LGBT Older Adults Research Articles

IMPROVING HEALTH CARE OF LGBT OLDER ADULTS: INTERDISCIPLINARY PROJECT ENHANCES HEALTH OUTCOMES

To date, there is a dearth of interdisciplinary simulation education and research that involves LGBT older adults within schools of social work and nursing. The purpose of this mixed method study was to examine the use of an intervention among social work and nursing students to determine if lecture and simulations impacted their health-related knowledge and cultural sensitivity/awareness of health provisions with LGBT older adults. Interprofessional faculty created lecture and interdisciplinary simulations with actual members of the older LGBT communities using simulation clinic/lab and health care scenarios. An adapted survey with permission from Grubb et al (2013) was used to include quantitative and qualitative measures of cultural awareness with LGBT populations. Pre-Post test data were analyzed using Generalized Linear Models in SAS software. Results indicated that the intervention positively changed perceptions and increased knowledge among (N=90; 32 social work; 58 nursing) allied health students. Statistically significant change experiences in their work with LGBT individuals were noted to positively alter their beliefs about sexuality, gender identity, and sexual development (Agree to Strongly Agree, X2(1)=26.51, p<0.001). Qualitative findings include four primary themes about how gender identity and sexual orientation influences health: (a) bias of health care providers, (b) access to quality care, (c) specific health care needs, and (d) health risks of LGBT older adults. As older adults continue to be the largest population needing health care, it is imperative that professionals are trained to give culturally sensitive health care and demonstrate this competency in their practice and interpersonal interactions with clients.

LGBT OLDER ADULTS IN RURAL SOUTHERN APPALACHIA: PERCEPTIONS OF CURRENT AND FUTURE FORMAL SERVICE NEEDS

Older sexual and gender minority adults in rural communities face challenges in accessing formal health, mental health, and long-term care services (Butler, 2017; Koch & Knutson, 2016; Stein et al., 2010). Formal service providers in rural Southern Appalachia are more likely to have conservative values that are closely linked to their religious beliefs (Keefe, 2005). Some may be opposed to gender non-conformity and same-sex relationships or marriage, making it wise for LGBT older adults in rural contexts to carefully select formal service providers and settings (Willging et al., 2006). Barriers to accessing formal services for LGBT older adults residing in rural contexts include few LGBT-inclusive service providers and facilities, transportation, cost, and health insurance (Butler, 2017). When faced with the prospect of long-term care, older LGBT adults are more likely to conceal their sexual or gender identity due to fears of being mistreated (Brotman et al., 2003). This session will present results of a qualitative study examining experiences, concerns, and recommendations regarding formal services among 11 LGBT older adults residing in rural southern Appalachia. Several of the participants described experiencing discrimination from local service providers. A number of participants were fearful about the perceived lack of LGBT-inclusive services in the area and expressed that they would consider leaving the area if their own or their partner’s health declined. Many participants expressed the need for local provider education about the needs of LGBT older adults. The presenters will discuss the implications for research and for health, social, and long-term care services.

SOCIAL ISOLATION AMONG LGBT OLDER ADULTS: LESSONS LEARNED FROM A PILOT FRIENDLY-CALLER PROGRAM

Lesbian, gay, bisexual, and transgender (LGBT) older adults face heightened risks of social isolation, given decades of discrimination. Research on telephone buddy programs with non-LGBT participants have proved predominantly unsuccessful at addressing social isolation and have found the greatest success with same-age matches. However, evidence suggests that LGBT adults may actually benefit from telephone buddy programs and in ways uniquely different from other groups. This article shares lessons learned from 30 participants across a 12-month pilot program that matched LGBT older adults to both LGBT and non-LGBT volunteer callers of various ages. One-third of participants identified as African American or Black. This project employed community-based participatory action research to identify, execute, and evaluate the program. Data includes information from questionnaires and telephone interviews prior to and during the program. In contrast to other research, data here revealed strong support for intergenerational matches. LGBT older adults of color especially benefited from program referrals and matches with/from LGBT adults of color, regardless of age. While the project aimed to capture two groups (LGBT older adults experiencing isolation and volunteer callers), the project revealed a third group: LGBT adults at risk of social isolation. This third group usually emerged among the “volunteer” callers but also identified concerns and risk factors for social isolation. The program also revealed unexpected benefits to both LGBT and non-LGBT volunteers, including less loneliness and a stronger sense of community. This article concludes with recommendations for developing similar programs to reduce social isolation in the LGBT community.

