Meeting End-of-Life Needs of Older gbMSM with an Inverted SES Model of Health Promotion

Older gay, bisexual, and other men who have sex with men (gbMSM) face unique challenges in end-of-life (EOL) care. In addition to specific age-related health issues, gbMSM face obstacles in accessing and engaging in healthcare services due to discrimination and stigma from homophobia and heterosexism. The primary research question for this study was: "What are EOL care experiences and expectations of older gbMSM in Canada?" The barriers and facilitators older gbMSM face in EOL planning and where those barriers/facilitators fit within a social ecological (SES) model were explored. Focus groups were held at research sites nationally with older gbMSM as part of the Fostering End-of-Life Conversations, Community and Care among LGBT Older Adults study in 2014/2015. Each focus group was facilitated by two members of the research team using an established set of semi-structured questions. Focus groups were held with 40 old gbMSM in five sites (Vancouver, Edmonton, Toronto, Montreal, and Halifax). Transcripts were thematically analyzed guided by descriptive qualitative methodology; major themes and issues were mapped to an inverted SES model for health promotion. Older gbMSM report exclusion and further marginalization from the larger LGBTQ+ community, the healthcare community, and even their own community of care/support network. Recognizing the unique needs of this population can help reduce barriers to healthcare access and reduce the healthcare inequities faced by this marginalized group. Limited research has been conducted on holistic approaches to EOL for older gbMSM Canadians with little focus on health promotion. The inverted SES model focuses on policy first and works out to the individual. By hearing first voice of the affected, marginalized population, policies and procedures can be created, adapted, or updated to address their needs. This approach recognizes change needs to made 'top down,' bringing the voices of those impacted 'up.'