Assessing the combined effect of ageism and sexuality-related stigma on the mental health and well-being of older lesbian and gay adults

'Manopause': sexual response changes as a threat to ageing manhood

When men root manhood in sexual performance, their inability to get and maintain an erection (i.e. erectile dysfunction) may pose a threat to ageing men's ability to enact masculinity. Using data from the 2015-2016 National Social Life, Health and Aging Project (NSHAP) - a nationally representative survey of the USA - this study finds that age and erectile dysfunction interact: men who report 'trouble getting or maintaining an erection' have a higher odds of reporting anxiety before sex. However, this effect gradually declines as the sample of men with erectile dysfunction ages (from ages 49 to 95). Additionally, men who do not report erectile dysfunction have the same odds of sex-anxiety throughout the sample, regardless of their age. The change in sexual performance may cause distress for men, as they feel unable to maintain their dominant masculinity in old age. While previous studies have shown that age and gender interact to affect men's sexual health in mid-life and later-life, this study adds to the feminist gerontology literature by providing indirect evidence that changes in sexual response may become gradually less anxiety-inducing, and thereby, less threatening for men as they age.

Needs, Experiences, and Hopes for Aging Futures among Older Adults in the LGBTQ Communities: A Qualitative Study in Israel

Older lesbian, gay, bisexual, trans, and queer (LGBTQ) individuals tend to live alone, mostly without children and with scarce support from nuclear family members or biological kin. Moreover, traditional resources may not suit their specific end-of-life care needs. While studies have examined these topics in general, they lack focus on end-of-life needs, care, and planning in Israel. Moreover, research on this topic among members of LGBTQ communities is specifically lacking. This study, therefore, aimed at identifying and understanding the attitudes, perceptions, and meanings of older LGBTQ individuals in Israel regarding their needs and challenges, as they age and near end of life. The phenomenological qualitative research methodology was applied, following the interpretive approach. Twenty-one middle-aged and older LGBTQ individuals in Israel, aged ≥ 55, participated in the study. In-depth semi-structured interviews, conducted from November 2020 to April 2021, were audio-recorded, transcribed, and de-identified. Five themes emerged from the interviews: (1) Experiences of loneliness, marginalization, and trauma, and coping through liberation; (2) ageism and exclusion of older adults; (3) elastic and challenging relationships; (4) end of life as reverting into the closet and heteronormativity; and (5) death as a source of generativity and creativity. The study demonstrates that loneliness is an existential experience, exacerbated by the intersectionality of LGBTQ communities. In turn, chosen family members play a minimal role in the end-of-life care of their loved ones. While conveying ambivalence toward social services and housing for the aging, participants in this study expressed fear of being discriminated against and having to re-enter the closet as they age. Ageism and end of life do not represent finality and extinction, yet instead, signify hope and revival. Following Sandberg and Marshall's (2017) concept of queering aging futures, this study refines our understanding of life courses, demonstrating that living and thriving in old age could be positive and desirable. As such, ageism and end of life do not necessarily represent finality and extinction, and may instead signify hope and revival. The unique challenges associated with family and social support of older adults who are LGBTQ members, and their implications on care, deserve further research and are important for practice.

Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey

This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50 years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity.

Ageism: the -ism affecting the lives of older people living with HIV

WHO defines ageism as stereotypes, prejudice, and discrimination based on age. Ageism is a multidimensional concept that encompasses multiple components related to the individual, the social group, and the institution in different cultural and environmental settings. In people ageing with HIV these elements include self-stigma, discrimination in society, and experiences in care, many of which are unique to older people. In this Position Paper, we use experience of people with HIV and clinicians taking care of them to explore these issues in high-income countries. The intersectionality of multiple -isms, which affect the lives of older people living with HIV, and ageism enhance several HIV-related issues, including self-inflicted stigma, and loneliness. Research is needed to explore how ageism contributes to worse physical, mental, and social wellbeing outcomes for people with HIV. The model of care for older people living with HIV needs to go beyond virological success by adopting a geriatric mindset, which is attentive to the challenge of ageism and is proactive in promoting a comprehensive approach for the ageing population. All stakeholders and the community should work together to co-create institutional strategies and educational programmes and enable respectful intergenerational dialogue to foster a stigma-free future for older people living with HIV.

The mediating role of self-directed ageism in sexual health among Jewish-Israeli older people

This article examines the relationships between physical health, personal resilience and healthy sexuality in older adults, and the mediating role of self-directed ageism in these relationships. Healthy sexuality, which encompasses sexual partnership satisfaction, sexual behaviors, successful sexual functioning, few negative changes, and few sexual health concerns, is important in old age. Five hundred Jewish-Israeli women and men, aged 60 years and over, participated in the study. Five questionnaires were administered that examined the number of diseases, level of resilience, self-perceptions of aging, and sexual relationships and activities. The data were analyzed using multiple linear and logistic regressions, and path analysis for the mediating role of self-directed ageism. The results showed that higher levels of resilience were positively related to aspects of sexual health, while reporting more diseases and higher self-directed ageism were negatively related to sexual health. Self-directed ageism mediated the relationships between resilience and number of diseases and sexual health. The findings supported the biopsychosocial model of healthy sexuality. It was concluded that sexual health in older age may be promoted by fostering resilience, promoting good health, and reducing self-directed ageism.