MODIFIABLE DETERMINANTS OF PHYSICAL FUNCTIONING AMONG LGBT OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Heightened risks of cognitive impairment are a critical health concern for lesbian, gay, bisexual, and transgender (LGBT) older adults. The physical and functional declines associated with cognitive impairment are known to increase risks of injury and decrease independent mobility. Guided by the Health Equity Promotion Model, this study analyzed longitudinal data (T0 to T2, N=646) to examine risk and protective factors predicting changes in physical functioning over time among LGBT older adults with cognitive impairment. According to the results of multilevel mixed models, social support, physical, recreational, and wellness activities, and nutrition were associated with improvement in physical functioning over two years; while stigma contributed to decline in physical functioning. LGBT older adults with cognitive impairment face unique challenges due to social stigma and isolation. The findings suggest that enhancing their access to community resources and their participations in physical, social, community, and recreational activities would improve their physical functioning.

PALLIATIVE AND END-OF-LIFE CARE TO THE LGBT COMMUNITY

The lesbian, gay, bisexual, and transgender (LGBT) community experiences discrimination and stigma in accessing health care and social services – including palliative, hospice, and long-term care – across cultures and countries. Health care providers may fail to recognize, acknowledge or address disparities in care. Providers and institutions may be uncomfortable with gender and sexuality issues, and often fail to inquire about sexual orientation and gender identity. It is estimated that there are approximately 2.7 million LGBT adults in the U.S. age 50 and older and approximately 1.1 million age 65 and older. In the UK, an estimated 5-7% of the population identify as LGBT; there are between 600,000 and 840,000 LGBT adults aged 65+. With the projected increased number of older adults and improved treatments that extend the life of seriously ill individuals, even greater numbers of LGBT older adults, and their families, will require palliative and end-of-life in the coming years. Researchers in the US and UK have found that LGBT older adults living in the community and in long-term care facilities experience inadequate, disrespectful, and abusive care due to their sexual orientation and gender identity status. They fear being open about their identities, not receiving equal or safe treatment, and having their family of choice and designated surrogates disrespected or ignored by health care staff. This symposium will describe the experiences of LGBT individuals and their family members, and compare commonalities and differences faced by LGBT communities in the US and UK in accessing palliative and end-of-life care.

LGBT WIDOWHOOD: THE ASSOCIATION BETWEEN PARTNER LOSS AND PSYCHOLOGICAL WELL-BEING

Death of a partner – one of the most stressful events many people will ever experience – has profound effects on psychological well-being. However, research on widowhood focuses almost exclusively on heterosexual couples, with little known about these studies’ applicability to the LGBT population. Further, the few studies of partner loss among LGBT individuals are qualitative and many focus on gay men. As a result, little is known about the effects of partner loss in this population as a whole or among other sexual minorities, including lesbians, bisexuals, and transgender individuals. Addressing this issue, our study examines the association between partner loss and psychological well-being using data from the 2010 Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) (n=2,322), the largest nationally representative sample of LGBT middle-aged and older adults. We use OLS regression to examine the association between partner loss and psychological well-being, measured as depressive symptoms, loneliness, and subjective mental health. Results reveal a significant association between partner loss and psychological well-being across all three measures. However, the association is significantly weaker in models controlling for current partner status. In models predicting depressive symptoms and loneliness, partner loss no longer reaches significance, though it remains significant in the model predicting subjective mental health. Results suggest that current partner status more strongly impacts psychological well-being than does partner loss, though further research is needed to identify how, for whom, and under what circumstances the negative effects of partner loss may linger.

