End-of-Life Preparations among LGBT Older Adults

LGBT elders tend to reach late life without partners or children, making it doubly difficult to engage in effective end-of-life planning.Worth American attitudes toward the end of life cluster around denial and avoidant behaviors (Kearl, 1995); thus, preparations for end of life often are wanting. If, as research shows (The Conversation Project, 2016), the uncomfortable issues surrounding life's ending are rarely discussed by families, it should be no surprise that such topics fall outside the fuzzier boundaries of friendship discourse, with its more sociable focus (Barker, 2002; Johnson, 1983). Such dynamics pose particular challenges for those who stand outside of traditional family structures, including LGBT older adults.Anxieties Exist Over Late-Life and End-of-Life PlanningAs reported elsewhere and also in this journal, LGBT older persons, especially gay men, disproportionately reach the very later years without partners, without children, without traditional families-i.e., without those people typically called upon to provide care or to participate in end-of-life preparations (de Vries, 2013). Concomitantly, LGBT older adults report poorer overall health (MetLife Mature Market Institute, 2010), higher rates of disability (Fredriksen-Goldsen et al., 2011), and greater psychological distress (Wallace et al., 2011) than do heterosexual persons of similar ages. As a result, LGBT older adults may have higher needs for care and fewer traditional resources for care provision in the very later years than do heterosexual and genderconforming older persons. The importance of preparing for later life and end of life arguably is greater among LGBT persons-as is their anxiety about these preparations.Research supports this assertion. In a large, national survey study, LGBT baby boomers, relative to those of comparable age in the general population, were found more likely to fear dying alone and dying in pain, particularly in settings wherein LGBT rights are poorly defended (de Vries et al., 2009)-which is how long-termcare settings are viewed within this community (SAGE, 2011). De Vries and colleagues (2009) linked these fears-a type of unfortunate spur into positive action-to higher rates for completing end-of-life documents. LGBT older adults were more likely to have completed living wills and durable powers of attorney. Still, such documents (including wills and trusts) were completed by fewer than 50 percent of all older persons in this national survey.LGBT older persons were found more likely to identify friends as potential caregivers (MetLife Mature Market Institute, 2010; Fredriksen-Goldsen et al., 2011). Notwithstanding the positive implications of this finding, friends as actual or anticipated caregivers tend to be individuals of similar age and health (among other shared attributes), a factor that challenges their availability and ability to provide the high level of care potentially needed in life's very later years (de Vries and Croghan, 2014). Moreover, friend relations fall outside of typical policy and program parameters, which focus on traditional family ties and obligations for care provision (Barker, 2002). And even as the rise of the LGBT community often is invoked with reference to LGBT persons' community-building and caregiving efforts during the early years of the HIV/AIDS crisis (de Vries and Croghan, 2014), much has changed socially and politically since the first wave of HIV/AIDS; age has not served as an effective rallying point for action. Older LGBT adults too often remain vulnerable and hidden (as LGBT persons in heteronormative service systems, and as older persons in LGBT organizations, though there have been several admirable efforts to redress this). Questions of Care and Support RemainWithin-group differences also have been noted. We found that higher percentages of gay men and transgender persons (almost a third in both cases), reported that they did not know who their caregiver might be when the need arose (de Vries, in press). …