responses.

Methods

This study used baseline (i.e., cross-sectional) data gathered from participants in the CLSA Tracking and Comprehensive Cohorts, a population-based, large-scale study on health and aging in Canada; at baseline, participants in the CLSA were 45 to 85 years old. Baseline data were collected between 2010 and 2015 for two CLSA cohorts: the Tracking and Comprehensive cohorts. Multiple sampling frames were employed in order to recruit the targeted CLSA sample size (>50,000) (Raina, Wolfson, & Kirkland, 2008). The sampling frame excluded individuals residing on federal First Nations reserves or other First Nations settlements, full-time members of the Canadian Armed Forces, residents of long-term care facilities, individuals with cognitive impairment at baseline, individuals residing in the three territories, or individuals who were unable to respond in English or French.

Participants in the Tracking cohort (n > 20,000) completed 60-minute telephone interviews, whereas those in the Comprehensive cohort (n = 30,097) were asked to complete face-to-face in-home interviews, and clinical or physical measurements at a data collection site. All participants were asked questions about their health, well-being, as well as demographic, social, economic, physical, and psychological determinants of health. Participation in the Comprehensive cohort was contingent upon the participant residing within a 25 to 50 km radius of one of the 11 data collection sites (Raina et al., 2008). Further details about the CLSA research design and sampling frame can be found elsewhere (Raina et al., 2008). In the analyses presented here, data from the Tracking and Comprehensive cohorts were pooled to increase the total sample size. Research Ethics Board approval for these analyses was obtained from the University of Ottawa.

Measures

Sociodemographic information

Sociodemographic information, including age, education, marital status, and household income, was collected from each participant.

Sex or gender and sexual orientation

Participants were asked to indicate their sex as either male or female. This question did not provide a definition of sex nor did the CLSA include a question about gender identity at baseline. Given that we are unable to determine whether participants responded to this question based on their sex (i.e., biological attributes) or gender (i.e., socially constructed roles, behaviors, expressions, and identities), we refer to this item as sex or gender and refer to participants in the study as men and women. Participants were also asked to identify their sexual orientation as: heterosexual (sexual relations with people of the opposite sex), homosexual (sexual relations with people of your own sex), or bisexual (sexual relations with people of both sexes).

Social networks

Social networks were captured by asking participants to report whether they have living children, siblings, and relatives; if so, participants reported how many they had of each. Participants were also asked to identify the time of “the last get together” with any individuals living outside of their household who belong to each of these relationship categories. For example, participants were asked about their “last get together with neighbors.” Response options included “Within the last day or two,” “Within the last week or two,” “Within the past month,” “Within the past 6 months,” “Within the past year,” and “More than 1 year ago.” Finally, the participants were also asked “Not counting family members, how many people do you consider close friends” and “How many of your neighbors do you know?”. For each, they were asked to identify the timing of the last get together, ranging from “Within the last day or two” to “More than 1 year ago.” In the analyses, the response options “Within the past 6 months” and “Within the past year” were combined to ensure adequate cell sizes.

Pet ownership

Participants were asked whether they own a household pet that provides them with companionship. Response options included “Yes” or “No.”

Caregiving

Participants were asked whether they had provided assistance to another person in in the past year. Participants who endorsed having provided assistance were queried as to whether: “During the past 12 months, have you provided any of the following types of assistance to another person because of a health condition or limitation?”. Participants indicated yes or no to providing the following types of assistance: personal care, medical care, managing care, assistance with activities, transportation, and meal preparation. Participants were also asked to indicate the relationship of the main care recipient for whom care was provided: parent, child, sibling, friend, other relative, and spouses or partners. For purposes of this study, in-laws and immediate family were collapsed into single categories.