TRANSGENDERED OLDER ADULTS IN LONG-TERM CARE: PREPARING FOR THE RISING TIDE

Gender non-conforming older adults are more likely to be without traditional support systems in place; many may need to turn to nursing homes for long-term care (LTC). Little information is available about the experiences of LGBT older adults in these settings. Research questions: What is known about the experiences of transgender (TG) older adults in LTC? What evidence-based recommendations exist to guide LTC administrators in providing quality care to TG residents? What are key future research areas? Method: Systematic review of extant literature, using databases: PubMed, Medline, Psych Info, CINAHL, Academic Search Complete, and ProQuestCentral. Key Results:RQ1) Published research in transgender healthcare consists primarily of case reports, and retrospective and cross-sectional studies; minimal literature specifically on TG individuals; combining LGBT carries risk of minimizing or equating the TG experience to that of gays and lesbians. RQ2) Recommendations: take proactive approach; focus on awareness of relevant laws and regulations; establish non-discriminatory and inclusive environments, policies, and procedures; regular staff training, monitoring, and evaluation. RQ3) Need exists for quantitative and qualitative research into all aspects of the TG experience in LTC. Key areas include: lived experience of the TG in LTC; beliefs, attitudes, values and practices of LTC staff; administrative challenges and responses. Conclusions: Transgender and gender non-conforming individuals frequently experience discrimination in healthcare. Lack of cultural and clinical competence, and discrimination and bias by providers, create barriers to quality healthcare. Healthcare professionals and systems must be proactive in preparing for the inevitable growth of this population in the LTC setting.

DETERMINANTS OF PHYSICAL AND MENTAL HEALTH AMONG LGBT OLDER ADULT CAREGIVERS

Caregivers experience chronic stress that can negatively affect their health, resulting in lower quality of life. This study aims to understand the physical and mental health of caregivers by examining modifiable risk and protective factors. Life experiences of LGBT older adults are considered. In the longitudinal study, Aging with Pride: National Health Aging, Sexuality and Gender Study, approximately one third (31%, n=754) of LGBT older adults (50+ years) provide care: 38% to partner/spouse, 29% friends, 20% other relatives, and 8% ex-partner/ex-spouse. Linear regression models examined the effects of risk and protective factors at T0 on health outcomes at T2. Mastery, physical activity, and nutrition predicted better physical functioning, lower mental distress, and higher health-related quality of life (HRQOL). Social participation and support, community engagement, and lower identity stigma predicted better mental health. Microaggression predicted lower physical HRQOL. Interventions enhancing protective factors may promote physical and mental health of LGBT caregivers.

THE JOURNAL OF GERONTOLOGY: SOCIAL SCIENCES: GLOBAL SCHOLARSHIP CHALLENGES AND OPPORTUNITIES

Journal of Gerontology: Social Sciences aims to publish the highest quality social scientific research on aging and the life course in the U.S. and worldwide. The disciplinary scope is broad, encompassing scholarship from demography, economics, psychology, public health, and sociology. A key substantive focus is identifying the social, economic, and cultural contexts that shape aging experiences worldwide. In the coming decade, social gerontology research is poised to present many opportunities for cross-national and cross-cultural scholarship – driven in part by the proliferation of large parallel data sets from many nations in Europe, Latin America, and Asia. I will discuss the role that peer-reviewed cross-national scholarship can play in disseminating knowledge that informs gerontological research, policy, and practice internationally. I will also identify under-researched areas that will be of great interest to scholars in the coming decade, including LGBT older adults, aging in the Global South, reconfigured families, and centenarians.

ESPO/HEALTH SCIENCES: STRENGTH IN NUMBERS: LEVERAGING THE POWER OF NETWORKS FOR RECRUITING OLDER ADULTS AND CAREGIVERS

Recruitment of older adults and/or their family caregivers for participation in research is challenging. This process is further complicated by population or procedure-specific factors that can impede recruitment efforts. The purpose of this symposium is to describe various recruitment challenges and solutions as well as strategies used to engage older adults and family caregivers in research. Dr. Glenna Brewster will present recruitment strategies used for a multisite telehealth intervention for caregivers of persons living with dementia. Dr. Todd Monroe will examine barriers and solutions for recruitment and retention of persons with Alzheimer’s disease for neuroimaging studies. Dr. Karen Moss will share strategies used to recruit family caregivers of African American older adults with dementia for end-of-life research. Dr. Shiva Prasad will share strategies to recruit LGBT older adults to a study on exploring the idea of an LGBT online senior center, and Dr. Karen Rose will describe stigma associated with recruiting persons with Alzheimer’s disease and other dementias, and their family caregivers, including best practices from the literature coupled with lessons learned from experiences. Shared strategies and solutions will assist researchers in identifying and addressing recruitment challenges and help to ensure recruitment of diverse groups of older adults and/or family caregivers for studies that use various research methodologies, including leveraging the power of professional and community-based networks. Increasing research participation will yield the knowledge necessary for improving health outcomes for older adults and their family caregivers living with serious chronic illnesses such as Alzheimer’s disease and related dementias.

