The Perspectives and Experiences of Older LGBTI+ Adults About Long-Term Care: A Qualitative Systematic Review and Meta-Synthesis.

Background and objectives: LGBTI+ older adults have experienced historical and systemic discrimination. Such discrimination has led to health inequities and avoidance of services. As LGBTI+ people age, they may need to access services, but information about this experience is situated in small-scale qualitative studies. As such this meta-synthesis aimed to bring together the perspectives and experiences of LGBTI+ older adults in literature about engagement with long-term care services.

Research design and methods: A meta-synthesis with a meta-ethnographic approach was conducted with qualitative published and gray literature. Findings were then confirmed through community consultation conducted with LGBTI+ adults aged 50.

Results: A total of 55 qualitative studies were included in the meta-synthesis. LGBTI+ older adults' perspectives and experiences were synthesized into 4 key themes: (1) We see it as being heterosexualized, (2) With no one there to guard us, (3) You have to hide 90% of yourself, and (4) I don't want a different service, I want a good service.

Discussion and implications: Overarching heterosexism, experiences of discrimination, and complexities in maintaining identity all contributed to a predominately negative experience for LGBTI+ adults when engaging with long-term care. These experiences were found to align with "minority stress" theory. Our review found that a multilevel approach that included staff education, LGBTI+ affirmative care, and signs and symbols of inclusivity was required to reduce the impact of minority stress experienced by LGBTI+ older adults and to increase their engagement in long-term care services.