Sexual orientation and cognition in aging populations: Results from the Canadian Longitudinal Study on Aging

The current study utilized the Canadian Longitudinal Study on Aging (CLSA) data to investigate the relationship between sexual orientation and cognitive health of the aging population. Cognitive flexibility and verbal fluency were examined as outcome variables in the study. A total of 45,993 respondents were included in the analyses. Each model had social support or social participation as a mediator. A series of mediation analysis, stratified by gender, revealed that aging gay men performed better in cognitive tasks related to cognitive flexibility when compared to their heterosexual counterparts. The results also indicated that social support is a protective factor for cognitive health in aging lesbian women. This study provides an opportunity to consider how clinical and social services can strategize to build inclusive environments for the aging sexual minority population.

Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data

As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.

Neuropsychological assessment with lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals: Practice, education, and training survey

Objective: We sought to describe the LGBTQ + related education, training, and clinical practice of independently licensed neuropsychologists in the United States and to identify factors that predict affirmative neuropsychological practices. We hypothesized that LGBTQ + identity, female gender, more recent training, and extent of LGBTQ + education/training would predict use of LGBTQ + practice guidelines. Method: A workgroup of clinical psychologists with experience in LGBTQ + psychology and neuropsychology developed a survey to identify personal and professional factors that predict affirmative neuropsychological testing practices. The survey was distributed through professional organizations and listservs between August and September 2021 with 118 responses meeting inclusionary criteria. Results: The majority of participants identified as heterosexual (70.3%) and cisgender (97.5%), and most (48-63%) received LGBTQ + training post-licensure. Between 19% and 32% of participants reported never completing LGBTQ + specific education. Consistent with our hypotheses, factors predicting affirmative clinical practice behaviors were LGBTQ + education/training, and personal background (sexual minority status, female/feminine gender, and years since degree). Other significant factors included prior experience with LGBTQ + patients and primary patient population (child vs. adult). Qualitative responses indicated varying values, attitudes, and knowledge regarding collection of LGBTQ + information and modification of clinical practice. Conclusions: Neuropsychologists underutilize affirming practices as evidenced by low rates of querying pronouns, knowing whether LGBTQ + health information is available at their institutions, and adjusting evaluation and feedback approaches. We provide specific training and education recommendations to increase knowledge and skills and to address beliefs about LGBTQ + health that can serve to promote affirmative neuropsychological practice.

No country for old gay men: Age and sexuality category intersection renders older gay men invisible

Four studies analyzed how sexual orientation (heterosexual vs. gay) and age categories (young vs. elderly) referring to men are cognitively combined. In Study 1, young gay men were judged as more prototypical of gay men than adult or elderly gay men, while young, adult, and elderly heterosexual men were perceived as equally prototypical of heterosexual men. In Study 2, gay men were stereotyped more by young rather than elderly stereotypical traits, while heterosexual men were not stereotyped in terms of age. In Study 3, elderly men were stereotyped more by heterosexual than gay-stereotypical traits, while young men were not stereotyped in terms of sexual orientation. In Study 4, gay men were judged to be young rather than elderly, while elderly men were judged to be heterosexual rather than gay. Overall, elderly gay men were overlooked when processing their constituent categories, “gay” and “elderly” men. Implications for models of intersectionality are discussed.

The Coming-Out Process in Family, Social, and Religious Contexts Among Young, Middle, and Older Italian LGBQ+ Adults

