seven - “I can’t ask that!”: promoting discussion of sexuality and effective health service interactions with older non-heterosexual men

Summary

Introduction

This chapter aims to enhance the understanding of social policy academics and practitioners with regard to the homosexuality of older men, with whom they may interact on a professional basis or write about through their research, without actively and consciously considering how sexuality can substantially influence aspects of daily living. In order to fulfil this aim, I first outline research to date on the size of the older gay male population in order to argue that this is significant enough to warrant more wholehearted interest from policy makers and service providers. Then, the discourse of sexual citizenship is discussed as this also contextualises my work. Finally, the substantive sections of the chapter introduce the research and the participants, before exploring decision making regarding coming out in a healthcare setting and the implications of different scenarios for the well-being of older gay men. It is argued that healthcare professionals require greater information in order to recognise the wider relevance of knowing a person's sexual orientation and to gain a better understanding of how best to discuss such subjects with patients who might be reluctant to access care and discuss their sexuality and relationships.

A number of professional responses are subsequently discussed that have implications for macro-level policy making and local service provision within healthcare institutions. This is also relevant research in light of the active ageing agenda and the government's aim to ensure later life is lived through activity, good health, secure income and independence. The cross-departmental Opportunity Age initiative launched in 2005 (DWP, 2005) reflects this and lays out the responsibilities of central and local government and governmental agencies, as well as older people and communities themselves. Arguably the efforts under the National Service Framework for older people (DH, 2001) concerning the NHS, and Opportunity Age (DWP, 2005), can only succeed if all aspects of older people's social worlds are recognised and accounted for.

The population

Older men form a relatively small proportion of the UK population, with the number aged 65 and over standing at 4,143,300, and with 1,754,200 men aged over 75 (ONS, 2006). A limited body of gerontological work focuses specifically on older men, with contributions made by Thompson (1994), Neugebauer-Visano (1995) and Schiavi (1999), who offer substantial, albeit quite heterosexist, contributions about older men and their sexuality.