Double Stigma in Portuguese Lesbian, Gay, and Bisexual Older Adults: A Study of Health Status

The double stigma-sexual stigma and ageism-can affect the health status of lesbian, gay, and bisexual (LGB) older adults, but little is known about this topic in Portugal and internationally. The aim of this study was to assess the health status and the prevalence of chronic diseases of Portuguese LGB older adults, as well as to assess the relationship between double stigma and health status. A sample of 280 Portuguese LGB older adults completed a chronic disease questionnaire, the Homosexuality-Related Stigma Scale, the Ambivalent Ageism Scale, and the SF-12 Short Form Health Survey. A structural equation model was performed using the double stigma variables as independent variables and health status as outcome. The mental health status of Portuguese LGB older adults was lower when compared to people from studies from more than 10 countries. Higher sexual self-stigma, sexual enacted stigma related to health care, and benevolent ageism significantly explained the worse general health status. The double stigma significantly affects the health status of these older adults in a profile of internalization of sexual stigma and benevolent age discrimination, and not necessarily by a hostile/aggressive profile. More research is needed on the double stigma.

Defining and researching the concept of resilience in LGBT+ later life: Findings from a mixed study systematic review

Within the literature, resilience is described as either a trait, an outcome or a process and no universal definition exists. A growing body of research shows that older LGBT+ adults show signs of resilience despite facing multiple inequalities that negatively impact their health and social wellbeing. The aim of this review was to examine how resilience is defined in LGBT+ ageing research and how it is studied. A mixed-study systematic search of peer-reviewed research papers published before June 2022 was conducted using the electronic databases CINAHL, Embase, Medline, PsycInfo, Social Science Database and Web of Science. This resulted in the screening of 7101 papers 27 of which matched the inclusion criteria. A quality appraisal was conducted using the Mixed Methods Appraisal Tool. Findings show that papers often lack a clear definition of resilience and application of resilience theory within the studies, although many of the papers conceptualised resilience as either a trait, process or an outcome. However, resilience was rarely the primary focus of the studies and was researched using a variety of measurement instruments and conceptual frameworks. Given the socioeconomic disparities, diverse social relations, histories of discrimination and stigma, and acts of resistance that have shaped the lives of older LGBT+ populations, resilience is a topic of growing interest for researchers and practitioners. Clear definitions of resilience and application of resilience theory could help improve methods used to study the concept and lead to more robust findings and the development of effective interventions. Greater clarity on the concept of resilience could also broaden the focus of research that informs policies and practice, and support practitioner training in resilience and the particular experiences of older LGBT+ adults.

Health and Social Inclusion: The Impact of Psychological Well-Being and Suicide Attempts Among Older Men Who Have Sex With Men

Older adults' mental health and suicidal tendencies have garnered much attention because of their vulnerability. Few studies have examined the impact of psychological well-being and suicide attempts among older men who have sex with men (OMSM). This study examines the levels of depression and suicidal tendencies among OMSM, factors impacting their mental health, and their likelihood of committing suicide. Descriptive statistics are used to analyze the correlation between depression and suicidal tendencies among OMSM in the United States. We constructed a regression model using relevant data, and scales were selected based on a literature review. The validity and relevance of the control variables were considered. Depression and suicidal tendencies were dependent variables. Data were obtained from the U.S. General Social Survey and analyzed with an ordinary least squares model. There were significant differences between MSM and general groups in depression and suicidal tendency scores (t = 67.084, 58.193, p < .01). Compared with general groups, MSM scored significantly higher on depression and suicidal tendencies. The regression analysis revealed that sex with men was associated with depression and suicidal tendencies (p < .01) among older men. This indicates that OMSM generally have higher levels of depression and suicidal tendencies than the general population. Finally, in the intermediary test, the level of depression had a significant mediating effect on the relationship between homosexuality and suicidal tendencies (p < .01). This suggests that depression intervention can help reduce suicidal tendencies among OMSM.

Healthy Longevity Among the LGBTQIA+ Population: From Neglect to Meeting Their Needs: Здоровое долголетие представителей сообщества ЛГБТКИА+: от игнорирования к удовлетворению потребностей

The world is facing rapid population aging. This is associated with an increase in the number of older people from the lesbian, gay, bisexual, trans, queer, intersex, or asexual (LGBTQIA+) community. This population faces unique challenges, including ageism, sexual identity stigma, and self-stigma. The older LGBTQIA+ population are neglected by, and invisible to, healthcare interventions, research, and policy changes. In light of the paradigm shift in healthcare towards a rights-based approach, healthy aging has become an important construct. Healthy aging, according to the World Health Organization (WHO), is a "continuous process of optimizing opportunities to maintain and improve physical and mental health, autonomy, and quality of life throughout the life course". This commentary highlights the unique vulnerabilities of the aging LGBTQIA+ population, advocates the inclusion of their voices at all levels of the healthcare system, and discusses the way forward to enable their 'healthy aging'.