The coming out (CO) process is fundamental for identity integration among LGBQ+ people, and its impact can vary greatly depending on personal and contextual factors. The historical, cultural, and social contexts in which LGBQ+ people develop their sexual identity can mediate the relationship between CO and health outcomes. The present study aimed at clarifying the CO process in three generations of Italian LGBQ+ people (young adults: aged 20-40 years; middle adults: aged 41-60 years; older adults: aged 61-80 years) by providing data on: (a) sexual orientation milestones, such as age of first awareness, age of first self-label, and age of first CO, as well as the rate of disclosure during different life stages; (b) the rate and average age of CO to significant others; and (c) CO within the religious context and its effect on participants' minority stress experiences. A total of 266 Italian LGBQ+ people participated in the study, with ages ranging from 20 to 80 years (M = 41.15, SD = 16.13). Findings indicated that, on average, the older adult group became self-aware, self-labeled, and disclosed their sexual identity at a significantly older age than the other groups. Older adults were also more Catholic and had CO more frequently to their Catholic community, relative to young and middle adults. CO within the Catholic context was associated with distal and proximal minority stressors, such as discrimination, vigilance, and internalized sexual stigma. Catholic community reactions to participants' CO were distinguished through thematic analysis in three main types: unconditional acceptance, invitation to change, and open rejection. The present research extended current knowledge on CO and minority stress experiences in different generations of LGBQ+ people. Several differences emerged between generational groups on sexual orientation milestones, highlighting the potential impact of historical and cultural contexts in determining sexual minorities' experiences related to sexual identity. It is recommended that mental health professionals working with LGBQ+ clients implement targeted interventions based on their clients' multiple salient aspects, including age and religious background. Clinicians should also be aware of the potentially detrimental effects of CO within an unsupportive context, rather than encouraging CO tout court.

Disparities in Suicidality by Gender Identity Among Medicare Beneficiaries

INTRODUCTION

Suicidality is higher for gender minorities than the general population, yet little is known about suicidality in disabled or older adult gender minorities.

METHODS

This study used 2009-2014 Medicare claims to identify people with gender identity-related diagnosis codes (disabled, n=6,678; older adult, n=2,018) and compared their prevalence of suicidality with a 5% random non-gender minority beneficiary sample (disabled, n=535,801; older adult, n=1,700,008). Correlates of suicidality were assessed (via chi-square) for each of the 4 participant groups separately, and then disparities within eligibility status (disabled or older adult) were assessed using logistic regression models, adjusting first for age and mental health chronic conditions and then additionally for Medicaid eligibility, race/ethnicity, or U.S. region (each separately). The primary hypotheses were that gender minority beneficiaries would have higher suicidality but that suicidality disparities would persist after adjusting for covariates. Data were analyzed between 2017 and 2019.

RESULTS

Gender minority beneficiaries had higher unadjusted suicidality than non-gender minority beneficiaries in the disabled cohort (18.5% vs 7.1%, p<0.001). Significant suicidality predictors in all 4 groups included the following: age (except in older adult gender minorities), Medicaid eligibility, depression or behavioral health conditions, avoidable hospitalizations, and violence victimization. In age- and mental health-adjusted logistic regression models, gender minorities had higher odds of suicidality than non-gender minority beneficiaries (disabled, OR=1.95, p<0.0001; older adult, OR=2.10, p<0.0001). Disparities were not attenuated after adjusting for Medicaid eligibility, race/ethnicity, or region.

CONCLUSIONS

Heightened suicidality among identified gender minority Medicare beneficiaries highlights a pressing need to identify and reduce barriers to wellness in this population.

Psychological wellbeing of middle-aged and older queer men in India: A mixed-methods approach

Borrowing concepts from public health, we examined the association of several social determinants with the mental health of middle-aged and older queer men in India by combining quantitative and qualitative methodologies. A cross-sectional survey guided by Meyer’s Minority Stress Model was carried out to assess the links between minority stressors (internalized homophobia and degree of closetedness), age-related stressors (ageism and fear of ageing) and psychological wellbeing (loneliness, depressive symptoms and sexual compulsivity) among 207 Indian men (aged 40 years and above) who identified themselves as non-heterosexuals. Results from simple and multivariable linear regression models showed significant positive associations of ageism, internalized homophobia, and fear of ageing with loneliness, even after accounting for sociodemographic and stress mitigating factors. Ageism was not significantly related to depressive symptoms. However, fear of ageing and internalized homophobia was positively associated with depressive symptoms after accounting for covariates. Further, regression models demonstrated a consistent and statistically significant inverse association between income and adverse psychological outcomes suggesting the centrality of social class in the lived experience of Indian gay and bisexual men. The qualitative inquiry addressed the same research questions as the quantitative survey through in-depth interviews of thirty middle-aged and older gay and bisexual men in Mumbai. We found that older and midlife gay and bisexual men with higher income (a proxy for social class) found ways to manage their masculinities with no discernible adverse psychological outcomes. Depressive symptoms and loneliness in this population made them further vulnerable to excessive sexual impulses, especially in the older queer men who were passing off as heterosexuals. Overall, the theory-driven empirical findings suggest that even in India, where family and friends are social insurance for later life, the issues of ageism and internalized homophobia have the potential to lead to worse mental health outcomes among older queer men.

