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Aging and End-of-Life Care Planning Among Transgender and Nonbinary Individuals: A Systematic Review.

Ginger H Kwak¹, G Nic Rider², Emily A Paine^3,4,5

¹Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

|July 10, 2026

Summary

Transgender and nonbinary individuals face psychosocial barriers in end-of-life (EOL) care planning. Addressing these fears is crucial for supporting autonomy and successful aging for the transgender and nonbinary community.

Keywords:

advance care planning aging discrimination end-of-life care gender non-binary transgender

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Area of Science:

Social Sciences
Medical Humanities
Gerontology

Background:

Transgender and nonbinary (TNB) individuals experience unique challenges in healthcare settings.
End-of-life (EOL) care planning requires sensitive consideration of diverse patient needs and preferences.
Understanding the specific EOL care needs of TNB populations is essential for equitable healthcare.

Purpose of the Study:

To systematically review and identify the perceived end-of-life (EOL) care needs of transgender and nonbinary (TNB) individuals.
To explore the experiences and preferences of TNB individuals regarding EOL care.
To inform the development of inclusive and supportive EOL care strategies for TNB populations.

Main Methods:

A systematic literature review was conducted adhering to PRISMA guidelines.
Searches were performed in PubMed and Web of Science databases, covering publications from 1988 to 2024.
Thematic analysis was employed to identify prominent themes from 17 eligible articles.

Main Results:

Five major themes emerged: fear of discrimination, loss of independence, social connection challenges, logistical obstacles, and defining successful aging.
Subthemes included fear of identity loss, euthanasia preferences, and engagement in EOL planning.
Psychosocial factors were identified as significant barriers to effective EOL planning.

Conclusions:

Psychosocial aspects present substantial barriers to successful end-of-life (EOL) planning for transgender and nonbinary (TNB) individuals.
Further research and interventions are necessary to enhance TNB individual autonomy in EOL planning and care.
Healthcare providers should prioritize culturally competent and affirming EOL care for TNB patients.