True inner self or fantasies and fabulation? Discourses on gender identity, sexuality, and LGBTQ among care workers in Swedish dementia care

Lesbian, gay, bisexual, trans and queer (LGBTQ) people make up a considerable proportion of those in need of formal dementia care. Yet sexuality and gender identity have received little attention in dementia care research. Using a discursive approach, this article explores how dementia care workers discuss and reflect on dementia, gender identity, sexuality and caring for LGBTQ people with dementia. The article is based on a focus group study with dementia care workers in Sweden, primarily nurses and nurse assistants. The findings point to pervasive heteronormativity in everyday care practice; non-normative sexualities and gender nonconformity were primarily deemed invisible but also sometimes questioned as "fabulations" or "fantasies". The invisibility of LGBTQ people was discursively framed as a result of generational belonging: people with dementia belonged to generations who were assumed to be closeted. Gender identity and sexuality were also framed as sensitive issues that were difficult to address with people with cognitive conditions. Dementia was understood as bringing out the true sexual or gendered self, but also as causing confusion and inauthentic expressions of gender and sexuality. In conclusion, existing discursive framings locate problems of heteronormativity outside of care practice and risk leading to inaction; more direct challenges to heteronormativity are needed in dementia care.