Trends in Mental Health Care Use in Medicare from 2009 to 2014 by Gender Minority and Disability Status

Purpose: This study examines trends in Medicare beneficiaries' mental health care use from 2009 to 2014 by gender minority and disability status. Methods: Using 2009 to 2014 Medicare claims, we modeled mental health care use (outpatient mental health care, inpatient mental health care, and psychotropic drugs) over time, adjusting for age and behavioral health diagnoses. We compared trends for gender minority beneficiaries (identified using diagnosis codes) to trends for a 5% random sample of other beneficiaries, stratified by original entitlement reason (age vs. disability). Results: Adjusted outpatient and inpatient mental health care use decreased and differences generally narrowed between gender minority and other beneficiaries over the study period. Among beneficiaries qualifying through disability, the gap in the number of outpatient and inpatient visits (among those with at least one visit in a given year) widened. Psychotropic drug use rose for all beneficiaries, but the proportion of gender minority beneficiaries in the aged cohort who had a psychotropic medication prescription rose faster than for other aged beneficiaries. Conclusions: Mental health care needs for Medicare beneficiaries may be met increasingly by using psychotropic medications rather than outpatient visits, and this pattern is more pronounced for identified gender minority (especially aged) beneficiaries. These trends may indicate a growing need for research and provider training in safe and effective psychotropic medication prescribing alongside gender-affirming treatments such as hormone therapy, especially for aged gender minority individuals who likely already experience polypharmacy.

Social Context of Depressive Distress in Aging Transgender Adults

This study investigates the relationship between discrimination and mental health in aging transgender adults. Survey responses from 61 transgender adults above 50 ( Mage = 57.7, SD = 5.8; 77.1% male-to-female; 78.7% White non-Hispanic) were analyzed. Multivariable logistic regression models examined the relationship between gender- and age-related discrimination, number of everyday discrimination experiences, and past-week depressive distress, adjusting for social support, sociodemographics, and other forms of discrimination. The most commonly attributed reasons for experiencing discrimination were related to gender (80.3%) and age (34.4%). More than half of participants (55.5%) met criteria for past-week depressive distress. In an adjusted multivariable model, gender-related discrimination and a greater number of everyday discrimination experiences were associated with increased odds of past-week depressive distress. Additional research is needed to understand the effects of aging and gender identity on depressive symptoms and develop interventions to safeguard the mental health of this vulnerable aging population.

Same-Sex Contact and Lifetime Sexually Transmitted Disease Diagnoses Among Older Adults

Objective: This study examines difference in sexually transmitted disease (STD) prevalence between sexual minority and heterosexual older adults using lifetime experience of same-sex contact (SSC) as a measure of sexual orientation. Method: Data from the National Social Life, Health, and Aging Project (N = 2,519) are analyzed using negative binomial regression and propensity matching models to test for differences in average STD counts by sexual orientation. Results: Older adults who report any SSC have higher lifetime counts of STDs. This difference persists even when controlling for sex, race, education, age, military status, and incarceration. Propensity matching models show that this difference persists when respondents are matched on several factors that may influence SSC prior to STD contraction. Discussion: The present results call for greater attention from policy makers and researchers because the sexual orientation differences in STDs may exacerbate disparities in overall health status and quality of life.

