I am a university lecturer, occupational therapist and researcher. I have a particular interest in the recognition of culture and diversity in health and social care provision for older people. My interests are specifically concerned with minority groups within society. Older people in the UK are becoming more vocal about the health and social care they receive, but there are minority ethnic and sexuality groups within this wider older population whose voice goes unheard (Age Concern, 2002, 2008). I suggest that as the numbers of older people in the UK increases the need to develop insights into this population’s minority sub-group grows increasingly important. Recent developments in methodologies may provide valuable in- roads for researching with hidden populations who struggle to get their voice heard.
The older population in the United Kingdom (UK) is increasing. Demographics indicate that 16 per cent of the population are believed to be aged 64 and over. In 2006 4.7 million people in the UK were aged over 75 and it is predicted that by 2016 this population will be 5.5. Million, and will rise to 8.2 million by 2031 (Office for National Statistics, 2007; National Institute for Health Research, 2009). It can be envisaged how the longevity of older people in the UK will result in an increased demand for health and social care provision. In anticipation of this the UK Government has identified challenges for health and social care providers. These include meeting the health and social care needs of an older population who are expected to have complex long term health and social care needs and to be culturally diverse (Department of Health, 2001, 2006; HM Government, 2007).
The UK charity Age Concern has recently brought cultural and lifestyle issues of older people into its agenda (Age Concern, 2008). These cultural and lifestyle issues include ethnicity, gender and sexuality. A particular focus of Age Concern is older people’s lifestyle and self expression related to sexuality and specifically to lesbian, gay, bisexual and transgendered/transsexual (LGBT) lifestyles (Turnbull, 2001; Age Concern, 2002). A search of health and social care research literature indicated that issues of older LGBT lifestyles in relation to health and social care needs are rarely mentioned. An interesting point to emerge from the work by Age Concern (2002, 2008) is recognition that sexuality concerns lifestyle and cultural differences and is not simply related to sexual activity. This point is important because it highlights a cultural dimension to human sexuality. I suggest that health and social care providers’ knowledge and understanding of the cultural dimension of sexuality in older age can be enhanced through collaborative research work with members of the cultural groups.
Accessing cultural groups is not straightforward; according to Schein (2004) there are three levels of culture. The first level is described as those things of the culture which are explicit and public. The second level involves assumptions and rules known to the group and rarely shared with outsiders. The third level is thought to be harder for people outside a specific culture to appreciate and understand. It is the deepest level known to all in that cultural group and seldom stated. It can be envisaged how health and social care research may explore cultural issues of specific groups on the first level. The second level appears to be harder to access and requires some previous knowledge of the culture in order to be able to ask appropriate questions to deepen understanding. The final level can, I suggest, be accessible to researchers although these researchers should be members of the cultural group (Lee, 2005). It therefore seems important to consult with members of the population to be studied throughout the research process.
Research with older LGBT people is important. This population are reported to age in a heterosexual normative environment where their social and cultural differences are not acknowledged (Heaphy et al, 2004; Pugh, 2005). A heterosexual normative perspective appears to be assumed in health and social care in the United Kingdom (Sale, 2002; Heaphy et al, 2004; McNair, 2008). Research has indicated that this perspective informs the discourse of older people in general and may influence the appropriateness, or limit the support for older LGBT people (Hubbard and Rossington, 1995; Brown, 2002; Kitchen, 2003; Heaphy and Yip, 2006). According to Age Concern (2002) this discourse is; inadequate, often representing LGBT people in stereotypical ways, failing to differentiate between lesbian, gay, bisexual or transgendered/transsexual people. Age Concern (2002, 2008) argues that the voice of older gay men in particular is absent.
Currently males over the age of 64 years make up 7 per cent (4.1 million) of the UK population (Office for National Statistics, 2007). Gay men are believed to account for 5-7 per cent of the general population (Stonewall, 2009). If it is assumed that gay men could make up 6 per cent of the population of males aged over 64 this equates to 250,000 people with a likelihood that this number will increase in the future. Although this number is not large in general population terms, it is a sizable portion of older UK males. Older gay men also represent a hidden, silent, under-studied population for whom multiple discrimination associated with sexuality, age, and gender may intersect (Age Concern, 2002; European Commission, 2007; Heaphy, 2007).