Lesbian, Gay, Bisexual, and Transgender Older Adults' Experiences With Elder Abuse and Neglect

Little is known about elder abuse and neglect in the lesbian, gay, bisexual, and transgender (LGBT) community; however, this population faces a greater risk of abuse and likely experiences abuse differently and needs different resources. We conducted focus groups to investigate LGBT older adults' perspectives on and experience with elder mistreatment. We conducted three focus groups with 26 participants recruited from senior centers dedicated to LGBT older adults. A semistructured questionnaire was developed, and focus groups were audio recorded, professionally transcribed, and analyzed using grounded theory. Key themes that emerged included: definitions and etiologies of abuse, intersectionality of discrimination from multiple minority identities, reluctance to report, and suggestions for improving outreach. Participants defined elder abuse in multiple ways, including abuse from systems and by law enforcement and medical providers. Commonly reported etiologies included: social isolation due to discrimination, internalization of stigma, intersection of discrimination from multiple minority identities, and an abuser's desire for power and control. Participants were somewhat hesitant to report to police; however, most felt strongly that they would not report abuse to their medical provider. Most reported that they would feel compelled to report if they knew someone was being abused; however, they did not know who to report to. Strategies participants suggested to improve outreach included: increasing awareness about available resources and researchers engaging with the LGBT community directly. LGBT older adults conceptualize elder abuse differently and have different experiences with police and medical providers. Improved outreach to this potentially vulnerable population is critical to ensuring their safety. J Am Geriatr Soc 67:2338-2345, 2019.

Challenges for the successful aging of LGBT older adults

Challenges for the successful aging of LGBT older adults

Narratives of Generativity and Resilience among LGBT Older Adults: Leaving Positive Legacies despite Social Stigma and Collective Trauma

ABSTRACT The aim of many adults in middle to old age is to be generative. Generativity is the concern older adults direct toward the wellbeing of future generations. Being generative results in positive well-being during later life and is especially important to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults who have experienced lifelong discrimination. In this study, we identified stigmatizing social influences that both negatively and positively acted to inform understandings of generativity and the ability to leave a legacy for future generations. Using a narrative analysis methodology, we identified three overarching redemptive narratives from study participants: (1) experiences during the HIV/AIDS pandemic, (2) absence of positive role models, and (3) religious conviction. These life story narratives inform how generative contributions can contribute toward a legacy of resilience, despite social stigma and collective trauma.

Policy Recommendations to Improve the Quality of Life for LGBT Older Adults

This article explores the increased vulnerability of older lesbian, gay, bisexual, and transgender (LGBT) adults and their needs. Older LGBT adults lack legal protection, which leads to higher rates of discrimination in the work environment, living arrangements, and services. The impact of discrimination against older LGBT adults results in an elevated rate of physical and psychological consequences when compared to the general older population. A brief overview of legal precedence pertaining to the LGBT community is provided, and the needs of older LGBT adults are identified. Social work practice and policy recommendations are highlighted to address identified needs and improve the quality of life for older LGBT adults. A human rights framework is applied to inform all practice and policy recommendations to ensure basic human rights are met, as outlined in the Universal Declaration of Human Rights. The role of the social worker in addressing the needs of older LGBT adults is discussed, as well.

The Role of Information and Communication Technology in End-of-Life Planning Among a Sample of Canadian LGBT Older Adults.

To better understand the role of technology in later-life planning among older lesbian, gay, bisexual, and trans (LGBT) adults, we conducted focus groups to explore factors linked to diverse sexual orientations and gender identities. Twenty focus groups were facilitated across Canada with 93 participants aged 55 to 89. Constant comparative analysis yielded four categories: (a) fear, (b) individual benefits, (d) social elements, and (d) contextual elements. Fear related to technology and fear of end-of-life planning. Individual benefits referred to technology as a platform for developing LGBT identities and as a source of information for later-life planning. Social elements were establishment and maintenance of personal relationships and social support networks. Contextual elements referred to physical and situational barriers to technology use that limited access and usability. These findings can inform technological practice and services to enhance later-life planning.

The Role of Immigration in the Health of Lesbian, Gay, Bisexual, and Transgender Older Adults in the United States.

