SAME-SEX PARTNERSHIPS AND THE HEALTH OF OLDER ADULTS

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review

INTRODUCTION

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults.

METHODS

The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis.

RESULTS

Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes.

CONCLUSION

Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

The rural side of the rainbow: Mental health and the intersections of geography, sexuality, and partnership

Lesbian, gay, and bisexual (LGB) persons tend to be geographically concentrated in larger metropolitan areas and research persistently observes LGB persons as a disadvantaged population for mental health outcomes when compared to their heterosexual counterparts. Conflicting evidence suggests that mental health risk exposures are greater for LGB people in rural spaces while other research posits that urban residency is more detrimental for LGB mental health. One positively contributing factor to the mental well-being of LGB persons is their partnership status. To date, no study estimates how partnership may ameliorate unfavourable mental health outcomes for LGB populations in urban and rural areas. Using 10 years of pooled data from the nationally representative Canadian Community Health Survey (CCHS), this study examines mental health and the intersection of sexuality, geographic residency, and partnership. Logistic regression models estimate the intersections of sexuality, geography, and partnership status on mental health, stratified by respondents' gender. Findings show partnered gay men in rural areas experiencing better mental health than their partnered heterosexual counterparts in the largest urban cities. Although not significant, the same pattern is observed for partnered lesbian women who do not experience a significant mental health disadvantage at any geographic level. Regardless of partnership and geographic space, bisexual men, and especially bisexual women, exhibit worse mental health outcomes compared to their heterosexual counterparts.

Cognitive Aging with Dementia, Mild Cognitive Impairment, or No Impairment: A Comparison of Same- and Mixed-Sex Couples

BACKGROUND

Lesbian and gay older adults have health disparities that are risk factors for Alzheimer's disease, yet little is known about the neurocognitive aging of sexual minority groups.

OBJECTIVE

To explore cross-sectional and longitudinal dementia outcomes for adults in same-sex relationships (SSR) and those in mixed-sex relationships (MSR).

METHODS

This prospective observational study utilized data from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS) collected from contributing Alzheimer's Disease Research Centers. Participants were adults aged 55+ years at baseline with at least two visits in NACC UDS (from September 2005 to March 2021) who had a spouse, partner, or companion as a co-participant. Outcome measures included CDR® Dementia Staging Instrument, NACC UDS neuropsychological testing, and the Functional Activities Questionnaire. Multivariable linear mixed-effects models accounted for center clustering and repeated measures by individual.

RESULTS

Both MSR and SSR groups experienced cognitive decline regardless of baseline diagnosis. In general, MSR and SSR groups did not differ statistically on cross-sectional or longitudinal estimates of functioning, dementia severity, or neuropsychological testing, with two primary exceptions. People in SSR with mild cognitive impairment showed less functional impairment at baseline (FAQ M = 2.61, SD = 3.18 vs. M = 3.97, SD = 4.53, respectively; p < 0.01). The SSR group with dementia had less steep decline in attention/working memory (β estimates = -0.10 versus -0.18; p < 0.01).

CONCLUSION

Participants in SSR did not show cognitive health disparities consistent with a minority stress model. Additional research into protective factors is warranted.

The impact of mindfulness on self-stigma and affective symptoms among sexual minorities

BACKGROUND

Research shows that mindfulness may enable sexual minorities to resist stigma and reduce distress. Less is known, however, about the underlying processes. The present study addressed this gap in the literature by examining how mindfulness would mitigate self-stigma and, in turn, alleviate affective symptoms among lesbian, gay, and bisexual (LGB) individuals.

METHODS

A total of 401 LGB individuals from Hong Kong, China, provided cross-sectional questionnaire data on mindfulness, positive reappraisal, negative rumination, self-stigma content, self-stigma process, disempowerment, depressive symptoms, and anxiety symptoms. Structural equation modeling and Bootstrap analyses were conducted to analyze the relations among the variables.

RESULTS

Structural equation modeling showed that mindfulness was associated with increased positive reappraisal and reduced negative rumination, which were, in turn, associated with lower levels of self-stigma content and process, respectively. Moreover, lower levels of self-stigma content and process were associated with a reduced sense of disempowerment, which was, in turn, associated with lower levels of depressive and anxiety symptoms. Bootstrap analyses further demonstrated that mindfulness had significant indirect effects on depressive and anxiety symptoms via positive reappraisal, self-stigma content, and disempowerment and via negative rumination, self-stigma process, and disempowerment.

