LGBT Aging Research Articles

It matters who does the (unpaid) work: Gender and the provision of informal caregiving by lesbian, gay, bisexual, and transgender (LGBT) aging adults

This study examines the provision and expectation of informal caregiving by the lesbian, gay, bisexual, and transgender (LGBT) aging adult population. Using data from a 2017 nationwide AARP survey of LGBT aging adults (45+), we examine the effect of gender identity on the likelihood that LGBT older adults have been or anticipate becoming informal caregivers. Our findings reveal that LGBT older adults who are cisgender women, compared to those who are cisgender men, are more likely to have been or expect to be a caregiver for an adult loved one. We conclude that the heteronormative gender expectations and norms associated with caregiving in broader U.S. society could increase the possibility of adverse outcomes for LGBT older adults who are cisgender women, compared to LGBT older adults who are cisgender men.

The Stress of Expectation: The Significance of Gender on Concerns About Long‐Term Care Among Lesbian, Gay, Bisexual, and Transgender Older Adults

Given a history of discrimination in healthcare, lesbian, gay, bisexual, and transgender (LGBT) older adults may expect they could be subject to discrimination when seeking long‐term care (LTC). The expectation of mistreatment in LTC, which can contribute to minority stress, might vary, however, according to gender identity. In the current study, we use a nationwide survey to examine the impact of gender identity on the likelihood that LGBT older adults in the United States are concerned about the potential for (1) neglect, (2) abuse, (3) harassment, (4) denial of services, and/or (5) identity disclosure issues in LTC, should they or their spouse/partner need LTC in the future. We found significant differences in the likelihood of concern for cisgender females and gender‐expansive respondents, compared with cisgender males. More pointedly, we found that LGBT older adults who were gender‐expansive had a significant likelihood of concern across four of the five models, likely reflecting a history of discrimination in a cisnormative society. Our findings highlight the need for policies and practices that specifically aim to ameliorate the concerns LGBT aging adults who are gender‐expansive might feel when anticipating they or their spouse/partner might need LTC.

EFFECTS OF DISCRIMINATION/VICTIMIZATION ON HEALTHCARE UTILIZATION VIA HEALTHCARE BARRIERS

Abstract Aging lesbian, gay, bisexual, and transgender (LGBT) adults are a health disparate population with unique healthcare challenges. Using data from the Aging with Pride: National Health, Aging, Sexuality/Gender Study (NHAS; N = 2,560), we examined contextual factors that influence the healthcare utilization of LGBT middle-aged and older adults. Causal indirect, direct, and total causal effects based on counterfactuals were computed to assess mediational links between discrimination/victimization and healthcare utilization via healthcare barriers. Discrimination/victimization had an indirect effect on health screenings via fear accessing health services both inside and outside of the LGBT community, financial barriers to care or medication, and being uninsured. Discrimination/victimization also had an effect on routine checkups and having a regular provider, via fear seeking health services outside of the LGBT community, financial barriers and being uninsured. Findings can be utilized in LGBT cultural competency trainings for health and human service providers serving aging LGBT people.

The Role of Contextual Factors in the Health Care Utilization of Aging LGBT Adults.

Research suggests lesbian, gay, bisexual, and transgender (LGBT) populations have unique health care challenges. The purpose of this study was to understand contextual factors, including minority stress and social resources, associated with the health care utilization of LGBT middle-aged and older adults. Using data from the Caring and Aging With Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression investigated associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and health care utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources (i.e., social network size, social support, and LGBT community belonging) in these associations. Internalized stigma was negatively associated with having a routine checkup in the previous year. LGBT identity disclosure was positively associated with having a health screening within the past 3years. Social support moderated the association between LGBT identity disclosure and health screenings. Health and human service professionals and their clients should be educated about the ways that LGBT identity disclosure can affect health care utilization. Providers should consistently assess the social support of their aging LGBT clients and inform them about the potential risk of low social support in health care utilization.

