Older Gay Research Articles

Well Being of Older Gay and Bisexual Men and Women in England: Results of a Cross-Sectional Population Based Study

Abstract Background Lesbian, gay, and bisexual (LGB) older people are an under-represented population in research, with limited research noting more depression, loneliness, rejection, overall poorer health and well-being outcomes. Our study compared well-being, defined as quality of life (QOL), life satisfaction, sexual satisfaction, and depression, among LGB people with their heterosexual peers’. Methods Cross-sectional data from the English Longitudinal Study of Aging, collected 2012-2013. A total of 5691 participants were included in the analysis, with 326 (5.7%) self-identifying as LGB. We used CASP-19 questionnaire for well-being; the Satisfaction with Life Scale for life satisfaction; and the Center for Epidemiologic Studies Depression Scale for depressive symptoms. The question “During the past three months, how satisfied have you been with your overall sex life?” was used for sexual satisfaction. T-test and chi-square tests were used for differences in sociodemographic characteristics between LGB and heterosexual participants. Regression models were used to test associations between sexual orientation and well-being outcomes. Results LGB participants reported significantly lower mean quality of life and life satisfaction, and had significantly lower odds of reporting satisfaction with their overall sex life and higher odds of reporting depressive symptoms in unadjusted models. After adjustment for sociodemographic and health-related covariates, there remained significant differences between groups in mean QOL scores (B= -0.96, 95% [CI] -1.87 to -0.06) and odds of sexual satisfaction (OR = 0.56, 95% CI 0.38-0.82). Conclusions LGB older people report lower quality of life and lower sexual satisfaction than their heterosexual counterparts, possibly associated with experiencing lifelong social discrimination. Main message: Older lesbian, gay and bisexual people in England report significantly lower QOL and sexual satisfaction in comparison to heterosexual counterparts.

Recent versus lifetime experiences of discrimination and the mental and physical health of older lesbian women and gay men

AbstractThis study examines the potential health-related impact of recent versus lifetime experiences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their mental and physical health, including psychological distress, positive mental health and self-rated health. Among both lesbian women and gay men, recent discrimination uniquely predicted lower positive mental health after adjusting for experiences of discrimination across the lifetime and socio-demographic variables. In addition, recent discrimination uniquely predicted higher psychological distress among gay men. Experiences of discrimination over the lifetime further predicted higher psychological distress and poorer self-rated health among gay men after adjusting for recent experiences of discrimination and socio-demographic variables. However, there were no associations between lifetime discrimination and any of the outcome variables among lesbian women. Overall, recent and lifetime experiences of sexual orientation discrimination were related to mental and physical health in different ways, especially among the men. These findings have potential implications for policy/practice, and suggest that distinguishing between recent and lifetime experiences of discrimination may be useful when assessing potential health-related impacts of sexual orientation discrimination among older lesbian women and gay men, while also taking account of differences between these two groups.

Adding grey to the rainbow: a narrative analysis of generational identity through stories and counter-stories of older gay men

AbstractWe explored identity formation among nine gay men who were born between 1946 and 1964. This group of nine was the largest homogeneous sub-group within a larger sample (N = 18). Although participants share similar demographic characteristics, their individual social, personal and narrative identities diverge to represent distinctive embodied selves. Guided by queer and feminist theories, the qualitative analysis identified dominant and counter-narratives that demonstrate the complexity of sexual identity as it evolves over time. All nine men recall being aware of their gay identity as children; however, like many socially constructed labels, their outward identity was more complex and difficult to understand. The findings demonstrate how participants negotiated their sexual identities through decades of social change. As illustrated within each subset of identity (i.e.social, personal and narrative), some participants found themselves breaking ground for a broader gay rights social movement, while others described their experience of being relegated to silence and invisibility for most of their lives. This research contributes to an ongoing discussion concerning the individuality found among lesbian, gay, bisexual and transgender (LGBT) individuals in later life. As the LGBT population becomes more visible, there will be a growing need to understand the individualism that exists within this coalition and affirm their diversifying sexual and gender identities.

