Understanding Intersectionality in Aging: 2021 GGS Conference

The research employed a mixed methodology combining qualitative and quantitative techniques. Quantitatively, 1,189 telephone surveys were conducted with older adults aged 65+ in Aragón, using quotas for sex, age strata, province, and population size, covering over 200 municipalities. Qualitatively, 13 in-depth interviews were conducted with older adults and experts, plus two focus groups: one with older adults and another with professionals from university, associative, and institutional sectors.

Beyond traditional survey research and interviews, aging research has expanded to include ethnography (e.g., McCall's three-year study of people aged 85-103), documentaries, cultural representations, books, theater, and social media/netnography. These approaches provide unfiltered voices of older people themselves and help move beyond deficit-focused narratives of aging, representing a shift toward visual and participatory methodologies in gerontology.

The research combined qualitative and quantitative methods across the four UK nations. It examined differences within the 55+ age group (55-64s, 65-74s, 75+), considered intersectionality with gender and ethnicity, and included nine focus groups split by age, gender, socioeconomic groups, and ethnic minority representation.

The research employs a mixed methods approach combining qualitative and quantitative methodologies to comprehensively address the research objectives. The qualitative component utilizes life history narratives (historias de vida) to capture the lived experiences of older adults, while the quantitative component focuses on quality of life characterizations. The study involved 16 semi-structured interviews with older adults aged 60 and above in the urban zone of San Pedro de los Milagros, Colombia. Additionally, four workshops were conducted with 40 older adults, each with specific objectives: (1) Building trust and dynamism among older adults and their families; (2) Designing creative activities about emotions and family relationships; (3) Understanding family relationships of older adults; (4) Recognizing the rights of older adults. This methodological approach allows researchers to triangulate data and provide a more complete understanding of the phenomenon under study.

This section covers the unique characteristics of geriatric research and fundamental methodological approaches. The aging population represents a relatively new research frontier, with life expectancy increasing dramatically in recent centuries. Older adults exhibit significant heterogeneity in health characteristics, lifestyles, and living situations that differ from younger populations, requiring specialized research approaches. Hypothesis testing forms the foundation of statistical inference, providing rules for accepting or rejecting claims about populations based on sample evidence. Research methods are selected based on objectives: quantitative methods for generalizing to large populations, qualitative methods for exploring characteristics of less explored populations, and mixed methods for comprehensive research.

Effective geriatric care in multicultural societies requires clinicians to recognize and address three interconnected cultures—patient culture, clinician culture, and medical culture—through self-reflection on personal biases, open inquiry about patient beliefs regarding health and illness, and organizational strategies such as employing bilingual staff, providing interpreters, and creating inclusive environments; this approach is particularly critical for geriatric sexual minorities (LGBTQ+) who face higher rates of discrimination, isolation, and unmet healthcare needs due to fear of disclosure and lack of culturally competent care.

This final section presents a comprehensive framework for providing culturally competent care to SGM populations and actionable implementation strategies. The addressing model considers multiple intersecting social categories including age, disability, religion, ethnicity/race, socioeconomic status, sexual orientation, indigenous heritage, and gender identity. Cultural humility involves examining implicit and explicit biases, developing attitudes of supportiveness, confidentiality, avoiding assumptions, respecting individual perspectives, and honoring patient expertise. Responsiveness requires implementing inclusive practices, engaging in respectful advocacy, building trust, creating welcoming environments, committing to ongoing training, and taking systems approaches. Non-discrimination policies must explicitly include gender identity, sexual orientation, and gender expression. Best practices for intake forms include asking preferred names, pronouns, and providing open-ended options for sexual orientation and gender identity. Key resources include SAGE, National Resource Center on LGBT Aging, National LGBT Health Education Center, Long-term care.gov, Fenway Institute, Williams Institute, and Aging with Pride study data sets. These resources enable providers to deliver evidence-based, affirming care that addresses the unique health needs of SGM older adults.