CONCLUSIONS

Theoretically, this study revealed the potential pathways through which mindfulness could enable LGB individuals to mitigate self-stigma content and process and thereby alleviate depressive and anxiety symptoms. Practically, this study pointed to the potential utility of mindfulness training in facilitating LGB individuals to resist societal stigma, reduce internalized stigma, and lessen emotional distress.

Health Status and Quality of Life of Middle-Aged and Older Taiwanese Sexual and Gender Minorities

PURPOSE

To examine the health status and quality of life of middle-aged and older sexual and gender minority adults in Taiwan.

RESEARCH DESIGN AND METHODS

A cross-sectional online survey was conducted between May and December 2019. A total of 535 self-identified lesbian, gay, bisexual, and transgender (LGBT) men and women ≥40 years of age were included in the final sample. An online questionnaire, which included the following three sections, was used to collect data in this study: (a) demographics, (b) the World Health Organization Quality of Life-Brief Taiwan version, and (c) physical and psychological health status.

RESULTS

Middle-aged and older Taiwanese LGBT adults who were single, were unemployed, and earned monthly incomes of <20,000 New Taiwan Dollars reported poorer quality of life. Participants with one or more physical or psychological health problems also reported poorer quality of life than those who had no health problems. In addition, singlehood, unemployment, and poor quality of life and health were positively associated with mental health issues.

CONCLUSIONS

It is important to attenuate health disparities and mitigate discrimination within Taiwanese society to enhance the quality of life and mental health of middle-aged and older Taiwanese LGBT adults.

CLINICAL RELEVANCE

Healthcare providers should be attuned to and knowledgeable about the health issues and specific healthcare needs of middle-aged and older LGBT adults, and they should also provide culturally competent care to reduce health disparities of the LGBT adults.

Investigating differential protective effects of marriage on substance use by sexual identity status

BACKGROUND

Research suggests that marriage is protective against substance use. However, few studies have examined whether this protective effect differs for sexual minorities, a population at increased risk for substance use. Using data from four waves of the cross-sectional U.S. National Alcohol Survey (NAS; 2000, 2005, 2010, and 2015), we investigated whether the protective effects of marriage varied by sexual identity.

METHODS

Sex-stratified logistic regression models were used to examine independent and interactive effects of current marital status (being married vs. not) and sexual minority status (lesbian/gay/bisexual vs. heterosexual) on high-intensity drinking, alcohol use disorder, and marijuana use in the past year.

RESULTS

Among both women and men, sexual minority status was generally associated with higher odds of these outcomes and marriage was consistently associated with lower odds. Differential effects of marriage by sexual identity with respect to marijuana use were found only among men; marriage was significantly associated with decreased odds of marijuana use among heterosexual men but increased odds among sexual minority men.

CONCLUSIONS

Marriage may be less consistently protective against hazardous drinking and marijuana use among sexual minorities than heterosexuals. Findings underscore the importance of both quantitative and qualitative studies designed to better understand disparities in substance use across both sexual identity and relationship statuses.

Appointment of a Healthcare Power of Attorney Among Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Adults in the Southern United States

BACKGROUND

The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients' wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States.

METHODS

An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018.

PARTICIPANTS

The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018.

RESULTS

Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA (n = 311, 64.5%).

CONCLUSIONS

Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.

Single LBQ women of the baby boom planning for later life

The aim of this study was to understand how sexual minority women of the baby boom cohort viewed their social connections and planned for their later years. Framed by feminist and life course perspectives, this study used semi-structured interviews and constructivist grounded theory. Thirteen single sexual minority baby boom women from across the U.S. were interviewed. The women were active in their communities and viewed their social connections with local community, family of origin and of choice. The women had formal and informal plans for their future, anticipating the possibilities of aging-related issues, related to housing and support.

Sexual- and Gender-Minority Families: A 2010 to 2020 Decade in Review

OBJECTIVE

To review research on sexual and gender minority (SGM) families-including lesbian, gay, bisexual, transgender, queer, asexual, and intersex (LGBTQAI+) families- from 2010-2020.

BACKGROUND

Research on the SGM population has increased and diversified in the past decade.