Health policies for the LGBT population, cultural competence, and the organization for access to services:

This is a literature review that aimed to analyze the scope of public health policies for the LGBT population in different countries on the European continent, North America and Oceania in order to identify the differences and similarities in content and organization of services and programs. 24 articles were selected to compose the corpus of this review. The results demonstrated the existence of different scopes of health policies for LGBT in the USA, Canada, Australia and the United Kingdom and a heterogeneous result with regard to the objective of the implementation of actions, with emphasis on directions related to LGBT aging, smoking cessation, control of alcohol and other drugs use, as well as cancer and HIV care policies. There was a predominance of approaches limited to the diseases (or unsafe sexual practices, instead focus to comprehensive health care to the LGBT population at different levels of complexity in health care. Furthermore, cultural differences imply granting comprehensive or restrictive health rights. It's necessary to improve the design of public health promotion policies for gender and sexual diversity that are more inclusive and concatenated with other determinants that permeate comprehensive health care.

Social Representations of LGBT Old Age and Sex Workers in Brazilian Adults

Background: The number of elderly people in the world is growing significantly, so there is an urgent need to ensure that this population can live a full life, especially taking into account the current COVID-19 pandemic scenario. Objective: To analyze the social representations of LGBT old age for male and female sex workers through the pandemic. Method: A qualitative, descriptive, and exploratory research conducted with 10 male and 10 female sex workers aged between 18 and 48. Sociodemographic questionnaires and semi-structured interviews were administered using Google Forms and then analyzed by descending hierarchical classification through the IRaMuTeQ software. Results: The analysis showed three classes: (1) «Social understanding of the topic LGBT old age,» (2) «Stigma of genders and sexual orientations,» and (3) «Physical transformations and their accompanying obstacles». Conclusions: The representations are associated with the difficulties that elderly people have with aging in society, as well as debating LGBT old age. There are also greater obstacles regarding aging of female sex workers. In this way, the study seeks to contribute to broaden the knowledge of the psychosocial aspects of LGBT aging and old age, especially those of sex workers.

Growing Old in the Bible Belt: Resources for Aging LGBT Adults Living in the South

ABSTRACT There has been an increase in the literature about LGBT older adults in recent years; however, there is a need for further sociological quantitative research examining the impact of geographic region on LGBT aging. Utilizing data from a nationwide survey, this study focuses on the availability of LGBT-specific resources for LGBT aging adults living in the South. We examine the effects of community type and sociodemographics on the availability of LGBT-specific resources as well as the type of resources available. Findings reveal that in the South, community type, having a partner, household income, and education affect the LGBT-specific resources available. Of particular interest, LGBT-affirming faith organizations are identified as the resource most frequently available for LGBT aging adults in this region often referred to as the Bible Belt. Overall, this study sheds light on the LGBT-specific resources that are available to provide social support and help meet the unique needs of LGBT adults aging in the South.

The Role of Minority Stress and Social Resources in the Healthcare Utilization of Aging LGBT Adults

Research suggests that minority stress can influence the healthcare utilization of aging LGBT adults, and that social resources can buffer the effect of stress on healthcare utilization. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression assessed the associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and healthcare utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources, including social network size, social support, and LGBT community belonging, in these associations. Internalized stigma was negatively associated with having a routine checkup in the previous year (OR = 0.82, p = .038). Disclosure was positively associated with having a health screening within the past 3 years (OR = 1.52, p = .000) and having a regular provider (OR = 1.33, p = .021). Further, we found that social support moderated the association between disclosure and health screenings (OR = 1.52, p < .001); thus, having higher levels of social support and disclosure in tandem increased the likelihood of getting a health screening in the last three years. Health and human service professionals should provide information about internalized stigma and LGBT identity disclosure to educate their clients about the ways in which these minority stressors can impact their healthcare experiences. Providers should assess the social support of their aging LGBT clients and inform them about the added benefit that social support can have in their healthcare experiences.