Staff perceptions of barriers that lesbian, gay and bisexual residents face in long-term care settings

This study explores the difficulties that older lesbian, gay and bisexual residents may encounter when attempting to express their sexuality while living in long-term care facilities (LTCF), as perceived by staff. The sample was made up of 1714 staff members working in 152 Spanish long-term care institutions for older people. Answers to an open-ended question regarding barriers that older lesbian, gay and bisexual people living in residential institutions may face when attempting to express their sexuality were content-analysed. The results suggest that the barriers are almost exclusively caused by other people’s views on non-heterosexual issues, including both heterosexist assumptions (e.g. the lack of awareness of sexual diversity in LTC settings, something that is particularly frequent among care assistants) and homophobic attitudes and behaviours generally attributed by technical staff and managers to heterosexual residents. Practical and policy implications, which should take into account job role as a key factor, are discussed.

Economic barriers, evidentiary gaps, and ethical conundrums: a qualitative study of physicians\u2019 challenges recommending HPV vaccination to older gay, bisexual, and other men who have sex with men

BackgroundThe human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide. Gay, bisexual, and other men who have sex with men (GBM), and GBM living with HIV in particular, are disproportionately impacted by HPV-associated cancers. The HPV vaccine, given early enough in life, may markedly reduce the likelihood of such cancers. In Canada, most provincial insurance programs only cover HPV vaccination for GBM up to the age of 26. Our objective was to understand physicians’ everyday experiences and challenges in recommending HPV vaccination to older GBM patients.MethodsAs part of the HPV Screening and Vaccine Evaluation (HPV-SAVE) Study, we conducted semi-structured interviews with 25 HIV-positive GBM patients who had received anal cancer screening and 15 service providers, including 13 physicians, who had arranged for anal cancer screening in the Canadian provinces of Ontario and British Columbia. In this analysis, we draw upon the 13 physician interviews, which were coded following Grounded Theory.ResultsPhysicians strongly supported the HPV vaccine for all GBM and considered it to be important for the management of HIV-related care. However, the overall support for HPV vaccination among physicians did not translate into consistent recommendation practices. There were two overarching factors that limited the strength/frequency of physicians’ vaccine recommendation practices. First, cost/insurance coverage for some older patients impacted if and how the HPV vaccine was discussed. Second, physicians had diverse perspectives on both the prevention and therapeutic benefits of vaccinating older GBM and the reality that national guidelines are incongruent with publicly funded vaccine programs for vaccinating patients over 26 years old. These two interrelated factors have co-produced an apparent economic-evidentiary conundrum for many physicians regarding how and for whom to offer HPV vaccination.ConclusionEconomic barriers coupled with evidentiary and guideline gaps have created clinical practice challenges for physicians and has resulted in different messages being communicated to some older GBM patients about how important HPV vaccination is for their health.

Inequalities in older LGBT people's health and care needs in the United Kingdom: a systematic scoping review

The hostile environment that older lesbian, gay, bisexual and transgender (LGBT) people faced at younger ages in the United Kingdom (UK) may have a lasting negative impact on their health. This systematic scoping review adds to the current knowledge base through comprehensively synthesising evidence on what is known about the extent and nature of health and care inequalities, as well as highlighting gaps in the evidence which point the way towards future research priorities. We searched four databases, undertook manual searching, and included studies which presented empirical findings on LGBT people aged 50+ in the UK and their physical and mental health or social care status. From a total of 5,738 records, 48 papers from 42 studies were eligible and included for data extraction. The synthesis finds that inequities exist across physical and mental health, as well as in social care, exposure to violence and loneliness. Social care environments appeared as a focal point for inequities and formal care environments severely compromised the identity and relationships that older LGBT people developed over their lifecourse. Conversely, the literature demonstrated how some older LGBT people successfully negotiated age-related transitions, e.g. emphasising the important role of LGBT-focused social groups in offsetting social isolation and loneliness. While there exist clear policy implications around the requirement for formal care environments to change to accommodate an increasingly diverse older population, there is also a need to explore how to support older LGBT people to maintain their independence for longer, reducing the need for formal care.