Statistical Analysis

Given the gendered nature of the social networks and patterns of care among older adults, all analyses were conducted separately by sex or gender. Homosexual and bisexual participants were aggregated to prevent small cell sizes (≤5) that could compromise participant anonymity. Sample characteristics are described using means, standard deviations (SD), and proportions (%); results are presented by sex or gender and sexual orientation (heterosexual, lesbian or bisexual [women], and gay or bisexual [men]). To examine differences between heterosexual and sexual minority participants of the same sex or gender on measures of social networks, we computed independent samples t tests. In the event of unequal variances between groups, the Welch’s t test is reported. To compare the most recent in-person social interaction, types of caregiving and assistance provided, and relationship to the primary care recipient (i.e., categorical data), χ² tests of independence were conducted. To examine differences in caregiving (i.e., whether the respondent provided some assistance in the last 12 months) and pet ownership by sexual orientation, we used simple logistic regression to calculate crude odds ratios (OR) and 95% confidence intervals (CIs). Sexual orientation was entered in the models as the predictor (sexual minority participants were compared with heterosexual participants [referent group]), with caregiving and pet ownership modeled as the outcomes. In addition, the simple logistic regression models were followed up with a series of multiple logistic regression models in order to compute adjusted OR and corresponding 95% CIs controlling for known covariates (age, relationship status, household income, and education). Alpha was set to α = .05 (two-tailed) for all analyses. The CLSA dataset includes sampling weights used to obtain provincial and national population-based estimates. Given our interest in a subsample of participants, sampling weights were not applied. All analyses were conducted in SAS version 9.4 (SAS Institute, Inc., Cary, NC).

Results

Sample Characteristics

Sociodemographic characteristics are presented in Table 1. Within the pooled CLSA baseline sample of 51,338 Canadians aged 45 to 85 years (i.e., Tracking and Comprehensive cohorts combined), 1,057 participants (i.e., 2%) self-identified as LGB. A complete description of the sociodemographic characteristics of LGB participants in the CLSA is presented in Stinchcombe, Wilson, Kortes-Miller, Chambers, and Weaver (2018).

Table 1.

Respondent Sociodemographics by Sexual Orientation and Sex or Gender.

	Women		Men
	Heterosexual (%)	Lesbian and Bisexual (%)	Heterosexual (%)	Gay and bisexual (%)
Age (years)
45–54	26.4	40.1	25.6	35.7
55–64	32.3	36.8	31.6	33.3
65–74	23.2	16.1	23.7	22.8
≥75	18.2	7.1	19.2	8.2
Marital status
Single/never married	8.6	24.7	6.9	43.2
Married/common-law	60.3	57.2	78.8	40.6
Widowed	14.9	4.8	5.1	4.9
Divorced/separated	16.2	13.4	9.2	11.4
Education
<Secondary school	7.4	2.3	6.9	4.1
Secondary school	19.9	17.4	17.6	16.6
Postsecondary degree/diploma	72.7	80.4	75.5	79.3
Income
<$20,000	7.1	8.8	3.9	8.4
$20–49,999	27.2	21.7	20.0	24.9
$50–99,999	31.4	34.0	35.5	33.7
≥$100,000	26.0	31.0	36.0	29.3
Missing	8.3	4.5	4.6	3.7

The mean age at baseline for heterosexual and lesbian/bisexual women was 62.85 years (SD = 10.42) and 58.52 years (SD = 8.93), respectively. For men, the mean age for heterosexual and gay or bisexual men was 63.26 years (SD = 10.45) and 59.91 years (SD = 9.34), respectively. The majority of participants were in married or common-law relationships except for gay and bisexual men, who were mostly single or never married (Table 1). The majority of LGB participants reported a postsecondary degree or diploma. Approximately 30% of sexual minority men and women reported annual household incomes of $100,000 or greater.

Social network size

The results of the t tests comparing the size of social networks of sexual minority women and men relative to heterosexual participants in the CLSA are presented in Table 2. A consistent pattern of findings was observed among women and men. In particular, lesbian and bisexual women had fewer children (mean number of children = 1.07) compared with heterosexual women (mean number of children = 2.28; p < .001). Gay and bisexual men also had fewer children (mean number of children = .69) relative to heterosexual men (mean number of children = 2.32; p < .001). Compared with heterosexual participants, sexual minority women and men reported that they knew fewer neighbors (p = .001 and p = .029, respectively). Lesbian and bisexual women also reported having fewer living relatives than heterosexual participants (e.g., parents, grandparents, grandchildren, nieces, nephews, cousins, aunts, uncles) (p = .009). Gay and bisexual men reported having a greater number of living relatives than their heterosexual peers (p =.046).

