Thesis advisor: Kevin J. Mahoney / Lesbian, gay, bisexual, and transgender (LGBT) older adults in the U.S. face disproportionate risk of increased health and mental health problems as compared to their non-LGBT counterparts. Experiences of harassment, discrimination, and violence due to sexual orientation and gender identity (SOGI) contribute to the chronic stresses associated with being a sexual and/or gender minority. LGBT older adults may avoid or delay needed services in later life, rendering them invisible to health care providers (HCPs) if they do not disclose SOGI and if providers do not ask. This three-paper dissertation explored LGBT older adults' invisibility and outness in aging services. Paper 1 investigated gerontological social workers' biopsychosocial assessment practices to understand how they became aware of clients' SOGI; assessment forms were analyzed and qualitative interviews with social workers were conducted, showing that social workers did not have a systematic way of learning about clients' SOGI. Paper 2 was a quantitative analysis of survey data from 129 LGBT older adults that showed an association between experiences of SOGI-based discrimination/violence after age 50 and not disclosing SOGI to HCPs and having avoided using aging services for fear of coming or being out. Paper 3 was a qualitative analysis of interviews with 22 LGBT older adults that sought to understand how they disclosed SOGI to HCPs. Those who disclosed did so without being asked, because of health conditions, after having sought out an LGBT /LGBT-friendly provider, or after being asked about their sex and/or love lives. Paper 3 findings offered practice and environmental changes that could increase LGBT older adults' SOGI disclosure to HCPs. This dissertation provides suggestions for social work policy, practice, and research aimed at supporting gerontological social workers in learning about their clients' SOGI in an effort to address health disparities among LGBT older adults / Thesis (PhD) — Boston College, 2015. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

This paper examines the caring experiences of 7 LGBT older adults in Southwestern Ontario. Up to 2 90-minute interviews were conducted with 7 participants which were then transcribed and analyzed using interpretive phenomenological analysis (IPA). Participants described life histories of discrimination and isolation, as well as contemporary experiences of medical discrimination. As a result, participants were highly skeptical of the formal care system, with only one indicating they would be willing to enter long term care. Analysis was conducted according to four themes that were identified while engaging in the interpretive phenomenological process. The research was influenced by life course theory and cultural scripts: specifically, that the current cohort of LGBT+ older adults is perhaps the first to age openly in their identity and as a result lack cultural scripts as to what they should do as they age. Questions were open-ended and asked participants about their experiences giving or receiving care, life histories of discrimination, and how their care experiences influence their plans for the future. Although no questions were directly asked about the HIV/AIDS epidemic, the legacy of the HIV/AIDS epidemic on contemporary LGBT older adults became a major theme of this paper. Other themes identified include the role that stigma and concerns about autonomy play in their plans for the future, the importance of political advocacy and community caregiving for LGBT older adults, and how LGBT older adults have developed resiliency and the practice of holding loved ones in personhood in order to cope with medical issues and death. / Thesis / Master of Arts (MA) / This paper examines the experiences of LGBT older adults giving and receiving informal care for physical or mental health conditions. It highlights themes of stigma and autonomy, the relationship between community caregiving and political advocacy, the legacy of the HIV/AIDS epidemic, and how LGBT older adults hold each other and the dead in personhood. Seven LGBT older adults from Southern Ontario were interviewed about their experiences with care, and the relationship between social structures and discrimination and their personal experiences with the medical system.