The growing older adult population and the increased visibility of lesbian, gay, bisexual, and transgender (LGBT) individuals has led researchers to the long-neglected health needs of the LGBT older adult population. State- and community-level research shows that the population of LGBT older adults in the United States experiences many physical and mental health disparities as a result of higher rates of discrimination and victimization, as well as social and internalized stigma. A study in the Gerontologist reports on the health status and health needs of a national US sample of lesbian, gay, and bisexual (LGB) older adults.
The authors use a resilience framework as a way to understand the development of the disparate health outcomes affecting LGB communities, which emphasizes how individuals can adapt to existing risk factors. Using national survey data on 2,349 LGB older adults, the authors examine how risk and protective factors (such as discrimination, social isolation, or support), and individual health indicators (health behaviors and access to health care) are collectively associated with health outcomes among LGB older adults. Although this was a national sample, the authors state that this was not a representative sample of the older adult LGB population, as participants were recruited via service agencies that were primarily located in urban areas, and thus likely oversampled the urban population and individuals who use social services.
Health indicators assessed in the questionnaire included whether or not participants received routine health checkups, questions about health-related behaviors such as drinking and engaging in physical activity, and whether participants had financial impediments to receiving health care. Risk factors included the experience of anti-LGB victimization (such as threats or assault) and internalized anti-LGB stigma, while protective factors included the presence of social support and the size of participants’ social networks.
The surveys used existing standardized measures of overall health, disability, and depression to measure health outcomes, and used standardized measures of demographic and health background. This enabled investigators to see how individual and social factors affect the LGB older adult population, as well as different outcomes between subgroups and individuals within this population, while controlling for the influence of background demographic factors such as ethnicity and education.
The analysis showed that poor overall physical health, functional disability, and depression were associated with a variety of contributing factors such as the experience of victimization and financial barriers to health services. Functional disability and depression were also associated with internalized stigma. For protective factors, both social support and social network size decreased the risk for poor health, disability, and depression. All of these findings remained when controlling for the influence of background characteristics such as income and number of chronic health conditions. These findings highlight the importance of social connections in the study of LGB aging and health, while identifying the significance of structural and individual discrimination in LGB health disparities.
Fredriksen-Goldsen KI, Emlet CA, Kim H, et al. The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. The Gerontologist (2013); 53(4): 664–675.