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23. Februar 2024
HUMAN RIGHTS RESEARCH SOCIETY

Mental health disparities in older LGBTQ+ populations: A research roundup

In 2017, researchers estimated that 2.4% of the U.S. population 50 years and older identified as LGBTQ+, accounting for 2.7 million people. By 2060, they say, that number is expected to double to 5 million.

Even though some health concerns affect many older adults, older LGBTQ+ adults face particular challenges stemming from years of discrimination, stigma and social exclusion, and lack of access to health care, as explained in a 2020 report by the National Academies of Sciences, Engineering, and Medicine.

Mental health disparities in the LGBTQ+ population appear as early as adolescence and may persist into older age, according to the NASEM report, “Understanding the Well-Being of LGBTQI+ Populations.”

When covering the older LGBTQ+ community, it’s important not to imply that these disparities affect everyone, says Dr. Karen Fredriksen-Goldsen, one of the leading researchers in this area and director of the Goldsen Institute at the University of Washington, specializing in health equity research among underserved communities.

“Older LGTBQ adults have significant health disparities, but they’re a highly resilient community,” Fredriksen-Goldsen says. “Many enjoy good health. I don’t want to leave you with the impression that they’re all not doing well, because that just isn’t the case.”

With that said, members of the LGBTQ+ community are at increased risk for several health and mental health conditions compared with their heterosexual peers, studies have shown.

Older LGBTQ+ adults have higher rates of anxiety, depression, eating disorders, loneliness and suicidal thoughts, compared with their heterosexual counterparts, studies show. They are also disproportionately affected by substance use disorders, including tobacco, alcohol and other drugs, according to academic research. And, they’re at a higher risk of developing chronic health conditions.

Older LGBTQ+ also adults face dual discrimination based on their age and their sexual or gender identities, according to the American Psychological Association. In addition, bias and misunderstanding from health-care providers may prevent some older LGBTQ+ adults from getting care, the association explains.

In addition, older LGBTQ+ adults are less likely to have caregiver support compared with their cisgender heterosexual counterparts, says Darcy Connors, executive director of SAGEServes, a division of SAGE, a nonprofit that provides advocacy and services for older LGBTQ+ adults.

https://journalistsresource.org/home/covering-lgbtq-stories-resources-story-ideas/

“That leads to reduced supports for health care needs and quality outcomes,” Connors says. “They’re also more likely to live alone; that social isolation does affect their mental stability.”

This diverse population also faces economic disparities, as explained in a 2022 study by Fredriksen-Goldsen and colleagues, resulting from discriminatory practices and lack of access to benefits of marriage until marriage equality became law in 2015.

“There’s a myth that LGBT older adults are more likely to be wealthy or have economic resources, when in fact, because of some of the conditions of their early life, they’re actually more likely to have a disability and live in poverty,” Fredriksen-Goldsen says.

She is the principal investigator of the Aging with Pride: National Health, Aging and Sexuality/Gender Study, which is the first federally-funded national longitudinal study of LGBTQ+ adults 50 years and older. The long-term study began in 2009 and includes 2,450 individuals across the U.S. The participants are surveyed every two years.  

Fredriksen-Goldsen and her team, in addition to other researchers, have published more than one-hundred studies based on findings from the Aging with Pride cohort, paving the way to better understand health disparities in LGBTQ+ adults and each subgroup, highlighting the importance of remembering that the LGBTQ+ community is not a monolith.

“Even though we might use the LGBTQ acronym, these are very different groups and they often have unique life experiences and differing risks and protective factors,” she says.

Below, you will find a research roundup and a list of additional studies to help you better understand the topic.

Research roundup

Generational and Social Forces in the Life Events and Experiences of Lesbian and Gay Midlife and Older Adults Across the Iridescent Life Course
Karen Fredriksen-Goldsen, et al. Journal of Aging and Health, September 2022.

The study: This research examines life events among three generations of lesbian and gay adults: Invisible, born between 1920 and 1934, when their sexual and gender identities were “invisible”; Silenced, born between 1935 and 1949, when they could be arrested; and Pride, born between 1950 and 1964, the generation that witnessed the Stonewall Uprising. The researchers’ sample includes 2,079 adults from the 2014 round of Aging with Pride study.

The findings: They find the Invisible Generation disclosed their identity at older ages, were more likely to be retired, served in the military and survived a partner’s death. The Pride Generation was more likely to have disclosed their identities earlier and experienced higher levels of discrimination. The Silenced Generation was more likely to have been in a marriage with a different gender than the Pride Generation and have had fewer close family members.

From the study: “We found that the Pride Generation has benefited by many of the positive societal changes, yet this generation continues to experience significant disparities in health, well-being, work related discrimination, and experiences of victimization compared to the older generations. It is notable given the current social landscape that LGBT rights are increasingly under fire.”