LGBQ-Specific Elderly Housing as a "Sparkling Sanctuary": Boundary Work on LGBQ Identity and Community in Relationship to Potential LGBQ-Specific Elderly Housing in Sweden

This study explored how boundaries in relationship to community and identity were created and negotiated among lesbian, gay, bisexual, and queer (LGBQ) people within the framework of picturing LGBQ-specific elderly housing as a housing alternative in older age, by applying focus group methodology. "An island as a sparkling sanctuary" was identified as a metaphor for how symbolic resources defining the LGBQ community can be manifested in LGBQ-specific qualities of elderly housing. The boundary work underlying this manifestation included elaborations on the dilemma between exclusiveness and normality. The findings illustrate further how symbolic resources and collective identities were developed through dialectic interplay between internal and external definitions. Further, the findings show how boundary work generated shared feelings of similarity and group membership. The associated symbolic and social resources not only served to deal with difficult situations but also to manifest LGBQ identity and sense of community as a "gold medal."

Perspectives of LGBTQ Older Adults on Aging in Place: A Qualitative Investigation

This qualitative study conducted by a community-research partnership used multiple types of data collection to examine variables relevant for LGBTQ older adults who wished to age in place in their urban Denver neighborhood. Focus groups, interviews, and a town hall meeting were used to identify barriers and supports to aging in place. Participants (N = 73) identified primarily as lesbian or gay, aged 50-69, and lived with a partner. Ageism, heterosexism, and cisgenderism emerged as cross-cutting themes that negatively impact access to health care, housing, social support, home assistance, and legal services. Resilience from weathering a lifetime of discrimination was identified as a strength to handle aging challenges. Recommendations for establishing an aging in place model included establishing welcoming communities and resource centers and increasing cultural competence of service providers. This study provides a unique contribution to understanding the psychosocial, medical, and legal barriers for successfully aging in place.

Gay-friendly elderly care: creating space for sexual diversity in residential care by challenging the hetero norm

Studies on older lesbian, gay, bisexual and transgender (LGBT) adults in residential care point to their discrimination, invisibility and the taboo on LGBT lifestyles, and call for development of ‘gay-friendly’ care. Yet, the literature is short on how to create inclusive residential care for older LGBT people. We aim to acquire in-depth understanding of experiences and needs of LGBT older people concerning their inclusion and participation in care settings to contribute to development of inclusive and responsive care that structurally enhances visibility, ‘voice’ and wellbeing of LGBT residents. Responsive, multi-stakeholder research using interviews, participant observations and focus groups was conducted within three elderly care homes in the Netherlands. Thematic, interpretative analysis was performed. LGBT respondents reported social exclusion and the need to feel safe and at home and be yourself. Exclusive activities for LGBT people foster personal and relational empowerment. However, heterogenous activities seem crucial in dealing with stereotypical imaging, heteronormativity and an equality-as-sameness discourse that influenced culture and daily practice in the homes and negatively affected the position of LGBT older adults. For development of gay-friendly elderly care exclusionary social norms need to be addressed. Dialogical sharing of narratives can help to empower LGBT older adults and stimulate understanding and shared responsibility between LGBT and heterosexual older people, as well as professionals.

Exploring Staff Clinical Knowledge and Practice with LGBT Residents in Long-Term Care: A Grounded Theory of Cultural Competency and Training Needs

OBJECTIVES

Existing literature shows that LGBT residents are likely to face suboptimal care in LTC facilities due to prejudice and discriminatory policies. The aim of this project was to assess the LGBT cultural competency of staff working in LTC facilities, identify their current training needs, and develop a framework for understanding LGBT cultural competency among LTC staff and providers.

METHODS

This grounded theory study comprised data from focus groups of interdisciplinary staff from three LTC facilities.