Aging LGBT Adults’ Access to Social Resources According to LGBT Identity and Sociodemographics

Research suggests that social resources positively influence the health and well-being of lesbian, gay, bisexual, and transgender (LGBT) aging adults, but their access to social resources may vary according to LGBT identity. Using data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (N=2,536), multivariate models tested how access to social resources varied by LGBT identity and whether the effect of LGBT identity showed additional variations by sociodemographic characteristics (i.e., age and education) among aging LGBT adults. Lesbian respondents had larger social networks than gay respondents, while gay respondents had smaller networks than transgender respondents. Lesbian respondents had more social support and community belonging than other identity groups. Bisexual male respondents and transgender respondents had less support than gay respondents and bisexual male respondents reported less community belonging than gay respondents. Education and age moderated the association between LGBT identity and social support. Findings highlight the importance of considering social support separately from social network size with the understanding that large social networks do not necessarily provide ample social support and this distinction was particularly relevant for transgender respondents who had larger social networks, but less social support than gay respondents. Results also suggest that feelings of LGBT community belonging vary among LGBT identity groups. Health and human service professionals should not only consider the sexual and gender identity of their aging LGBT clients, but also consider the clients’ additional sociodemographic characteristics when assessing their access to social resources.

The (minority) stress of hiding: the effects of LGBT identities and social support on aging adults’ concern about housing

The lesbian, gay, bisexual, and/or transgender (LGBT) aging adult population is increasing rapidly in the United States. The literature reveals three shortcomings regarding research into the experiences of LGBT aging adults: (1) their needs have been largely overlooked, (2) there are few large-scale quantitative studies of this population, and (3) LGBT older adults are often treated as a monolith despite the potential for significant variations between subgroups under the umbrella. The current study addresses these issues by utilizing data from a nationwide AARP 2018 survey to study a central concern of LGBT aging adults: housing. Specifically, drawing upon the conceptual framework of minority stress, we examine how the LGBT identity of older people affects how concerned they are about having to hide their identity in order to find suitable housing as they age. Findings reveal (1) significant variations in the degree of worry among segments of the aging LGBT population, and (2) ameliorating factors such as social support may decrease the degree to which they worry about hiding their identity to access housing. These results may have implications for policies and practices aimed at increasing the community resilience available to support LGBT adults as they age.

Queering generativity and futurity: LGBTQ2IA+ stories of resistance, resurgence, and resilience

A preoccupation with heteronormative metrics of success in aging leaves many studies of “LGBT aging” focused on the needs, failings, and vul­nerabilities of older LGBTQ2IA+ people (i.e. lesbian, gay, bisexual, trans, queer, two-spirit, intersex, asexual, and people of other nonnormative sexual and gender expressions). As a result, LGBTQ2IA+ olders are fre­quently depicted as isolated, re-closeted, or simply nonexistent. Heeding calls to intervene into such bleak and pathologizing portrayals of queer/ trans aging (e.g. Ramirez-Valles 2016; Sandberg &amp; Marshall 2017), this article explores diverse subjectivities, nonnormative aging experiences, and their potential intergenerational implications. It draws on stories of queerness, gender, aging, futurity, and social change from 13 LGBTQ2IA+ people ranging in age from 23 to 74, recorded in an intergenerational research-generation workshop held in Nogojiwanong (Peterborough, Canada) in 2018. This article argues that queer and trans stories are crucial to confronting the erasure of LGBTQ2IA+ aging, aiming to extend ongoing efforts within aging studies to queer concepts of successful aging, aging futures, generativity, and intergenerationality. Ultimately, this article aims to complicate constricted understandings of queer/trans aging, instead of depicting LGBTQ2IA+ people aging with connection, pride, learning, and purpose, as well as with struggle and vulnerability.

Learning Together About Racism

Learning Together About Racism

As we age: listening to the voice of LGBTQ older adults

ABSTRACT The LGBT+ community is gaining long-overdue public health attention within the rapidly expanding demographic of older adults. As a group, LGBT+ older adults represent a range of diverse biopsychosocial needs and life experiences that may differ markedly from the general population. This has translated into health disparities experienced by this group and the emergence of policies calling for improved services for this community. In response, this qualitative study engaged ten focus groups (a total of 48 participants) throughout one mid-Atlantic state to better understand the experiences and perceptions of LGBT+ older adults regarding their expectations and needs as they age. Themes included (1) an emphasis on the nuance of connection as an aging LGBT+ adult; (2) a rich discussion of experiences with and expectations for quality of services as this group ages; (3) the realities of planning for future living arrangements as a member of this population; and (4) a clearer understanding of the two sides of advocacy for this group, as a personal responsibility and a call for allyship. Based on insights shared by participants, implications are discussed for improved and more visible engagement of this community within our heath and humans service sectors. We also affirm the need for greater attention from researchers and policy makers in respect to the whole health needs of this group. As a society and as professionals, we need to respond to these needs in better support of equity in the aging process for LGBT+ older adults.