RESULTS

This paper reviews three subareas that make up the majority of research on SGM families today: (1) SGM family of origin relationships, (2) SGM intimate relationships, and (3) SGM-parent families. This review also highlights three main gaps in the existing literature: (1) a focus on same-sex and gay and lesbian families (and to a lesser extent bisexual and transgender families) and a lack of attention to the families of single SGM people as well as intersex, asexual, queer, polyamorous, and other SGM families; (2) an emphasis on white, socioeconomically advantaged SGM people and a failure to account for the significant racial-ethnic and socioeconomic diversity in the SGM population; and (3) a lack of integration of SGM experiences across the life course, from childhood to old age.

CONCLUSION

The next decade should aim to examine the full range of SGM family ties, include more vigorous examinations of race-ethnicity and socioeconomic status, and develop more robust accounts of family across the life course with novel theory and data sources across the methodological spectrum.

The State of Theory in LGBTQ Aging: Implications for Gerontological Scholarship

Social research in lesbian, gay, bisexual, transgender, and queer (LGBTQ) aging is a rapidly growing field, but an examination of the use of theory has not yet been conducted for its impact on the field's direction. We conducted a systematic review of empirical articles published in LGBTQ aging in the years 2009-2017 ( N = 102). Using a typology of theory use in scholarly articles, we analyzed these articles for the types of theories being used, the degree to which theories were used in each article, and the analytical function they served. We found that 52% of articles consistently applied theory, 23% implied or partially applied theory, and 25% presented as atheoretical. A wide range of theories were used and served multiple analytical functions such as concept development and explanation of findings. We discuss the strengths and weaknesses of theory use in this body of literature, especially with respect to implications for future knowledge development in the field.

Iridescent Life Course: LGBTQ Aging Research and Blueprint for the Future - A Systematic Review

BACKGROUND

LGBTQ* (lesbian, gay, bisexual, trans, and queer) older adults are demographically diverse and growing populations. In an earlier 25-year review of the literature on sexual orientation and aging, we identified four waves of research that addressed dispelling negative stereotypes, psychosocial adjustment to aging, identity development, and social and community-based support in the lives of LGBTQ older adults.

OBJECTIVES

The current review was designed to develop an evidence base for the field of LGBTQ aging as well as to assess the strengths and limitations of the existing research and to articulate a blueprint for future research.

METHODS

Using a life course framework, we applied a systematic narrative analysis of research on LGBTQ aging. The review included 66 empirical peer-reviewed journal articles (2009-2016) focusing on LGBTQ adults aged 50 years and older, as well as age-based comparisons (50 years and older with those younger).

RESULTS

A recent wave of research on the health and well-being of LGBTQ older adults was identified. Since the prior review, the field has grown rapidly. Several findings were salient, including the increas-ed application of theory (with critical theories most often used) and more varied research designs and methods. While -existing life course theory provided a structure for the investigation of the social dimensions of LGBTQ aging, it was limited in its attention to intersectionality and the psychological, behavioral, and biological work emerging in the field. There were few studies addressing the oldest in these -communities, bisexuals, gender non-binary older adults, intersex, -older adults of color, and those living in poverty. -Conclusions: The Iridescent Life Course framework highlights the interplay of light and environment, creating dynamic and fluid colors as perceived from different angles and perspectives over time. Such an approach incorporates both queering and trans-forming the life course, capturing intersectionality, fluidity over time, and the psychological, behavioral, and biological as well as social dimensions of LGBTQ aging. Work is needed that investigates trauma, differing configurations of risks and resources over the life course, inequities and opportunities in representation and capital as LGBTQ adults age, and greater attention to subgroups that remain largely invisible in existing research. More depth than breadth is imperative for the field, and multilevel, longitudinal, and global initiatives are needed.

Social Network Types and Mental Health Among LGBT Older Adults

PURPOSE OF THE STUDY

This study was designed to identify social network types among lesbian, gay, bisexual, and transgender (LGBT) older adults and examine the relationship between social network type and mental health.

DESIGN AND METHODS

We analyzed the 2014 survey data of LGBT adults aged 50 and older (N = 2,450) from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. Latent profile analyses were conducted to identify clusters of social network ties based on 11 indicators. Multiple regression analysis was performed to examine the association between social network types and mental health.

RESULTS

We found five social network types. Ordered from greatest to least access to family, friend, and other non-family network ties, they were diverse, diverse/no children, immediate family-focused, friend-centered/restricted, and fully restricted. The friend-centered/restricted (33%) and diverse/no children network types (31%) were the most prevalent. Among individuals with the friend-centered/restricted type, access to social networks was limited to friends, and across both types children were not present. The least prevalent type was the fully restricted network type (6%). Social network type was significantly associated with mental health, after controlling for background characteristics and total social network size; those with the fully restricted type showed the poorest mental health.