Why we’re highlighting this study: The study provides in-depth historical and cultural context for the three generations of lesbian and gay older adults. It is one of the first to analyze health, social and family data for this population.

Related study: Historical and Generational Forces in the Iridescent Life Course of Bisexual Women, Men, and Gender Diverse Older Adults

Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study
Karen Fredriksen-Goldsen, Meghan Romanelli, Hailey Jung and Hyun-Jun Kim. Behavioral Medicine, February 2023.

The study: Researchers analyzed the Washington State behavioral Risk Factor Surveillance System from 2011 to 2019, including 109,527 adults 18 years and older. They then compared several factors including economic stability, health outcomes, chronic conditions, access to health care and preventive care by gender and sexual identity.

https://journalistsresource.org/home/covid-19-lgbtq-research/

The findings: Sexual minority adults were at a higher risk of poor general health, physical and mental health, disability, cognitive decline and having financial barriers to access health care compared with their heterosexual counterparts. In subgroups, lesbians and bisexual women had higher rates of smoking and excessive drinking, while gay men had higher rates of smoking and living alone. Bisexual and sexually diverse women were less likely to receive a mammogram screening.

From the study: “Sexually diverse people are an understudied population, and more research across the life course is needed to investigate the meaning of these identities and their trajectories in health and well-being. Interventions are needed that address the underlying mechanisms of disparities, such as elevated stress, higher rates of bias and victimization experience, and more limited social supports, which impact the health and well-being of sexual minorities.”

Why we’re highlighting this study: Even though this study isn’t about older adults, it shows the disparities that affect lesbian, gay and bisexual adults throughout their lives. Moreover, the study includes sexually diverse individuals who identify as something other than gay, lesbian or bisexual.

Related study: Health, Economic and Social Disparities Among Transgender Women, Transgender Men and Transgender Nonbinary Adults: Results from a Population-Based Study

Predictors of Loneliness Among Older Lesbian and Gay People
Mark Hughes, et al. Journal of Homosexuality, November 2021.

The study: Researchers aim to understand the social and individual factors that predict loneliness among older lesbian and gay adults in Australia. The study is based on the survey of 508 gay men and 241 lesbian women 60 years and older.

https://journalistsresource.org/home/loneliness-among-older-people-a-research-roundup-and-5-tips-for-covering-the-topic/

The findings: Factors that are significant predictors of loneliness for this population include not being in an intimate relationship and having less connection to the lesbian and gay communities. Experiencing discrimination also played a role in loneliness for both gay and lesbian adults. The study finds the average loneliness scores for older lesbian and gay adults were much higher than what’s been reported for the general older population in the U.S.

From the study: “Strategies to strengthen and maintain older lesbian and gay people’s connections to communities may also serve to prevent or ameliorate loneliness. Investment in mental health programs targeting lesbian and gay people is essential to address issues such as internalized homonegativity.” (Homonegativity is when people attracted to the same sex feel negative about their own sexuality.)

Why we’re highlighting this study: Loneliness is a significant social issue and the experience of loneliness varies by several factors including sexual orientation. This study, along with several others have shown that older gay and lesbian adults are more lonely than heterosexual people. It also provides insight into the impact of discrimination on loneliness. Even though this study is out of Australia, its findings have been replicated, including in the related study below.

Related study: Social Relationships and Loneliness in Late Adulthood: Disparities by Sexual Orientation

Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults
Tara McKay, Nathaniel Tran, Harry Barbee and Judy Min. American Journal of Preventive Medicine, March 2023.

The study: Researchers examined whether access to a provider who understands the needs of LGBTQ+ older adults improves their health outcomes. The study includes survey data from 1,120 LGTBQ+ adults between 50 and 76 years old living in Alabama, Georgia, North Carolina, and Tennessee. The data were collected between April 2020 and September 2021.

The findings: Access to LGBTQ+-affirming providers, who understand the specific health needs and practice respectful communication with LGBTQ individuals, is associated with greater use of preventive health screenings such as colonoscopy, flu vaccination and HIV tests, and better management of mental health conditions. (Here are American Medical Association’s guidelines on creating an LGBTQ+ friendly practice.)

From the study: “Institutions should adopt higher-level policy statements on nondiscrimination of LGBTQ+ patients and employees, provide gender-neutral rest-room facilities; engage openly with LGBTQ+ referral networks and identify LGBTQ+ specific competencies on institution websites; develop protocols to support LGBTQ+ physicians, staff, and patients who encounter antagonistic patients in clinical spaces; and expand formal continuing medical education offerings and staff development trainings on inclusive language use, LGBTQ+ identities, family structures, behaviors, and health needs beyond sexual health.”

Why we’re highlighting this study: As much as one-third of the LGBTQ+ population in the U.S avoids seeing a doctor for fear of discrimination, research shows. This study not only highlight the existing disparities but also offers potential solutions to close the gap.