It appears to be an opportune moment in the UK to engage in research which explores the needs of a culturally diverse older population, in particular, sexuality and older gay men. The expression of self through sexual identity for gay men has become more open within society in recent years. The Sexual Offences Act (1967) decriminalised homosexual acts between consenting adults, and subsequent UK legislation has led to the present day where gay and lesbian sexuality is more openly expressed and acknowledged than ever (Tester et al, 2003). Nevertheless research has identified that older gay men may hide their sexuality from health and social care providers to avoid discrimination as a direct consequence of past life experiences of prejudice (Sale, 2002; Fish, 2007). The research suggests that many older gay men grew up ostracised by society and often by their families, so that trust in a hetero-normative society and hetero-normative services at times of vulnerability might be difficult and cause the older gay male to conceal their sexuality (Sale 2002).
An understanding of the lifestyles of older gay men is problematic because representations of older gay men are generally absent in the popular media and research literature. Issues of an older gay lifestyle are therefore rarely discussed in relation to health and social care. Older gay men appear to be difficult to identify and engage in research studies (Lee, 2005). To bridge this gap I suggest the need to explore and record the experiences, views and needs of older gay men. It is important that their voices are heard if recent health and social care policy and social and cultural change is to be enacted and discrimination avoided (Lavin, 2004). This is particularly important because, it is suggested, older gay people may experience an additional disadvantage to other older peers, because their views, opinions and issues are further hidden within the gay sub-culture of society (Heaphy, 2007).
I argue that researchers should strive to recruit and engage older gay men in research activity, ensuring that their voices are heard so that health and social care services are inclusive of the needs and lifestyle issues of this minority group in the UK population. I am currently involved in a research project, consulting with a group of older gay men about their health and social care needs. This information will shape research questions, forming a research agenda concerning health and social care provision of older gay men. Identifying a group to consult with was a difficult task because, as previously mentioned, this tends to be a hidden population of older men.
I began the project by making contacts in the University and local charity organisations to share my research ideas in the hope that they knew people I could contact. I looked for social groups in the gay press and asked friends if they knew or had heard of older gay men’s social groups. I had seen groups advertised in the gay press in the past, so I hoped that similar groups still existed. I considered using websites but rejected this idea because I wanted to meet with group members face-to-face to try to develop the beginnings of a collaborative research relationship. A university colleague told me of a person who led a social group for older gay men. This contact has proved to be my gatekeeper to the group, my advisor in how to approach the group, and my link to charities and other potential parties interested in research.
My contact began by providing me with level one and two cultural insights into the group, which Schein (2004) suggested outsiders of a group would need. My contact invited me to talk about my research ideas at a group meeting, but he told me I would be in for a rough ride. He explained that the group members were antagonistic to the notion of research and researchers. This stemmed from past experiences when they had cooperated with researchers but never found out the outcomes of the research, they felt they had been used. My collaborative approach to researching seemed to make this group encounter easier, but the meeting was difficult because the group had strong negative feelings about research. The second thing my contact advised me was to tell the group from the start that I was gay. This echoed the advice of Lee (2005) and I believe, as my contact suggested, helped the group members to associate with me as a member of the gay community, and as such someone aware of some of the issues faced by gay men. I felt I had second level insight into the cultural events, issues, and values discussed during the group meeting.
I felt confident to ask for the group members’ opinions of the research I wanted to do, and asked for volunteers to help me develop research questions which were meaningful and culturally relevant to the group and potentially a wider older gay male community. Some group members have now volunteered to participate in a research consultation meeting with me, I now need to develop this relationship to deepen my understanding of the health and social care concerns, issues and needs of older gay men. This will enable the development of research projects which will help to inform health and social care providers of a hitherto hidden and voiceless group of older people.
References
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