Table 2.

Mean Number of Individuals in Social Network by Sexual Orientation and Sex or Gender.

	Women			Men
	Heterosexual (n=25,305)	Lesbian and bisexual (n = 395)		Heterosexual (n = 24,035)	Gay and bisexual (n = 647)
Social networks	M (SD)	M (SD)	t (p)	M (SD)	M (SD)	t (p)
Children	2.28 (1.54)	1.07 (1.43)	15.58 (.001)	2.32 (1.51)	0.69 (1.28)	31.75 (.001)
Siblings	2.94 (2.34)	2.88 (2.12)	0.53 (.598)	2.86 (2.32)	2.91 (2.39)	−0.57 (.566)
Relatives	37.23 (29.42)	33.33 (27.95)	2.61 (.009)	33.38 (28.24)	35.80 (30.36)	−2.00 (.046)
Friends	5.60 (5.72)	5.90 (6.50)	−0.93 (.354)	5.68 (7.49)	6.05 (6.49)	−1.42 (.157)
Neighbors	11.51 (14.12)	9.58 (11.17)	3.38 (.001)	11.52 (14.07)	10.29 (14.34)	2.18 (.029)

Last in-person social interaction

Participants who reported at least one connection were asked about their most recent in-person social interaction by relationship type. The results are presented in Table 3. Compared with heterosexual participants, LGB participants with children were more likely to report that they saw them less recently (p = .020). The results showed that 14% of gay and bisexual men with at least one child saw them more than a year ago; this is in stark contrast to 3% of heterosexual men with at least one child who saw them more than a year ago (p < .001). Sexual minority respondents were more likely to report seeing their friends more recently than heterosexual peers of the same sex/gender and less likely to have recently seen their relatives (Table 3).

Table 3.

Most recent In-Person Social Interaction (%) by Relationship Type, Sexual Orientation, and Sex or Gender.

	Women			Men
	Heterosexual	Lesbian and bisexual		Heterosexual	Gay and bisexual
Time of last in-person contact	%	%	χ² (p)	%	%	χ² (p)
Children
Within the last day or two	37.54	31.41	11.64 (.020)	34.78	20.34	83.27 (<.001)
Within the last week or two	38.25	33.97		37.87	35.59
Within the past month	10.68	12.18		11.50	10.73
Within the past year	11.56	19.23		12.76	19.21
More than 1 year ago	1.98	3.21		3.09	14.12
Siblings
Within the last day or two	13.64	9.92	8.76 (.068)	11.17	11.26	3.74 (.442)
Within the last week or two	27.49	24.93		24.09	26.96
Within the past month	16.09	15.82		16.40	17.06
Within the past year	29.77	35.39		32.45	30.38
More than 1 year ago	13.00	13.94		15.89	14.33
Relatives
Within the last day or two	17.88	14.10	13.51 (.009)	15.37	9.69	34.01 (<.001)
Within the last week or two	29.37	23.85		26.69	22.50
Within the past month	15.50	17.95		14.79	17.66
Within the past year	26.36	30.77		29.01	30.63
More than 1 year ago	10.88	13.33		14.14	19.53
Close friends
Within the last day or two	38.65	41.05	9.87 (.043)	32.69	38.67	18.59 (.001)
Within the last week or two	42.10	41.58		42.10	43.04
Within the past month	10.47	6.84		12.57	9.55
Within the past year	7.53	10.00		10.43	6.96
More than 1 year ago	1.24	0.53		2.21	1.78
Neighbors
Within the last day or two	28.62	33.43	4.78 (.310)	31.38	32.04	1.56 (.816)
Within the last week or two	29.77	29.68		27.74	28.55
Within the past month	11.02	10.37		10.57	9.02
Within the past year	14.61	12.97		14.98	14.55
More than 1 year ago	15.98	13.54		15.33	15.84