IMPLICATIONS

Unique social network types (diverse/no children and friend-centered/restricted) emerge among LGBT older adults. Moreover, individuals with fully restricted social networks are at particular risk due to heightened health needs and limited social resources. This study highlights the importance of understanding heterogeneous social relations and developing tailored interventions to promote social connectedness and mental health in LGBT older adults.

The Unfolding of LGBT Lives: Key Events Associated With Health and Well-being in Later Life

PURPOSE OF THE STUDY

Life events are associated with the health and well-being of older adults. Using the Health Equity Promotion Model, this article explores historical and environmental context as it frames life experiences and adaptation of lesbian, gay, bisexual, and transgender (LGBT) older adults.

DESIGN AND METHODS

This was the largest study to date of LGBT older adults to identify life events related to identity development, work, and kin relationships and their associations with health and quality of life (QOL). Using latent profile analysis (LPA), clusters of life events were identified and associations between life event clusters were tested.

RESULTS

On average, LGBT older adults first disclosed their identities in their 20s; many experienced job-related discrimination. More had been in opposite-sex marriage than in same-sex marriage. Four clusters emerged: "Retired Survivors" were the oldest and one of the most prevalent groups; "Midlife Bloomers" first disclosed their LGBT identities in mid-40s, on average; "Beleaguered At-Risk" had high rates of job-related discrimination and few social resources; and "Visibly Resourced" had a high degree of identity visibility and were socially and economically advantaged. Clusters differed significantly in mental and physical health and QOL, with the Visibly Resourced faring best and Beleaguered At-Risk faring worst on most indicators; Retired Survivors and Midlife Bloomers showed similar health and QOL.

IMPLICATIONS

Historical and environmental contexts frame normative and non-normative life events. Future research will benefit from the use of longitudinal data and an assessment of timing and sequencing of key life events in the lives of LGBT older adults.

Who Says I Do: The Changing Context of Marriage and Health and Quality of Life for LGBT Older Adults

PURPOSE OF THE STUDY

Until recently, lesbian, gay, bisexual, and transgender (LGBT) adults were excluded from full participation in civil marriage. The purpose of this study is to examine how legal marriage and relationship status are associated with health-promoting and at-risk factors, health, and quality of life of LGBT adults aged 50 and older.

DESIGN AND METHODS

We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) participants who resided in states with legalized same-sex marriage in 2014 (N = 1,821). Multinomial logistic regression was conducted to examine differences by relationship status (legally married, unmarried partnered, single) in economic and social resources; LGBT contextual and identity factors; health; and quality of life.

RESULTS

We found 24% were legally married, and 26% unmarried partnered; one-half were single. Those legally married reported better quality of life and more economic and social resources than unmarried partnered; physical health indicators were similar between legally married and unmarried partnered. Those single reported poorer health and fewer resources than legally married and unmarried partnered. Among women, being legally married was associated with more LGBT microaggressions.

IMPLICATIONS

LGBT older adults, and practitioners serving them, should become educated about how legal same-sex marriage interfaces with the context of LGBT older adults' lives, and policies and protections related to age and sexual and gender identity. Longitudinal research is needed to understand factors contributing to decisions to marry, including short- and long-term economic, social, and health outcomes associated with legal marriage among LGBT older adults.

The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults

PURPOSE OF THE STUDY

Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes.

DESIGN AND METHODS

Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes.

RESULTS

Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes.

IMPLICATIONS

Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services.

Dismantling the Silence: LGBTQ Aging Emerging From the Margins

Historical, environmental, and cultural contexts intersect with aging, sexuality, and gender across communities and generations. My scholarship investigates health and well-being over the life course across marginalized communities, including LGBTQ (lesbian, gay, bisexual, transgender, and queer) midlife and older adults, native communities experiencing cardiovascular risk, and families in China living with HIV, in order to balance the realities of unique lives in contemporary society. By probing the intersection of age, sexuality, and gender, my analysis is informed by both personal and professional experiences. With the death of my partner occurring at a time of profound invisibility and silence before HIV/AIDS, I found my life out of sync, experiencing a loss without a name. My life was thrust into a paradox: My relationship was defined by a world that refused to recognize it. This essay provides an opportunity for me to weave together how such critical turning points in my own life helped shape my approach to gerontology and how gerontology has informed my work and life. Reflecting on this journey, I illustrate the ways in which historical, structural, environmental, psychosocial, and biological factors affect equity, and the health-promoting and adverse pathways to health and well-being across marginalized communities. Although gerontology as a discipline has historically silenced the lives of marginalized older adults, it has much to learn from these communities. The growing and increasingly diverse older adult population provides us with unique opportunities to better understand both cultural variations and shared experiences in aging over the life course.