Psychological Distress in Older Portuguese Gay and Bisexual Men: The Mediating Role of LGBT Community Connectedness

Objectives: Examining Psychological Distress (PD) among older Portuguese gay and bisexual men (GBM), and the mediator role of LGBT community connectedness (LGBTCC) of minority stress variables on PD. Methods: We performed a mediation analysis with LGBTCC as mediator between minority stress variables and PD with a sample of 110 elderly GBM. Results: We found moderate PD levels; LGBTCC was a significant mediator between concealment of sexual orientation and PD, but not between internalized stigma and expectations of rejection and PD. Conclusions: More attention is needed to Older Portuguese GBM’s mental health. LGBTCC is an important ameliorating factor for older GBM.

All the lonely people, where do they all belong? An interpretive synthesis of loneliness and social support in older lesbian, gay and bisexual communities

Purpose Loneliness is a phenomenon which affects people globally and constitutes a key social issue of our time. Yet few studies have considered the nature of loneliness and social support for older lesbian, gay and bisexual (LGB) people; this is of particular concern as they are among the social groups said to be at greater risk. The paper aims to discuss this issue. Design/methodology/approach Peer-reviewed literature was identified through a search of Scopus, PsycINFO and PubMed. A total of 2,277 papers were retrieved including qualitative and quantitative studies which were quality assessed using the Critical Appraisal Skills Programme. Findings In total, 11 papers were included in the review and findings were synthesised using thematic analysis. The studies were conducted in five countries worldwide with a combined sample size of 53,332 participants, of whom 4,288 were drawn from among LGB communities. The characteristics and circumstances associated with loneliness including living arrangements, housing tenure, minority stress and geographical proximity. Research limitations/implications The review suggests that among older LGB people, living alone, not being partnered and being childfree may increase the risk of loneliness. This cohort of older people may experience greater difficulties in building relationships of trust and openness. They may also have relied on sources of identity-based social support that are in steep decline. Future research should include implementation studies to evaluate effective strategies in reducing loneliness among older LGB people. Practical implications Reaching older LGB people who are vulnerable due to physical mobility or rural isolation and loneliness because of bereavement or being a carer is a concern. A range of interventions including individual (befriending), group-based (for social contact) in addition to potential benefits from the Internet of Things should be evaluated. Discussions with the VCS suggest that take up of existing provision is 85:15 GB men vs LB women. Social implications Formal social support structures which were provided by voluntary sector agencies have been disproportionately affected by recent austerity measures. Originality/value The authors sought to interrogate the tension between findings of lower levels of social support and discourses of resilient care offered by families of choice.

The impact of age on gay consumers’ reaction to the physical and social servicescape in gay bars

PurposeThe purpose of this study is to examine the effects of physical servicescape, social servicescape and age on gay consumers’ evaluations of a LGBT advertisement of a gay bar of a gay bar.Design/methodology/approachA 2 × 2 × 2 experimental design was used to test the effects with a sample of gay males in the USA. Data were analyzed using ANCOVA and bootstrapping mediation.FindingsResults of this study indicate a statistically significant three-way interaction effect of the two independent variables and age on the gay bar’s perceived LGBT (lesbian/gay/bisexual/transgender)-friendliness. Perceived friendliness mediated the effects of the independent variables on behavioral intentions. Furthermore, the mediation effect was moderated by the age cohort.Research limitations/implicationsThe findings indicate a changing perception of gay servicescape between the older and younger gay men. Implications for hospitality managers are provided.Originality/valueThis research contributes to the servicescape literature by expanding the realm of research to gay servicescape and gay consumers, an emergent and more visible hospitality segment.

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.

Be a Responsible and Respectable Man: Two Generations of Chinese Gay Men Accomplishing Masculinity in Hong Kong

This article seeks a dialogue between masculinity studies and generational sexuality studies by comparing two generations of gay men in Hong Kong through in-depth interviews with 15 older gay men born before the 1950s and 25 young gay men born after 1990 using a life course approach. The article highlights the sociohistorical and political changes shaping male identity, practice, and culture in colonial and postcolonial Hong Kong, and identifies responsibility and respectability as two key dimensions in the construction of Chinese masculinity. It argues that the two generations under study accomplish gay masculinities against changing Chinese masculine ideals and hetero/homonormativities sensitive to different social relations and institutions, as well as engage in constant negotiation with the dominant heteronormative life course and need to manage stigma. Drawing on the narratives of the participants from the two generations, the article examines continuity and change in the idealized and practiced forms of masculinity embedded in different institutions, thereby providing a nuanced understanding of the transformations of Chinese generational masculinities under broad social–historical changes.