Pet ownership

Sexual minority women were more likely than heterosexual women to own a household pet (OR = 1.89, 95% CI [1.51, 2.30], p < .001). Indeed, 61.80% of sexual minority women and 46.43% heterosexual women in the CLSA reported having a household pet that provides companionship. This association remained significant after adjustment of covariates (adjusted OR = 1.60, 95% CI [1.29, 1.99], p < .001). Among gay and bisexual men, 42.49% reported having a household pet, compared with 42.52% of heterosexual men. There were no significant differences between heterosexual or gay and bisexual men on the likelihood of owning a pet in crude (OR = 1.00, 95% CI [0.85, 1.17], p = .988) or adjusted analyses (adjusted OR = 1.18, 95% CI [0.99, 1.40], p = .063).

Caregiving

Approximately half (i.e., 49.34%) of lesbian and bisexual women and 47.44% of gay and bisexual men reported providing some assistance in the last 12 months (compared with 49.08% of heterosexual women and 40.80% of heterosexual men). There was no difference between heterosexual and lesbian and bisexual women for caregiving in crude (OR = 1.01, 95% CI [0.82, 1.24], p = .922) or adjusted analyses (adjusted OR = 0.94, 95% CI [0.77, 1.15], p = .549). Gay and bisexual men, however, had an increased odds of providing care relative to heterosexual men, even after adjustment for covariates (OR = 1.31, 95% CI [1.12, 1.54], p = .001, adjusted OR = 1.32, 95% CI [1.12, 1.56], p = .001).

Types of care and assistance provided

Participants who indicated that they were involved in the provision of care were asked to specify the nature of care activities. Table 4 shows a breakdown of the types of care activities by sex or gender and sexual orientation. The results indicated no differences in the types of care provided by sexual minority and heterosexual women. In contrast, relative to heterosexual men, gay and bisexual men were more likely to be involved in medical care (i.e., help taking medicine, help with nursing care) (p =.018), managing care (e.g., making appointments) (p < .001), meal preparation (p = .001), and social/emotional assistance (p < .001).

Table 4.

Types of Care Provided (%) by Sexual Orientation, and Sex or Gender.

	Women			Men
Type of care	Heterosexual (%)	Lesbian and bisexual (%)	χ² (p)	Heterosexual (%)	Lesbian and bisexual (%)	χ² (p)
Personal care	16.45	15.38	0.31 (.578)	9.41	10.86	1.50 (.221)
Medical care	14.76	14.32	0.06 (.811)	8.36	11.02	5.60 (.018)
Managing care	18.75	18.57	0.01 (.929)	11.33	17.09	19.93 (<.001)
Assistance with activities	24.64	24.93	0.02 (.894)	23.75	25.72	1.30 (.255)
Assistance with transportation	36.16	33.69	0.98 (.322)	30.59	33.87	3.08 (.079)
Meal preparation	24.90	24.67	0.01 (.919)	14.06	18.85	11.49 (.001)
Social/emotional assistance	4.73	5.31	0.27 (.604)	2.94	6.07	20.35 (<.001)

Participants who reported providing care were also asked about the nature of their relationship with the care recipient for whom they offer the most support. Table 5 shows the distribution of the relationship between the participants and the primary care recipient. Sexual minority men and women who indicated providing some care were more likely to provide care to a friend, compared with heterosexual peers of the same sex or gender. Heterosexual men who reported providing some care were more likely to report caring for a spouse/partner (e.g., wife, common-law partner).

Table 5.

Relationship to Primary Recipient of Care (%) by Sexual Orientation and Sex or Gender.

