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attractions in between. He presented sexual attraction as a continuum for the first time, blurring the harsh lines around homosexuality and heterosexuality.
Forty years later, Fritz Klein would present case studies of the ‘healthy bisexual’
in The Bisexual Option (1993). He also created the Klein Sexual Orientation Grid (KSOG), in which sexual identity is rated on a 7-point scale on multiple dimensions (e.g. attraction, behaviour, fantasy, etc.) as well as over time, illustrat-ing the importance of fluidity and complexity.
More recently, Rebecca Jones (2000) suggested a model specific to bisexu-ality in which individuals could locate themselves in terms of their bisexual feelings or attractions, behaviors and identity. This model remains useful for scholars and service providers who wish to understand the complexities of a bisexual population that might be defined in various ways based on these three overlapping spheres of experience. Jones (2000) and Paula Rodriguez-Rust (1993, 2000) have also defined bisexuality as a social or cultural construction, the meaning and cultural interpretations of bisexuality as an identity are con-stantly changing and will vary by societal context across time and space.
There are many factors that might influence one’s choice to identify with bisexuality, as evidenced by the narratives of older adults with a history of bisexual behaviors (Jones, Almack and Scicluna, 2016). Some see sexuality as too fluid to map onto any sexual identity label. Others opt for alternative labels such as ‘queer’ or ‘pansexual’ or to use no label at all. These findings highlight the continued variation in how and why bisexual populations self-identify.
It is also particularly important to account for variation in attraction, behav-iour, relationships, and identity in the lives of older bisexual individuals as they may have long and varied histories that reveal the fluid and complex nature of their sexual experience over time (Jones, 2019). With this in mind and for the purpose of this discussion, the defining characteristic that unifies bisexual individuals is their capacity to be attracted to or pursue emotional or sexual relationships with individuals of more than one sex and/or gender, although those attractions may vary in type, timing and degree (Ochs and Rowley, 2009).
This broad definition offers the benefit of accounting for various dimensions of sexuality by which a bisexual population might be identified, thereby includ-ing a larger population of interest, and acknowledginclud-ing the ongoinclud-ing fluidity and complexity that sexuality is increasingly understood to encompass.
Current research on bisexuality and ageing
Recent estimates indicate that bisexual-identified men and women make up a larger proportion of the adult population than gay men and lesbians combined, constituting about 3.5% of the US population age 18 and older, while up to 11% report attractions to multiple genders (Gates, 2011). While there are no current estimates of the size of the older bisexual population, recent studies suggest there are about three million LGBT adults age 50 or 55 and older in the US, a number that is expected to double by 2050 (Espinoza, 2014; Fredriksen-Goldsen and Kim, 2017). Despite the size of the population, research focused
Bisexuality and ageing 133 on bisexual populations or bisexual-specific experiences are rare. Common themes include comparisons of demographic patterns and health outcomes between bisexuals and lesbians, gay men or heterosexual adults, analyses that reveal possible causal factors related to bisexual-specific health disparities, and a small collection of qualitative studies that explore specific individual or social issues in greater detail.
When bisexual adults are studied as a separate population, they often report differences in life sequences and disparities in health compared to lesbians and gay men. Several studies have found that women are more likely to identify as bisexual or express bisexual attractions compared to men (Gates, 2011). Com-pared to lesbians and gay men, bisexuals also report lower socio-economic sta-tus (Fredriksen-Goldsen et al., 2016). In terms of health outcomes, bisexual adults report greater prevalence of depression, anxiety, substance use issues, sui-cidal ideation, negative affect and lower levels of social well-being compared to lesbian, gay and heterosexual adults (Fredriksen-Goldsen et al., 2011).
There are many possible reasons for these observed disparities in health.
The stability, reality, or definition of identities outside of accepted binary social categories (e.g. bisexual, multiracial, gender queer) are often questioned, chal-lenged or socially imposed as they threaten to disrupt the normalised social order, contributing to identity confusion or ambivalence, lack of identity cohe-sion or valence, higher rates of internalised stigma and struggles to maintain an internal sense of identity among these populations (Hartman-Linck, 2014).
Beyond the individual, anti-bisexual sentiment, termed ‘biphobia’ (Jones, 2010) or ‘binegativity’ (Eliason, 2000), also contributes to experiences of discrimina-tion and negative social interacdiscrimina-tions both inside and outside of LGBTQ com-munities (McLean, 2008). Because of these experiences, many bisexuals choose to conceal their sexual orientation and may not engage in queer environments, creating a lack of support from and connections with LGBTQ individuals and communities (McLean, 2008), adding to their relative invisibility.