Are Dementia Services and Support Organisations Meeting the Needs of Lesbian, Gay, Bisexual and Transgender (LGBT) Caregivers of LGBT People Living with Dementia? A Scoping Review of the Literature
Claudio Di Lorito, et al. Aging & Mental Health, June 2021.

The study: This review includes 20 articles, including published studies and documents from charities and lobbying organizations in the U.S., U.K. and Australia.

The findings: The review finds four common sets of experiences that may be unique for LGBT caregivers: A loss of shared LGBT identity resulting from the memory decline in the partner living with dementia, which can lead to loss of shared memories that are part of the caregiver’s LGBT identity; the negative impact of past experiences with discrimination in seeking help; caring for friends and non-family members as a result of lower access to family support; and the challenge of disclosing an LGBT identity to other support services and care staff who may hold conservative views.

From the study: “Meeting the needs of the growing population of LGBT caregivers is not only an economic issue, because of the costs of dementia care, but also a matter of social justice, as LGBT caregivers should have equal rights of access to care and services.”

Why we’re highlighting this study: Research on the experiences of LGBT caregivers is still limited. This review provides an international overview of barriers faced by caregivers, who face financial, physical and emotional demands in caring for someone with dementia.

Additional reading

The following studies also provide valuable context and information in understanding the health and mental health disparities that LGBTQ+ individuals experience. The list is sorted by date of publication.

“Courage to cobble something new”: Women’s queer and creative narratives of bisexuality and ageing
Rebecca Jones, Sarah Jen and Bea Reiter, Journal of Aging Studies, June 2023.

Key Determinants of Physical and Psychological Health-Related Quality of Life Over Time Among Midlife and Older LGBTQ and Sexual and Gender-Diverse Caregivers
Karen Fredriksen-Goldsen, et al. The Gerontologist, May 2023.

Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults: A Structural Competency Approach
Nik Lampe, et al. The International Journal of Aging and Human Development, April 2023.

Queer Aging: Older Lesbian, Gay, and Bisexual Adults’ Visions of Late Life
Lisa R. Miller. Innovation in Aging, March 2023.

End-of-Life Care for Transgender Older Adults
Lauren Catlett, et al. Global Qualitative Nursing Research, March 2023.

Mental health among sexual and gender minorities: A Finnish population-based study of anxiety and depression discrepancies between individuals of diverse sexual orientations and gender minorities and the majority population
Marianne Källström, et al. PLOS One. November 2022

Disparities in Mental Health and Well-Being between Heterosexual and Sexual Minority Older Adults during the COVID-19 Pandemic
Jen-Hao Chen. Journal of Aging and Health, April 2022.

Iridescent Life Course: LGBTQ Aging Research and Blueprint for the Future – A Systematic Review
Karen Fredriksen-Goldsen, Sarah Jen, Anna Muraco. Gerontology, March 2019.

Understanding the Well-Being of LGBTQI+ Populations
Charlotte Patterson, et al. National Academies of Sciences, Engineering, and Medicine, 2020.

A Systematic Review of the Discrimination Against Sexual and Gender Minority in Health Care Settings
Cemile Hurrem Balik Ayhan, et al. International Journal of Social Determinants of Health and Health Services, November 2019.

Chronic Health Conditions and Key Health Indicators Among Lesbian, Gay, and Bisexual Older US Adults, 2013–2014
Karen Fredriksen-Goldsen, Hyun-Jun Kim, Chengshi Shui, Amanda E. B. Bryan. American Journal of Public Health, August 2017.

The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults
Karen Fredriksen-Goldsen, et al. The Gerontologist, February 2017.

The Unfolding of LGBT Lives: Key Events Associated With Health and Well-being in Later Life
Karen Fredriksen-Goldsen, et al. The Gerontologist, January 2017.

Social Network Types and Mental Health Among LGBT Older Adults
Hyun-Jun Kim, Karen Fredriksen-Goldsen, Amanda Bryan, Anna Muraco. The Gerontologist, January 2017.

Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services
Karen Fredriksen-Goldsen, et al. Journal of Gerontological Social Work, May 2014.

The Aging and Health Report
Karen Fredriksen-Goldsen, et al. National Resource Center on LGBTQ+ Aging, November 2011.

Resources

SAGE, advocacy and services for LGBTQ+ Elders.

National Resource Center on LGBTQ+ Aging, a program of SAGE.

List of long-term care providers that are welcoming to LGBTQ elderly, by SAGE.

The Williams Institute at UCLA School of Law.

Adult LGBT Population in the U.S., estimates by the Williams Institute.

The Movement Advancement Project.

The Journalist’s Resource is part of the Mental Health Parity Collaborative, a group of newsrooms covering stories on mental health care access and inequities in the U.S. Collaborators on this project include The Carter Center, The Center for Public Integrity (CPI), and newsrooms in select states across the country.

This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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