June 2025
Interviewed by Brittany Jakubiec
Hannah Kia is an Associate Professor at the University of British Columbia’s School of Social Work. Her current program of research addresses a variety of issues pertaining to sexual and gender minority (SGM) populations and has, in recent years, focused primarily on the health and well-being of transgender and gender diverse (TGD) people. Hannah’s scholarship is grounded in intersectional and other critical scholarship. She maintains registration as a clinical social worker in British Columbia.
What is the “Aging with Affirmation” study, and why is this project so important?
“Aging with Affirmation” is a qualitative study that I led, in partnership with Egale and a wonderful group of researchers from across Canada, to examine the healthcare and social service experiences and needs of transgender and gender diverse (TGD) older adults in this country. Specifically, we conducted virtual focus groups with a total of 21 participants, including 10 TGD older adults (meaning TGD folks at or over the age of 50), and 11 individuals who self-identified as community advocates and service providers. Two of the participants in the latter participant category were also TGD older adults. In the context of focus groups, we asked participants to discuss their insights on how older TGD people in Canada experience healthcare and social services, and what they think would be needed to improve care systems for this population. This study was funded by a Social Sciences and Humanities Research Council (SSHRC) Partnership Engage Grant.
As a research team, we’ve been very excited about the opportunity to do this work. A wealth of past quantitative research has indicated that TGD older adults experience profound disparities in social and health outcomes (Catlett, 2024; Fredriksen-Goldsen et al., 2014). Qualitative studies have additionally shown us that TGD older adults have distinctive priorities and needs when they interact with healthcare and social service providers across domains such as dementia care (Baril & Silverman, 2024) and end-of-life care planning (Pang et al., 2019). We wanted to build on this rich literature by learning, more broadly, how TGD older adults in this country experience health and social care systems and what can be done to strengthen or perhaps transform existing services.
Can you tell me more about the experiences of trans and gender diverse (TGD) older adults in various systems of care?
Our study highlights that TGD older adults often have complicated and, in some cases, difficult historical experiences with healthcare and social service providers. Several TGD older adult participants, for example, talked to us about how they had interacted with care professionals who had been overtly hostile or stigmatizing towards them on the basis of their transness and/or gender non-conformity. Not surprisingly (and understandably), our findings indicate that folks with these experiences are reluctant to trust service providers and may, in many cases, avoid formal systems of care altogether if possible.
A number of participants also emphasized that although TGD older adults commonly experience a combination of cisnormativity, transphobia, and ageism, the specific issues and needs of this population are incredibly varied. For example, TGD older folks who are racialized, living with disabilities, or financially insecure may experience racism, ableism, poverty, and other factors that further strain their encounters with healthcare and social service systems. These varied experiences also mean that TGD older adults are exceptionally diverse when it comes to the array of insights and skills they have in ‘pushing back’ or resisting against systems of oppression.
What kinds of challenges did trans and gender diverse (TGD) older adults face navigating various systems of care? What were some enablers or facilitators?
In light of what I have mentioned, it should come as no surprise that TGD older adults often experience significant challenges in areas such as accessing safe, timely, and relevant healthcare, and that folks in this population commonly face enormous challenges in areas like housing and financial security. When we approach some of these more granular issues with a lens like intersectionality, which takes into consideration how multiple systems of oppression come together to impact people’s lives, the picture gets more complex. Specifically, we see that TGD older adults experience heightened strain in accessing services and securing resources like housing if they are affected by factors like racism and ableism in conjunction with transphobia and ageism.
In spite of these challenges, our findings revealed that TGD older adults are skillful – and often accomplished – advocates. Several folks in our study talked about how they had historically been at the helm of catalyzing change across healthcare and social services, often simply by existing and asserting their issues and needs, and in some cases by pursuing more large-scale change as activists. Building on this notion, TGD older adults in “Aging with Affirmation” spoke consistently of the need for “ground-up” change, meaning change that is borne out of (and guided by) TGD people’s own knowledge, perspectives, and lived experience. For example, folks commonly talked about the need to involve TGD older adults in all aspects of policy and programming across healthcare and social services as an important departure point from which to build stronger and more responsive systems of care.