	Women		Men
	Heterosexual%	Lesbian and bisexual%	Heterosexual%	Gay and bisexual%
Primary recipient of care
Parent (includes in-laws)	38.43	38.97	38.76	39.93
Child (includes in-laws)	7.90	4.10	4.70	2.64
Sibling (includes in law)	8.30	3.59	6.74	5.94
Friend	27.83	35.90	24.84	38.28
Other relative	4.42	3.59	3.71	4.29
Spouse/partner	13.13	13.85	21.25	8.91

Note. χ² tests of independence were conducted to compare type of primary recipient of care by sexual orientation (heterosexual and lesbian or gay and bisexual) for women and men. χ² tests of independence for both women, χ² (5)=13.57, p=.019, and men, χ² (5)=45.81, p<.001, reached statistical significance.

Discussion

In Canada, much of the support provided to community dwelling older adults is given by informal caregivers (Statistics Canada, 2015c). Evidence suggests that care networks among LGBTQ+ subpopulations are comprised of members of their families of choice (Hughes & Kentlyn, 2011). This study examined social networks and informal care giving among LGB participants in the CLSA and yielded several noteworthy findings.

Consistent with previous research (Fredriksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, 2013), LGB men and women in the CLSA sample reported having fewer children compared with heterosexual peers of the same sex or gender. Lesbian and bisexual women also reported fewer relatives, a result that may be partially explained by the fact that grandchildren were also included within this response category. Given that sexual minority women reported fewer children and that they were on average younger than the heterosexual participants, opportunities to grandparent may be reduced thereby limiting the number of relatives reported by these participants.

LGB participants stated that they knew fewer neighbors than heterosexual participants. Given that LGB older adults have had lengthy experiences of stigma and discrimination (Gordon & Meyer, 2007), safety concerns may prevent older LGB from getting to know individuals who reside in their communities. Such vigilance has been shown to arise out of historic and anticipated experiences of discrimination (Brotman et al., 2007).

In terms of social interactions, LGB older adults in this study reported seeing their friends more recently than their heterosexual peers. These findings align with previous research showing that sexual minority older adults’ social networks are more frequently friend- rather than family-centered (Kim et al., 2017). There is a growing body of literature highlighting the importance of pets in the lives of LGB people (Riggs, Taylor, Signal, Fraser, & Donovan, 2018). Our results highlighted that sexual minority women were more likely report pet ownership. Muraco et al. (2018) suggested that women might be more likely to be pet owners due to a greater need for companionship and for support during difficult life events. Future inquiry could examine the mechanisms underlying differences in pet ownership and the extent to which it contributes to perceived levels of social support.

With respect to caregiving, gay and bisexual men were more likely to report providing support in comparison to heterosexual men. When examining the relationship with the care recipient, LGB participants were more likely to provide support to friends. These findings support existing research which indicates that sexual minority individuals frequently adopt caregiving roles for friends (MetLife Mature Market Institute, 2010) and report higher levels of anticipated care for friends in the future (Czaja et al., 2016). The results presented here also emphasize the role of gay and bisexual men in providing informal care. Their unique involvement in caregiving is an important consideration for health systems to ensure that all caregivers are supported and recognized.

A strength of this study is that it employed data from the CLSA, a large-scale Canadian survey on health and aging. Sexual minority older adults have historically been invisible within statistical portraits of Canada and the CLSA offers a unique opportunity to examine trajectories in their health over time. Canada is an ethnically and culturally diverse country, provides universal health-care, and has its own history of LGBTQ+ discrimination and human rights progress (e.g., the Toronto bath house raids; Nash, 2014). LGBTQ+ older Canadians have unique historical, social, and political struggles that have contributed to risk and resiliency factors throughout their lifespan (e.g., intersecting marginalized identities, treatment by health-care professionals, homophobic, and transphobic experiences). The social care networks and rates of informal care provision among older LGB Canadians emerge from a distinct sociohistorical context wherein families of choice are resources for LGB older adults who may fear real or anticipated discrimination. The findings presented here can be used to develop inclusive policy and practice approaches that account for differences in social networks and the provision of care among diverse and aging LGB Canadians. When considered alongside national research on the health disparities of older LGB Canadians (Stinchcombe et al., 2018), this work offers a more comprehensive portrait of the health experience of aging LGB Canadians and the unique role that their social relationships play in providing support. Given the growing body of evidence around sexual orientation and caregiving, there are opportunities to align services and policies to reflect diversity within care for older adults both in Canada and abroad.