Same-Sex Couples' Decisions and Experiences of Marriage in the Context of Minority Stress: Interviews From a Population-Based Longitudinal Study

In the emerging context of marriage equality, it is important to explore the reasons for and experience of marriage for long-term same-sex couples, including the role of minority stress. In Wave 3 of the population-based, longitudinal CUPPLES Study we interviewed 21 long-term same-sex couples (14 female, 7 male) who resided in 12 different states and who were legally married. Couple members ranged in age from 37 to 84 and reported being together as a couple from 15 to 41 years. Seven couples lived in states that did not recognize their marriage at the time of the interview. Legal protection and social validation emerged as the two primary domains that captured couples' lived experiences of marriage. Minority stress experiences emerged in the narratives in the context of couples' long-term commitment, the availability of civil marriage, and couples' participation in activist efforts on behalf of marriage equality for themselves and others.

When Sex and Power Collide: An Argument for Critical Sexuality Studies

Attentive to the collision of sex and power, we add momentum to the ongoing development of the subfield of critical sexuality studies. We argue that this body of work is defined by its critical orientation toward the study of sexuality, along with a clear allegiance to critical modalities of thought, particularly feminist thought. Critical sexuality studies takes its cues from several other critical moments in related fields, including critical psychology, critical race theory, critical public health, and critical youth studies. Across these varied critical stances is a shared investment in examining how power and privilege operate, understanding the role of historical and epistemological violence in research, and generating new models and paradigms to guide empirical and theoretical research. With this guiding framework, we propose three central characteristics of critical sexuality studies: (a) conceptual analysis, with particular attention to how we define key terms and conceptually organize our research (e.g., attraction, sexually active, consent, agency, embodiment, sexual subjectivity); (b) attention to the material qualities of abject bodies, particularly bodies that are ignored, overlooked, or pushed out of bounds (e.g., viscous bodies, fat bodies, bodies in pain); and (c) heteronormativity and heterosexual privilege, particularly how assumptions about heterosexuality and heteronormativity circulate in sexuality research. Through these three critical practices, we argue that critical sexuality studies showcases how sex and power collide and recognizes (and tries to subvert) the various power imbalances that are deployed and replicated in sex research.

The health equity promotion model: Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities

National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model-a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group

PURPOSE

Lesbian, gay, bisexual, and transgender (LGBT) people are a health disparate population as identified in Healthy People 2020. Yet, there has been limited attention to how LGBT older adults maintain successful aging despite the adversity they face. Utilizing a Resilience Framework, this study investigates the relationship between physical and mental health-related quality of life (QOL) and covariates by age group.

DESIGN AND METHODS

A cross-sectional survey of LGBT adults aged 50 and older (N = 2,560) was conducted by Caring and Aging with Pride: The National Health, Aging, and Sexuality Study via collaborations with 11 sites across the U.S. Linear regression analyses tested specified relationships and moderating effects of age groups (aged 50-64; 65-79; 80 and older).

RESULTS

Physical and mental health QOL were negatively associated with discrimination and chronic conditions and positively with social support, social network size, physical and leisure activities, substance nonuse, employment, income, and being male when controlling for age and other covariates. Mental health QOL was also positively associated with positive sense of sexual identity and negatively with sexual identity disclosure. Important differences by age group emerged and for the old-old age group the influence of discrimination was particularly salient.

IMPLICATIONS

This is the first study to examine physical and mental health QOL, as an indicator of successful aging, among LGBT older adults. An understanding of the configuration of resources and risks by age group is important for the development of aging and health initiatives tailored for this growing population.

Time for Transformation: Public Policy Must Change to Achieve Health Equity for LGBT Older Adults

The marriage equality movement and the Affordable Care Act have enormous potential to reduce health disparities in LGBT elders, but more data and additional policy changes are sorely needed.