“I don’t want to be seen as a screaming queen”: An interpretative phenomenological analysis of gay men’s masculine identities.

It has been argued that gay men who live in Western societies must negotiate masculine identities against a cultural backdrop where the most desirable and locally hegemonic masculinity is heterosexual. However, contemporary masculinity theories conceptualize masculinities as increasingly inclusive of gay men. The purpose of this study was to use a discourse-dynamic approach to studying masculine subjectivity to identify how gay men in England and Wales negotiated masculinity discourses to construct their masculine identities. One-to-one, semi-structured interviews were undertaken with six younger gay men aged 20 to 24, and 11 older gay men aged 30 to 42. Participants were asked to describe their subjective experiences of masculinity. The results of an Interpretative Phenomenological Analysis indicated that discourses of hegemonic and alternative masculinities had implications for lived experiences of masculinity. Older participants in particular emphasized their attributes they associated with masculine dominance, including anti-effeminacy attitudes. The majority of younger participants did not feel masculine. Irrespective of age, many participants resisted hegemonic masculinity by highlighting the value of “gayness” at times. The findings suggested that hegemonic masculinity was the most readily available discourse for conceptualizing masculinity, but that lived experiences of masculinity were not necessarily located within this discourse.

How healthcare professionals can support older LGBTQ+ people living with dementia.

Older lesbian, gay, bisexual, trans, queer and others (LGBTQ+) people living with dementia have specific needs related to their sexual orientation and identity that should be addressed to maintain their personhood. They may face challenges in health and social care settings, such as heteronormativity and lack of awareness of older LGBTQ+ needs. Service provision for older LGBTQ+ people with dementia is lacking. Healthcare professionals' attitudes towards older LGBTQ+ people with dementia are often poor and there is a clear need for better training, while increased knowledge and awareness would help to challenge the concept of heteronormativity. This article explores some of the needs of older LGBTQ+ people with dementia, the role of legislation and regulation and how healthcare professionals can provide support.

Sexual identity and confidence in medicine: an analysis of national survey data

The institution of medicine has at times been associated with the pathologisation of sexual minority individuals. Studies also show that sexual minority individuals sometimes encounter discrimination or hostility when interacting with medical professionals. The current study asks whether this results in a systematic lack of confidence in medicine among sexual minority groups, which could have consequences for these groups’ utilisation of health care. Using nationally representative data from the US General Social Survey, the current study investigates whether gay, lesbian and bisexual individuals have less confidence in medicine as compared to their heterosexual counterparts. The analyses indicate there is no overall gap between heterosexual and gay, lesbian and bisexual individuals’ confidence in medicine. However, age moderates this finding. Specifically, older gay and lesbian individuals express significantly less confidence in medicine as compared to older heterosexual individuals. Limitations and future directions are presented.

Psychosocial and Behavioral Correlates of Internalized Homonegativity in Midlife and Older Gay and Bisexual Men.

This study investigated psychosocial and demographic variables that might influence internalized homonegativity (IH) in midlife and older gay and bisexual men (GBM). Data were collected from 802 community-dwelling GBM aged 40 to 94 years (M = 54.8) through an anonymous questionnaire that assessed levels of IH, coping self-efficacy, self-silencing, and other characteristics. Multivariate logistic regression analysis successfully explained 22% of the variance in predicting IH, which was significantly related to coping self-efficacy, self-silencing, gay community volunteering, partnership status, and race, F = 59.74, p < .001. IH scores were highest in participants who were single, had lower education levels, were non-White, were less involved in gay community volunteering, experienced less coping self-efficacy, and reported higher levels of self-silencing behaviors. These data underscore the need for more tailored programming approaches for midlife and older GBM, focusing on underlying factors contributing to IH that include skill-building to increase coping self-efficacy, community involvement, and decrease self-silencing behaviors in this overlooked population.