A model project funded by the Federal Ministry for Family Affairs, Senior Citizens, Women and Youth (2019-2021) developed materials for opening long-term care to LGBTQ+ seniors. The project involved collaboration with two state services and four full-time elderly care facilities in Bavaria, supported by the Federal Representation of Gay Seniors and the Federal Association for Trans People. The project established a virtual coordination center and developed a practice handbook containing a model concept for facilities, a diversity scan tool, and comprehensive training materials. The handbook includes self-assessment criteria, action planning tools, and resources for community engagement.

Key policy recommendations emerge from the research: (1) Implement trauma-informed care and suicide prevention specifically designed for LGBTQ+ older adults; (2) Expand economic security programs including friendly housing options rather than segregated facilities; (3) Support existing organizations like OpenHouse and LA LGBT Center that provide essential services; (4) Mandate cultural competency training for healthcare workers, mental health professionals, and first responders; (5) Establish mental health supports and social groups to reduce stigma and build social networks; (6) Ensure long-term care facilities post the LGBTQ+ Residents Bill of Rights and provide appropriate training. These policies must address intersectional needs while building on community strengths.

This webinar presents a comprehensive framework for delivering culturally competent long-term services and supports (LTSS) to diverse populations. The CMS Office of Minority Health establishes a three-phase approach to health equity: increasing understanding of disparities, developing culturally appropriate solutions, and implementing sustainable actions. Cultural competency is defined as the ability to work and communicate effectively in cross-cultural situations, requiring examination of daily operations rather than treating it as an add-on. The framework emphasizes intersectionality—how race, ethnicity, gender, age, and geography overlap to shape individual experiences. The Diverse Elders Coalition reveals systemic barriers through their 2016 campaign collecting nearly 5,000 comments: Latino seniors face language barriers with only 4% speaking English very well; American Indian elders encounter geographic isolation and cultural insensitivity; over 60% of LGBT adults fear discrimination in long-term care; and the model minority myth obscures challenges for AAPI elders with up to 90% limited English proficiency. Two complementary models demonstrate successful implementation: Nikkei Manor's purpose-built cultural care for Japanese-American elders integrates architecture, dining, activities, and staff training; Boston Center for Independent Living's consumer-driven LTSS coordination uses holistic matching, pre-visit preparation, and keyword-triggered referrals. Both models emphasize staying away from medical terminology to focus on member-defined independence, demonstrating that effective cultural competence requires understanding unique intersectional experiences and adapting services accordingly.

The concept of heterogeneity recognizes that older people are not homogeneous, with different experiences based on social class, ethnicity, gender, and life circumstances. Critical gerontology emerged in the 1980s, questioning natural or functional explanations for aging phenomena. It examines how political, economic, and social structures shape aging experiences, viewing discrimination as products of power relations rather than natural processes. Feminist gerontology analyzes how gender intersects with aging to create compounded discrimination, examining how cultural norms limit femininity throughout the life course. Both approaches challenge traditional theories by emphasizing structural inequalities and the need to address both micro-level individual needs and macro-level structural changes.

Three theoretical paradigms explain aging: structural functionalism views aging as adaptation to societal expectations (disengagement, activity, continuity theories); conflict perspectives analyze power dynamics (modernization, exchange, age stratification theories); symbolic interactionism focuses on subjective experience (subculture of aging, selective optimization with compensation, gerotranscendence theories). Each paradigm offers distinct lenses for understanding how aging intersects with social structure, power relations, and individual meaning-making.

Critical gerontology is a value-committed approach that examines how aging is socially constructed through political, economic, and cultural structures, rather than viewing it as merely a biological process; it emerged in response to the individualistic focus of mainstream gerontology and has evolved through three phases—from welfare state aging to active aging to precarious aging—highlighting how neoliberal policies, globalization, and declining social protection have created new forms of vulnerability for older people, particularly those from disadvantaged backgrounds.

This lecture introduces critical perspectives on community gerontology, explaining that power is not a fixed possession but a dynamic force that operates through social mechanisms, narratives, and ideologies to either empower or disempower older adults. Drawing on Foucault's theories, the course examines how power is both repressive (limiting desires) and productive (creating new realities), and how biopolitics transforms bodies and social practices around aging. The instructor emphasizes that gerontology should not merely provide care but should critically analyze and potentially destabilize established power structures to create new forms of meaning and empowerment for older adults.