What are some recommendations you’d make for change to enable service providers to better support TGD older adults in service settings?
Taking my lead from TGD older adults who generously shared their insights in our study, I’d say the most important recommendation I have for both policymakers and service providers is to meaningfully engage TGD older adults in all aspects of governing, designing, and delivering services intended to address the priorities of this population. Folks in this group have, in many cases, navigated adverse social conditions and harmful norms that many would not be able to imagine resisting, and those who have survived these historical harms have much to teach decision-makers who do not share in this lived experience.
A related recommendation I have is for service providers to help TGD older adults connect with one another as peers, wherever possible. One issue that surfaced commonly in our findings was that although many older TGD folks discussed having developed rich social networks – in many cases, families of choice – others mentioned lacking opportunities over their lifetime to build these informal systems of support. Those who were disconnected from peers were particularly likely to indicate feeling isolated. By helping TGD older adults find one another, service providers can contribute to the critical work of supporting communities to grow and strengthen as bastions of safety and sources of mutual aid.
Your report speaks to the importance of understanding the historical context of the TGD older adult participants in your study, who were born between the 1950s and 1970s. What should service providers know about this period of time?
Though I am not a historian, a few features of this time period are important to foreground for policymakers and decision-makers. During these decades, based on what we know from our participants in “Aging with Affirmation” and from countless other sources, it was not uncommon for TGD folks in Canada to be denied services, experience outright harassment, physical violence, and other forms of victimization at the hands of healthcare and social service providers, and encounter a profound pathologization and stigmatization of their bodies and identities as a matter of course. Many TGD people experienced criminalization on the basis of simply embodying a gender expression that felt authentic to them – in fact, a participant in our study provided a chilling account of having been arrested earlier in her life for wearing a dress as a trans woman.
Service providers should understand that when TGD older adults appear disengaged from services, or perhaps express skepticism about the intentions of a care professional, such interactions often represent adaptive strategies that many in this group have had to develop over the years simply to survive. I can’t overstate the importance of service providers holding space for older TGD folks to set boundaries in service provision, share their stories and experiences (if and when they feel like they want to share), seek accountability for past harms, and determine their own terms of engagement.
Where can people go to learn more about the Aging with Affirmation Study and your work more broadly?
You can check out the community report that my amazing team and I have prepared, which contains a detailed summary of our research process and findings (egale.ca/awareness/aging-with-affirmation/). For folks who prefer videos, we also have a recorded webinar that you can check out on YouTube (https://www.youtube.com/watch?v=OU6VqJKOKBw). Finally, for readers who are curious to know about the study in great detail, I recommend reading our flagship peer-reviewed manuscript, which is available as an open-access article in the Journal of Applied Gerontology (https://doi.org/10.1177/07334648241295570).
References
Baril, A. & Silverman, M. (2024). “We’re still alive, much to everyone’s surprise”: The experience of trans older adults living with dementia in an ageist, cisgenderist, and cogniticist society. Journal of Aging Studies, 68, 101208. https://doi.org/10.1016/j.jaging.2024.101208
Catlett L. (2024). Healthcare needs and assets of gender diverse older adults: A systematic integrative review. Journal of Nursing Scholarship, 56(1), 119–141. https://doi.org/10.1111/jnu.12810
Fredriksen-Goldsen, K.I., Cook-Daniels, L., Kim, H.-J., Erosheva, E.A., Emlet, C.A., Hoy-Ellis, C.P., Goldsen, J. & Muraco, A. (2014). Physical and mental health of transgender older adults: An at-risk and underserved population. The Gerontologist, 54(3), 488–500. https://doi.org/10.1093/geront/gnt021
Pang, C., Gutman, G. & de Vries, B. (2019). Later life care planning and concerns of transgender older adults in Canada. The International Journal of Aging and Human Development, 89(1), 39–56. https://doi.org/10.1177/0091415019843520