Accounting for HIV Health Disparities: Risk and Protective Factors Among Older Gay and Bisexual Men.

Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with (n = 371) and without (n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Results: Those with HIV reported poorer health and more depressive symptomatology accounted for by lower income, resilience and social support, and more lifetime victimization. Poorer health among those with HIV was associated with more chronic conditions. Higher depressive symptomatology was associated with diagnosed anxiety and drug addiction. Community engagement reduced disparities in poor health and depression. Implications: Older gay/bisexual men living with HIV infection are at greater risk for physical and mental health issues. Assessments should be conducted with attention to these risk factors. Interventions for improving social support, resilience, and community engagement are warranted.

Perceived discrimination, health and wellbeing among middle-aged and older lesbian, gay and bisexual people: A prospective study.

ObjectiveTo examine cross-sectional and prospective associations between perceived discrimination in daily life (based on a range of attributes), sexual orientation discrimination, and health and wellbeing in middle-aged and older lesbian, gay and bisexual (LGB) people.MethodsData were from 304 LGB men and women aged 41–85 years participating in the English Longitudinal Study of Ageing. Perceived discrimination in daily life was reported in 2010/11. Participants could attribute their discrimination experience to characteristics including age, sex, race, physical disability, and sexual orientation. Self-rated health, limiting long-standing illness, depressive symptoms, quality of life, life satisfaction and loneliness were assessed in 2010/11 and 2016/17. Analyses adjusted for age, sex, ethnicity, partnership status and socioeconomic position.ResultsPerceived discrimination in daily life was reported by 144 (47.4%) participants. Cross-sectionally, perceived discrimination in daily life was associated with increased odds of depressive symptoms (OR = 2.30, 95% CI 1.02 to 5.21), loneliness (OR = 3.37, 95% CI 1.60 to 7.10) and lower quality of life (B = -3.31, 95% CI -5.49 to -1.12). Prospectively, perceived discrimination in daily life was associated with increased odds of loneliness (OR = 3.12, 95% CI 1.08 to 8.99) and lower quality of life (B = -2.08, 95% CI -3.85 to -0.31) and life satisfaction (B = -1.92, 95% CI -3.44 to -0.39) over six-year follow-up. Effect sizes were consistently larger for participants who attributed experiences of discrimination to their sexual orientation compared with those who attributed experiences of discrimination to other reasons (e.g. age, sex, race).ConclusionThese results provide cross-sectional and prospective evidence of associations between perceived discrimination in daily life and health and wellbeing outcomes in middle-aged and older LGB adults in England.

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.

Prevalence, incidence and predictors of anal Chlamydia trachomatis, anal Neisseria gonorrhoeae and syphilis among older gay and bisexual men in the longitudinal Study for the Prevention of Anal Cancer (SPANC)

ObjectivesSexually transmitted infection (STI) notifications are increasing among older individuals. Many older gay and bisexual men (GBM) are sexually active and have multiple partners. We aimed to investigate the prevalence,...

Experiences and perceptions of residential and home care services among older lesbian women and gay men in Australia.

The needs of older lesbian and gay people regarding access and use of aged-care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged-care and home-based aged-care services in Australia. The focus of this paper is their preparedness for using aged-care services. The results highlight that participants had a number of concerns related to accessing residential-care services in particular, including perceptions of a lack of inclusivity and concerns of potential for discrimination and hostility, loss of access to community and partners, decreased autonomy and concerns relating to quality of care and the potential for elder abuse. Participants noted a number of strategies they employed in avoiding residential-care services, including the use of home-care services, renovating the home for increased mobility, moving to locations with greater access to outside home-care services, a preference for lesbian/gay-specific housing and residential-care options if available, and the option of voluntary euthanasia to ensure dignity and autonomy. Participants, on the whole, were hopeful that they would never require the use of residential-care services, with some believing that having current good health or the support of friends could prevent this from happening. The findings suggest that older lesbian and gay people have a variety of concerns with aged-care and may need additional support and education to improve their perceptions and experiences of services, whether these are needed presently or in the future.