Published October 2020
Very little research has been done to understand the health and social care needs of older trans people, particularly those transitioning at an older age. Dr Paul Willis and his team wanted to understand the challenges faced by older trans people accessing health and social care in Wales.
We wanted the research to be with trans people, not just about themDr Paul Willis, Principal Investigator
There hasn’t been much focus on older trans people within the UK and internationally. There are very few studies focusing on ageing and its implications for trans adults, particularly those who are seeking to gender transition – whether medically or socially – when they are older. And little is known about the attitudes of health and social care workers towards older trans people as patients and service users. Our project aimed to investigate these issues to improve care for this overlooked group.
From the start, we wanted the research to be with trans people, not just about them. Trans people were involved in the writing of the research proposal and in our team. Half of our advisory board was made up of people who identify as trans, and we recruited trans people and supported them as ‘peer interviewers’ to speak with study participants about their lives and concerns.
We found the Dunhill Medical Trust to be highly supportive throughout the project. They let us get on with our research but were there when we needed them. They were also really supportive in terms of funding our publications so that they could be open access – this is vital if we want health and social care workers to read our findings and put them into action.
What did we do?
Firstly, we surveyed health and social care professionals about their work with older trans adults. Respondents were mainly positive and supportive about equal rights and recognition of older trans people. However, there was varied knowledge around legal requirements, medical procedures and how best to support older trans people. Often, these knowledge gaps were filled by trans people themselves acting as informal educators. Our findings strengthen the case for more professional development and education around supporting trans people, particularly those transitioning in later life.
Ageing as a trans person
For the second part of the study, we interviewed 22 people who identified as trans, all of whom were living in Wales and navigating the Welsh health and social care systems.
Several people voiced fears about entering a care home as they grew older, worrying about how they might be treated, how care workers would react to their bodies, and whether they would be stripped of their gender identity were they to lose mental capacity
Many different issues were raised in the interviews, with many interviewees reporting difficulties in accessing appropriate medical care. Examples included GPs who weren’t appropriately informed about options and referral processes, or geographical barriers to accessing services based in London.
We also uncovered concerns related directly to being older. Some people felt that their clinician or GP was reluctant to refer or support them with accessing particular medical services or surgeries because they were ‘too old’. Several people voiced fears about having to enter a care home as they grew older, worrying about how they might be treated by other residents or staff, how care workers would react to their bodies, and whether they would be stripped of their gender identity were they to lose mental capacity.
Telling trans stories
We created several videos telling these individuals’ stories, to convey to policy makers and practitioners the perspectives and concerns of trans people using health and social care services as they age.
These were shown in the Senedd (the Welsh Assembly parliament building) as part of a launch event for the findings of this project, where we informed people about the issues faced by older trans people in Wales. We also produced guidance documents for Welsh health and social care professionals.
We are pleased to see that a gender identity service has now been established in Wales since the start of our project, and we hope that they use our findings and guidance to ensure that the needs of older trans people are appropriately met.
Find out more
You can access the project website via this link – through the website you can also read the reports and practice guidance we produced from our findings.
The ‘Growing Older as Me’ films, which capture the experiences and concerns of older trans people, are available to watch on YouTube.