Bisexual older adults
Although bisexuality has become increasingly common and accepted among young people in many Western countries, researchers note the continued invis-ibility of the history, lives and experiences of older bisexual people (Westwood and Lowe, 2017; Jones, 2019). The exclusion of bisexuals as a relevant subgroup within LGBTQ research is even more pronounced in ageing-related scholar-ship. In a recent review of empirical LGBTQ ageing literature, less than one-third of articles included bisexuals in their study sample and none focused solely on bisexual ageing (Fredriksen-Goldsen and Muraco, 2010). This gap renders bisexuals invisible among an already understudied and underserved population and limits knowledge development specific to bisexuality and the ageing process (Scherrer, 2017).
Although less information is available regarding the health of older bisexual adults, preliminary findings identify similar health disparities relative to younger
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adults. Older bisexuals report poorer physical and mental health compared to gay men, lesbians and heterosexuals (Fredriksen-Goldsen et al., 2013, 2017).
Similar risk and protective factors are also relevant in the context of bisexual ageing, contributing negative health impacts that might be minimised (risks) and positive influences that might ameliorate the impact of negative expe-riences and contribute to resilience (protective factors; Fredriksen-Goldsen et al., 2013). In terms of risk factors, older bisexual individuals report higher levels of internalised stigma and more concealment of their sexual identity, which are associated with higher rates of depressive symptomology and dis-ability. Older bisexuals also report having smaller social networks, lower levels of social support, and fewer feelings of belonging in LGBTQ communities, all of which can be protective for older sexual minorities in terms of health (Fredriksen-Goldsen et al., 2017).
Of particular concern for bisexual men, HIV-related issues can add complex-ity to health care and social concerns in later life as nearly one-fifth of older bisexual men are living with HIV (Fredriksen-Goldsen et al., 2011). Among gay and bisexual men living with HIV, the number of comorbid conditions individuals experience and instances of victimisation over the life course are associated with poorer physical and mental health-related quality of life (Emlet, Fredriksen-Goldsen and Kim, 2013). Gay and bisexual men are also less likely to be married or partnered or to have children compared to lesbian and bisex-ual women, making them particularly vulnerable to loneliness and a lack of social support (Kuyper and Fokkema, 2010).
There remains almost no research that addresses the experiences of trans or gender non-conforming folks who also identify as bisexual. In one interna-tional study of bisexual transgender older adults, more than half subjectively reported that they were ageing successfully (Witten, 2016). However, many worried they may not have access to needed health care and ageing services at the end-of-life due to discrimination or financial strain and nearly one-third did not know who would provide their informal care if needed in the future.
When asked what factors contributed to their ageing-related concerns, most focused on the potential negative impact of their trans identity, while only one mentioned their bisexual identity as a factor. These findings offer nuance to the combined influences of living with both marginalised identities. However, in order to further build on this small area of study, researchers must take care to thoroughly conceptualise and operationalise the intersections of gender and sexual identity categories in later life (Fredriksen-Goldsen and Muraco, 2010).
As Jones (in press) has noted, the life course perspective is particularly perti-nent to the experiences of older bisexual individuals. This perspective makes up a key theoretical paradigm in social gerontology literature from which to theo-rise how individual lives interact with historical context and how the timing of individual lives come to influence the ageing process. When considering the timing and sequence of life events, bisexuals, and particularly bisexual women, often recognise their same-sex attractions later in life compared to gay men and lesbians and their coming out milestones are also spread over more years
Bisexuality and ageing 135 of development (Koh and Ross, 2006; Rust, 1993). Older cohorts of bisexuals also report different patterns of partnership, such as being more likely to experi-ence an opposite-sex marriage, separation, divorce or widowhood (Fredriksen-Goldsen et al., 2017).