Evaluating the Impact of State Policy Interventions for LGBT Aging: Comparative Case Study of New York and California

The majority of aging network service providers are unprepared to deliver targeted services to lesbian, gay, bisexual, or transgender (LGBT) older adults. In 2017, California legislature mandated ongoing LGBT sensitivity training for congregate living providers. Services and Advocacy for GLBT Elders (SAGE) developed a specialized training, Creating Inclusive Communities, for congregate living staff to learn the unique needs of LGBT elders. This secondary data analysis compared pre-test knowledge and attitudes of training participants in two states, one mandating LGBT aging sensitivity training (California, N=328) and one without the mandate (New York, N=622). Preliminary results show that prior to receiving training, California participants demonstrate significantly less knowledge of LGBT aging issues compared to New York participants; t(948)=-3.808, p<.001. Attitudinal differences were also demonstrated. These results suggest that laws mandating LGBT sensitivity training may help reach providers with greater training needs. Policy and practice implications will be discussed. Part of a symposium sponsored by Rainbow Research Group Interest Group.

Clinical Care for the Aging LGBT Population

US Census estimates indicate that there are currently 1.75 to 4 million Americans who identify as lesbian, gay, bisexual, and transgender (LGBT), which will double by 2030. Life expectancy for the aging LGBT population is lower than that of the same age cohort due to health care disparities. Most nurse practitioners (NPs) and certified nurse midwives (CNMs) are not aware of needs of this population and clinical modifications required to improve access to care and health outcomes. This lack of information adds to the gap in health care services and deepens disparities. NPs and CNMs are in a unique position to improve care by addressing unique the health care needs of the aging LGBT population.

KNOWLEDGE OF LGBT CULTURAL SENSITIVITY AMONG AGING SERVICE PROVIDER NETWORKS

The population of lesbian, gay, bisexual, and transgender (LGBT) adults aged 50 or above is rapidly aging, posing distinct challenges to aging service providers who work to meet their complex health and social needs. In 2011, Services and Advocacy for GLBT Elders (SAGE), home of the National Resource Center on LGBT Aging (NRC), developed and implemented a suite of trainings designed to sensitize aging service providers to the needs and experiences of LGBT elders. This descriptive study examines baseline (pre-test) survey data from individuals trained between 2013 and 2018 (N=10,500). Training participants represent all states throughout the U.S. and vary widely in race/ethnicity, age, and job title. Preliminary results indicate that knowledge measured prior to trainings shows substantial variation across geographic regions, suggesting the need for more geographically targeted approaches to training delivery. Implications for practice, research, and policy with LGBT adults in later life will be discussed.

DETERMINANTS OF DEPRESSION AMONG AGING LGBT IN TEXAS

Introduction: Aging LGBT experience significant health disparities compared to their heterosexual counterparts. As a sexual minority, they have a high likelihood of acquiring physical and mental illnesses. Methods: This study investigated factors that are associated with reports of depression among LGBT. Data came from Project Gray Pride, a study of aging gay, lesbian, bisexual, and transgender men and women living in a metropolitan area in Texas (N=126). Linear regression analysis was used. Results: Results show a negative association between respondents who self-identified as cisgender female and depression compared to those who self-identified as transgender. However, social vigilance and reports of health symptoms positively correlate with depression. Additionally, the interaction term of gender and race showed that respondents who were non-Whites and female reported higher levels of depression relative to their counterparts who were White males or White transgender. Other factors such as HIV status, age, education were not statistically significant. Conclusion: This study shows that being socially vigilant increases depression among aging LGBT. Also, aging female LGBT who are non-White may have an increased burden of negative social experiences leading to high levels of depression. As the population of older LGBT is increasing, intervention efforts must take into account these important findings in order to devise sound policies and programs to improve mental health among LGBT.

