Indigenous 2SLGBTQIA+ Identities and Age-Related Cognitive Decline: A Scoping Review

Abstract

Research on Two-Spirit (2S) and Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual and other identities (LGBTQIA+) Indigenous communities and age-related cognitive decline (ARCD) is still an emerging field of study. Historically, Indigenous and 2SLGBTQIA+ individuals are underrepresented in healthcare research and practices. Our research question was as follows: what is the scope, breadth, and depth of published and gray literature about First Nations, Métis, and Inuit 2SLGBTQIA+ people’s experiences of aging and dementia? This scoping review used an Indigenous-informed methodology, grounding our research in a guidance committee comprising all Two-Spirit knowledge-keepers, community advocates, and scholars. This method adapts a five-step scoping review approach, including Indigenous knowledge through consultation with Indigenous community members. The committee informed all five steps of the scoping review methodology. Our initial search identified 1320 articles; after screening, seven articles remained, comprising six journal articles and one book chapter. Manuscripts were published in Canada, the USA, and Australasia. There were five qualitative studies, one scoping review, and a book chapter. The aims, results and recommendations from the included studies are presented. We found minimal published literature on the intersecting identities of 2SLGBTQIA+ Indigenous Peoples and ARCD. Gaps included epidemiological research, assessment and interventions, and qualitative experiences in this population. Further investment in research is needed to expand what is known to understand the needs of Indigenous 2SLGBTQIA+ people with dementia.

Plain Language Summary

The question we studied: We know that 2SLGBTQIA+ older adults face unique challenges in healthcare and often feel unsafe or overlooked. We wanted to learn what is already known about aging and memory loss (like dementia) in Indigenous people who are also part of 2SLGBTQIA+ communities. These are people who may identify as Two-Spirit, lesbian, gay, bisexual, trans, queer, or another gender or sexual identity, and who are also First Nations, Métis, or Inuit. We didn’t know how much research exists about how this affects their memory and brain health as they age. We asked: What studies have already been done on this topic? And where are the biggest gaps in what we know?

How we studied it: We looked through thousands of articles, reports, and book chapters to find any research about dementia or memory loss in Indigenous 2SLGBTQIA+ people. Our team included Two-Spirit researchers and community members, and we worked with a Two-Spirit advisory committee throughout the whole process.

What we found: There is almost no research focused specifically on Indigenous people who are both 2SLGBTQIA+ and experiencing memory loss or dementia. Of the seven studies we found, most talked about personal stories and life experiences, but very few used data or statistics. Many of the stories showed that people often feel excluded, unsafe, or misunderstood in healthcare settings. Some studies have shown that reconnecting with culture, community, and traditional roles can help individuals cope with aging and memory changes. Gaps we found included that existing memory tests and treatments don’t reflect the lived experiences of Indigenous 2SLGBTQIA+ people. There is a need for studies on how common memory loss is in this group of older adults. Most studies recommended making health services safer by including Indigenous knowledge and Two-Spirit voices in planning and care.