Several qualitative studies have included older bisexual individuals, but were not driven solely by their experiences nor were they focused on bisexuality, focusing instead on experiences with LGBTQ living environments (Sullivan, 2014), home care services (Grigorovich, 2015, 2016), caregiving (Muraco and Fredriksen-Goldsen, 2014) and HIV-related stigma (Haile, Padilla and Parker, 2011) among older sexual minority women or men or LGBT adults. These studies indicate that older LGBT individuals feel embarrassment or frustration at becoming a burden to informal caregivers (Muraco and Fredriksen-Goldsen, 2014) or may lack caregivers altogether due to strained relationships with family or a lack of biological children (Grigorovich, 2015). Most would prefer to live in an LGBTQ-specific retirement community where they feel acceptance, com-fort and safety (Sullivan, 2014). They conceptualise quality of care as providing competent, non-judgemental care while being sensitive to the possible histori-cal sources of victimisation and oppression that care recipients have experienced (Grigorovich, 2016). One study of 20 older Black gay and bisexual men living with HIV in New York City revealed the complex interrelated impacts of mul-tiple sources of stigma. Participants reported that HIV-related stigma marked them as dehumanised bodies in the context of social and medical institutions, while their experiences of poverty, illness and race made them vulnerable to economic and health-related crises (Haile, Padilla and Parker, 2011).
Qualitative studies also reveal the agency and resilience of bisexual partici-pants. By asking bisexual individuals to create images of their own imagined ageing futures, Jones (2011) revealed how bisexuals enact agency through imag- ining and idealising non-normative ageing futures outside the bounds of nor-mative expectations. Additionally, in the Looking Both Ways study, Jones, Almack and Scicluna (2016) gathered the life course histories of 12 bisexual individuals age 51 to 83 that illustrated the diversity of paths that older adults have taken to reach a bisexual identity as well as reasons individuals who might be behav-iourally bisexual choose not to identify as such. This limited qualitative work illustrates the possibilities for exploring issues of social influence, agency and diverse life stories through qualitative analytic methods.
This overview of the current definitions of bisexuality and the state of research provides a backdrop for understanding issues related to bisexuality and ageing. I now turn to a deeper examination of particular aspects of inequality experienced by older bisexual individuals, framed by Fraser’s concepts of rec-ognition, representation and resource access.
Recognition
According to Fraser (2007), successfully achieving recognition in cultural vis-ibility, cultural worth and social status entails not only creating and maintaining
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‘a positive relation to oneself ’ (30) but also being seen as an equal social partici-pant. Being able to positively relate to oneself is a particular struggle for older bisexual individuals, informed by the limited cultural and historical narratives available to them and their devalued cultural and social worth. These experi-ences are shaped by the intersections of ageism, heterosexism and biphobia.
As bisexuality has become more common, it has also been imbued with cer-tain cultural meanings, stereotypes and possible narratives. One possible script, depicted by the idea of a ‘lesbian-until-graduation’ is that of the young woman experimenting with her attractions to women for a transitional period of time, after which she will return to dating men exclusively and go on to live a heter-onormative, and therefore privileged, lifestyle (Eisner, 2013). Another common bisexual-specific storyline often depicted in literature and film, is that of the bisexual predator who takes on a near sociopathic role, seducing and disrupting the lives of people of various genders and leaving a trail of jealously and heart-break behind them (Ochs and Rowley, 2009). While both scripts contribute to the negative image of bisexual individuals as promiscuous or untrustworthy as sexual partners and allies, they are also limited to younger individuals. In fact, one would be very hard-pressed to find any representation of older bisexual characters in film or fiction texts. This lack reflects the relative lack of atten-tion to the sexuality of older adults in general, making issues of sexual identity appear less relevant in later life as well as the assumed heterosexuality in most cultural representations. The non-existence of older bisexual models in cultural representations limits bisexual individual’s opportunities to envision or plan for their own ageing futures (Jones, 2011).
In addition to cultural silence, Klein (1993) demonstrated the erasure of many historical figures who were known to have bisexual relationships but were later portrayed by history as gay or lesbian, such as Alexander the Great and Oscar Wilde among many others. In recent history, the influence of many bisexual activists is also forgotten or unacknowledged, such as Brenda Howard, who organised the first Pride march in New York City to commemorate the Stonewall riots (San Francisco Human Rights Commission, 2012). While a lack of popular media figures limits the cultural influence and visibility of bisexual older adults, the erasure of bisexual figures from history further suggests that their past experiences and contributions do not matter, particularly in the con-text of the modern gay rights movement (Eisner, 2013).