MIGC 2019 SYMPOSIUM: STRENGTH IN CREATING DIVERSIFIED SPACES IN EDUCATION AND RESEARCH ON AGING

Populations of minority older adults will continue to increase at an accelerated pace in the coming decades. As such, it is increasingly important to disseminate minority aging education and research topics in spaces that will prepare gerontology scholars to address the needs of diverse elders. This symposium will highlight efforts to diversify academic spaces by scholars engaged in minority aging education and research. The first presentation describes a service-learning pedagogical approach to teaching minority aging topics to graduate students. It will discuss how a gerontological social work course seeks to offer real-world learning experiences through community partnership. The second presentation discusses an experiential learning pedagogical approach to teaching social determinants of health to graduate students at a historically Black university and highlights how to apply theoretical concepts to creating community needs assessments and health promotion programming for the local community. The third presentation discusses efforts to teach undergraduate students about older LGBT individuals, who represent a growing group of minority elders. This presentation advocates for the use of various strategies for integrating both research and pedagogical approaches to increase knowledge and awareness of LGBT aging topics. The last presentation focuses on the promotion and dissemination of scholarship produced at minority-serving institutions (MSI) through the creation of a new open-source journal. This presentation describes publication challenges for tenure-track MSI faculty and developed opportunities for inclusiveness of such scholarship. The symposium discussant will summarize these challenges, opportunities, and implications to promote minority-focused gerontological topics in academia.

THE ATTITUDE OF MEDICAL PRACTICES TOWARD LGBTQ OLDER ADULTS BEFORE AND AFTER INTERVENTION

Individuals who identify as lesbian, gay, bisexual, transgender or other non-heterosexual or binary gender identifiers (LGBTQ) face tremendous obstacles in search of quality healthcare. Older LGBTQ adults face these obstacles in the setting of more complex health problems with few social services and support. Negative treatment from healthcare professionals has proven to be one of the most pervasive barriers to care faced by older LGBTQ adults. Sensitization training with the film, Gen Silent, is one way knowledge gaps and biases of healthcare professionals has been addressed. By utilizing the survey previously validated by Porter et al., health professionals’ knowledge, perceptions, and attitudes toward LGBTQ older adults before and after viewing Gen Silent were assessed in Lehigh Valley Health Network (LVHN)-affiliated primary care practices. The principle outcome of this study was a statistically significant change in responses. Primary care practices were recruited for 45-minute sessions that included the showing of an educational, abbreviated version of Gen Silent to available staff. It was preceded by administration of a pretest survey and followed by a posttest survey and discussion. A paired t-test was conducted to determine significance of differences between pre- and posttest responses. Seventeen individuals (N=17) viewed the film and finished pre- and posttest surveys. Nearly all questions exhibited changes between pre- and posttests. Significantly, respondents indicated increased awareness of additional barriers to care faced by LGBTQ older adults compared to heterosexual peers. While limited, these results indicate that primary care professionals would benefit from training specific to the aging LGBT population.

Care and LGBT Aging in Canada: A Focus Group Study on the Educational Gaps among Care Workers

ABSTRACTObjectives: Educational interventions have the potential to equip healthcare providers to support diverse aging populations. The purpose of this research was to identify educational gaps hindering the provision of person-centered care to older adults who identify as LGBT.Methods: Three focus groups were conducted in urban centers in northern, southern, and eastern Ontario with healthcare professionals and frontline staff. Semi-structured focus group discussion guides were developed based on the literature identifying some of the knowledge gaps, attitudes, challenges, and barriers around providing care for older LGBT adults.Results: The focus group data revealed several key findings related to 1) lack of curricula within formal education; 2) the need to create safer physical and social environments; and 3) the need to build relationships with LGBT-focused groups/organizations.Conclusions: Care providers want to provide open space for sexual and gender diverse older adults but lack the knowledge to do so.Clinical Implications: There is an ongoing gap within formal education systems such that historically marginalized populations who are now aging may be systemically neglected within formal curricula.