Lesbian, gay, bisexual, and transgender (LGBT) aging research is growing around the globe. Yet, few studies have examined the interconnectedness of different populations and cultures. This study examines whether LGBT foreign-born older adults experience greater health disparities than their U.S.-born counterparts. We conducted a cross-sectional analysis of the National Health, Aging, and Sexuality/Gender Study: Aging with Pride from 2014, which assessed measures of health and well-being among LGBT adults aged 50 years and older ( n = 2,441). We compared sociodemographic characteristics, health-care access, health behaviors, and health outcomes between foreign-born and U.S.-born participants. Foreign-born LGBT older adults reported greater socioeconomic disadvantage and higher levels of experiencing barriers to health-care access than U.S.-born LGBT older adults. Groups did not significantly differ in health behaviors and health outcomes when controlling for sociodemographic factors. Greater understanding of the mechanisms that shape the relationship between migration and health among the LGBT population is warranted.

LGBT Older Adults at a Crossroads in Mainland China: The Intersections of Stigma, Cultural Values, and Structural Changes Within a Shifting Context.

In this article, we explore the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults in mainland China, with an emphasis on the shifting nature of the cultural context. Based on a culturally informed perspective, the intersection of LGBT stigma with cultural values (familial responsibility, filial piety, and loss of face) and larger structural changes (the aftermath of the one-child policy, economic reforms and globalization, LGBT human rights, and HIV policies) are creating dramatic shifts in Chinese society and impacting the lives of LGBT older adults. The increasing prevalence of HIV among gay and bisexual older men, although rarely acknowledged, is also contributing to challenges facing LGBT older adults and their families. These changes render LGBT older adults and those living with HIV and their caregivers at risk of economic insecurity. Resilience and resistance of LGBT older adults in China must be considered in both practice and policy to strengthen LGBT human rights globally.

Engaging the New Generation of Health Providers in Serving Older LGBT Adults: Conferences as Tools.

Engaging the New Generation of Health Providers in Serving Older LGBT Adults: Conferences as Tools.

END-OF-LIFE PERCEPTIONS AND PREPARATIONS OF LGBT OLDER ADULTS

There is an estimated 2.7 million individual 50 years old and older who identify as lesbian, gay, bisexual, and transgender (LGBT). Of the 2.7 million, 1.1 million are 65 years and older. Undergoing a lifetime of discrimination and stigma, many older LGBT adults are hesitant to approach social support in end-of-life planning. While there have been several studies on end-of-life care for the general population, there is a dearth of knowledge regarding end-of-life preparation and perceptions of LGBT older adults (Murphy, 2014, p. S10). This qualitative, grounded theory method study strove to identify the perceptions of LGBT older adults regarding their ideal end-of-life experience as well as investigate this population’s preparations for their ideal experience. Participants were recruited for the study via snowball sampling with the assistance of community partners. In total, 17 semi-structured interviews were conducted, transcribed, coded, and analyzed. Themes emerged from the subsequent analysis. Participants responded with their need for “respect of their family of choice” and being able to present their “true selves.” In addition there were strict boundaries set regarding not wanting to be a burden nor wanting to rely on long-term-care communities due to fear. Four components emerged as necessities to achieve one’s goals: understanding past experiences with end-of-life, ensuring practical considerations are taking into account, spiritual beliefs as a coping mechanism, while recognizing the uncertainty of life. This study provides better understanding of the unique wishes and experiences of LGBT older adults as they prepare for end-of-life.

EFFECTS OF STIGMA AND DISCRIMINATION ON THE HEALTH AND HEALTHCARE OF LGBT OLDER ADULTS

Throughout their lifetime, older adults in the US have seen dramatic changes in the psychological, social and legal/political aspects of LGBT identity. However, stigma and discrimination against LGBT people remains prevalent. Understanding this history, and evolution in attitudes and laws, is necessary for today’s healthcare providers to deliver culturally-competent care to LGBT older adults. Although societal attitudes about LGBT people are shifting towards tolerance and acceptance, the effects of earlier discrimination can be long-lasting on the individual. This presentation provides an historical overview of stigma and discrimination against the LGBT community in the United States from the latter half of the 20th century to the present. It reviews the literature on the ways discrimination and stigma impact the health and healthcare of LGBT older adults. The presentation includes suggestions and tips on delivering culturally-competent care to LGBT older adults, and resilience factors will be highlighted.