The absence of bisexual figures from the cultural imaginary and retelling of history can be tied to multiple sources. The continued misunderstanding, denial, and degradation of bisexual identities and resulting stigma continue to discourage individuals from choosing the identity for themselves or from form-ing a collective that might be seen as a coherent and proud community (Jones, 2019). Additionally, within LGBTQ communities, there is a troubled history between bisexual individuals and gay and lesbian communities. In 1970s, femi-nism drove a wedge between lesbian separatists and bisexual women who were considered traitors for their continued relationships with men and associated privilege through patriarchy. In the anthology Bi Lives (Orndorff, 2012), Lani
Bisexuality and ageing 137 Ka’ahumanu describes the political resonance of a bisexual identity in this context:
It was a badge of honor, coming out as lesbian . . . I always felt strong and proud when I said I was a dyke or lesbian. When I said I was bisexual it was not empowering; it didn’t feel good.
(105) The lack of positive resonance around bisexual identities is likely associated with the relative frequency of ambivalence that bisexuals report in relation to their sexual identity (Rust, 1993). The stereotype of the bisexual traitor or untrustworthy sexual partner was deepened through the social and medical discourses surrounding the HIV/AIDS epidemic, portraying bisexual men as an ‘infection bridge’, connecting otherwise separate heterosexual and homo-sexual circles of homo-sexual contact (Kaestle and Ivory, 2012). Because of these frac-tures, the bisexual-specific community and movement are still relatively new and immature in development. The 1990s would also see the beginnings of a bisexual-specific political movement in the US, evidenced by the establish-ment of national organisations (e.g. BiNet USA established in 1990),1 events (e.g. Bisexual Pride Day established in 1990), magazines (e.g. Anything that Moves established1991) and anthologies (e.g. Bi Any Other Name: Bisexual People Speak Out, Ka’ahumanu and Hutchins, 1991). However, the bisexual portion of LGBTQ communities has not yet found a voice as unified and directive as other aspects of LGBTQ rights activism.
While this history may not impact younger generations of bisexual indi-viduals to the same degree, historical tensions continue to cast shadows over the dynamics between older members of LGBTQ community dynamics today.
Unfortunately, older bisexuals have access to fewer positive associations or community connections to outweigh these negative experiences and remain isolated from the broader society. Thus, finding no cultural models, little recog-nition for their political contributions, and lacking a positive sense of their own identity or community, there are few positive sources of recognition available to older bisexual individuals.
Representation
In terms of representation, Fraser emphasises access to political participation and voice (2007). In the lives of older bisexual individuals, it is also crucial to account for their lack of representation in research and service provision, which are factors that in turn limit access to political representation.
Research and practice
To date, the fields of gerontology and LGBTQ research have been characterised by under-representation of bisexual ageing at best and complete silence at worst
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(Scherrer, 2017). In addressing the ‘disappearing B’ in LGBTQ research, Jones (2010) has cited multiple examples of LGBTQ reports and studies that, while including the ‘B’ or bisexuals in their name, fail to report on findings specific to bisexuals, allowing these experiences to go unknown. When bisexual indi-viduals are included in empirical research, they are often combined with other sexual minorities (e.g. sexual minority women, SMW; men who have sex with men, MSM, etc.) or enveloped into acronyms such as ‘LGB’. Another com-mon practice is to combine bisexual individuals of multiple gender identities into a single category, effectively collapsing the bisexual experience and ignor-ing differences between bisexual men, women, and gender non-conformignor-ing individuals (Fredriksen-Goldsen and Muraco, 2010). While these practices are common in research, Keppel and Firestein (2007) have noted that they are also present in practice settings:
It is startling to realize how little attention is being directed toward older bisexual men and women by organizations focused on LGBT ageing that nominally include bisexuals in the titles of their organizations and in their mission statements.
(168) Many service providers assume that bisexual clients will find culturally competent and responsive services in LGBTQ-specific organisations (Johnston, 2016). In contrast, bisexual older adults may feel even less welcome or safe accessing ser-vices in these organisations due to the historical tensions between sexual minority groups and ongoing bi-erasure in queer political movements (Johnston, 2016;
Fredriksen-Goldsen et al., 2011). The exclusion of bisexual representation in research and practice reveals the relative marginalisation of bisexual populations from both LGBTQ communities and the broader population (Brewster and Moradi, 2010; Kaestle and Ivory, 2012), echoing issues of recognition. However, this lack of representation also has implications for political voice.
When the needs of a population are not captured through research, they fail to become political priorities. As one pertinent example, practices of the US Census as well as other large-scale and population-based studies, allow for bisexual lives to be obscured by collecting data on the gender or sex of one’s
When the needs of a population are not captured through research, they fail to become political priorities. As one pertinent example, practices of the US Census as well as other large-scale and population-based studies, allow for bisexual lives to be obscured by collecting data on the gender or sex of one’s