In terms of study limitations, the social networks of individuals in Canada’s territories and residents of First Nations reserves were not captured within the CLSA. This is a crucial area of much-needed future research as the 2016 Canadian Census of the Population showed that Indigenous Peoples accounted for 4.9% of the total Canadian population. Indigenous Peoples constitute an axis of diversity in the Canadian aging population and, yet, two-spirit aging remains a knowledge gap in the scientific literature. This study employed a complex sampling frame; authors have noted that such sampling approaches do not accurately capture minority populations who have historical experiences of discrimination (Fredriksen-Goldsen & Hooyman, 2007). In addition, while this analysis did not report on caregiving received, it has been reported elsewhere; the proportion of LGB respondents receiving formal and informal care (14.4%) was comparable to that received by heterosexual survey respondents (14.3%) (Stinchcombe & Wilson, 2018). This will be an important field of inquiry as the CLSA cohort ages and a greater proportion of the sample receives care.

Approximately 2% of the CLSA cohort self-identified as LGB. Participants were asked if they considered themselves to be heterosexual, homosexual, or bisexual. The framing of this question implies the presence of sexual behaviors as requirements for LGB membership rather than sexual identity. Furthermore, evidence suggests that sexuality may be fluid and can change over the lifespan (Mock & Eibach, 2012). The narrow scope of the sexual orientation question in the survey may have contributed to underreporting of sexual minority status among participants. Other lines of inquiry hold that LGB individuals may choose not to disclose their sexual orientation in a survey, or resist participation altogether (Meyer & Wilson, 2009). Yet, recent research indicates that nonresponse rates for heterosexual individuals were higher than their LGB individuals (Lee, Fredriksen-Goldsen, McClain, Kim, & Suzer-Gurtekin, 2018). This possible shift from previous research may be reflective of changing social views on sexual orientation.

The findings of this study demonstrate distinct social networks and patterns of care among LGB Canadians between the ages of 45 and 85 years. These data highlight that health and social care providers who support aging sexual minority individuals and communities should consider these differences when developing strategies to promote healthy aging for diverse Canadians. Considering that aging sexual minority Canadians are less likely to have children and that children are a primary source of informal care for the majority population, they may be more likely to rely on formal care (e.g., home care and long-term care homes). As such, interventions to increase health-care professionals’ awareness of LGBTQ+ caregiving and family of choice relationships may help address and anticipate unmet care needs of this subpopulation.

Footnotes

Acknowledgment

This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 9447 and the Canada Foundation for Innovation. This research has been conducted using the CLSA dataset Baseline Tracking Dataset version 3.2, Baseline Comprehensive Dataset version 3.1, under Application Number 170321. The CLSA is led by Drs. Parminder Raina, Christina Wolfson, and Susan Kirkland. This project was funded through a CIHR Catalyst grant (FRN 151288) awarded to Dr. Arne Stinchcombe. The opinions expressed in this manuscript are the author’s own and do not reflect the views of the CLSA.

ORCID iD

Mariam Ismail

Kimberley Wilson

Arne Stinchcombe

Notes

Author Biographies

Mariam Ismail, BA, is a Master's student at Saint Paul University (Ottawa) with research interests in mental health and minority communities.

Nicole G Hammond, MSc, MA, is a research associate in Dr. Stinchcombe's lab.

Kimberley Wilson, PhD, MSW, is an assistant professor of Adult Development & Aging in the Department of Family Relations & Applied Nutrition at the University of Guelph. As a social gerontologist, her research focuses on improving health and well-being for diverse older adults and aging communities.

Arne Stinchcombe, PhD, is an assistant professor in the Department of Recreation and Leisure Studies at Brock University, Canada. His research interests include the psychosocial aspects of health and aging.

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