RESULTS

Results suggested that LTC staff struggle with how to be sensitive to LGBT residents' needs. Tension appeared to exist between wanting to provide an equal standard of care to all LTC residents and fearing they would show "favoritism" or "special treatment," which might be viewed as unprofessional. Participants indicated training could help to address the ambivalence they experience about providing sensitive care to subpopulations of residents who face stigma and oppression.

CONCLUSIONS

LTC staff stand to benefit from cultural competency training focused on LGBT residents. Training should be not only informational in nature, but also facilitate greater self-awareness and self-efficacy with respect to providing care to LGBT people.

Challenges to and opportunities for improving mental health services for lesbian, gay, bisexual, and transgender people in Ireland: a narrative account

The views and opinions of people who use mental health services are being increasingly acknowledged in relation to rights-based, socially-inclusive, and recovery-oriented care. However, little is known of the experiences of lesbian, gay, bisexual, and transgender (LGBT) people in this respect. The aim of the present study was to explore the experiences and needs of LGBT people in relation to mental health services. The study was an exploratory design utilizing mixed methods. Both quantitative and qualitative data were collected using a survey instrument (n = 125) and in-depth semistructured interviews (n = 20) with a sample of people who had completed the survey. This paper will report on the findings from the interview data. The data were thematically analysed, and the main themes that emerged included accessing services, treatment choices, mental health service experiences, and other supports. The findings inform the discussion, and recommendations are made in terms of future mental health practice, education, and research.

Same-sex sexual relationships in the national social life, health and aging project: making a case for data collection

This study describes the previously unexplored subsample of respondents who reported at least 1 same-sex sexual relationship (SSSR) in the National Social Life, Health, and Aging Project (NSHAP). The NSHAP collected data from 3,005 adults (aged 57-85). Approximately 4% (n = 102) of respondents reported at least one SSSR. These sexual minority elders were younger, more educated, were more likely to be working, had fewer social supports, and better physical health. Results may indicate crisis competence in sexual minority elders. Collecting sexual orientation and gender identity data in larger, US-based probability samples would inform the development of appropriate community-based services and supports.

GayBy Boomers' social support: exploring the connection between health and emotional and instrumental support in older gay men

We evaluate the association between emotional and instrumental support and perceived health and depression symptoms in a sample of 182 gay/bisexual men age ≥ 55. Perceived health was positively correlated with number of sources of emotional support and depression was negatively associated with instrumental support and health care providers' knowledge of patients' sexual orientation. Depression mediates the connection between providers' knowledge of patients' sexual orientation and perceived health. Number of sources of emotional support varied negatively with age and ethnic minority status, and positively with living with a partner. Instrumental support seemed to be dependent on living with a partner.

Resilience in attaining and sustaining sobriety among older lesbians with alcoholism

This phenomenological study illuminates coping among older lesbians with alcoholism. Twenty study participants were recruited through purposive and snowball sampling; each completed 3 interviews structured to gain a deeper understanding of participants' lived experiences. This article focuses on the key situations and people that helped study participants obtain sobriety and stay sober. Five major themes emerged from the data: wake-up calls, impact of formal treatment, impact of 12-step recovery groups, consequences from other sources, and resiliency. Findings support the need for culturally sensitive approaches to practice with this subpopulation of older adults.

Domestic harm and neglect among lesbian, gay, and bisexual older adults

This study examined harm, hurt, and neglect by caregivers as well as self-neglect and physical and mental health status among 113 lesbian, gay, and bisexual (LGB) older adults aged 60-88 years, who attended community-based social and recreation programs or groups in the United States. Reporting on their experiences with caregivers, 22.1% of the participants experienced at least one type of harm, including physical, emotional, verbal, sexual, financial, and neglectful; additionally, 25.7% of the participants reported they knew LGB older adults who experienced at least one type of harm from his or her caregiver. With regard to self-neglect, 62.8% reported experiencing it; those indicating positive psychological health reported fewer experiences with self-neglect.

The Greater St. Louis LGBT Health and Human Services Needs Assessment: an examination of the Silent and Baby Boom generations

This study sought to understand differences and similarities between lesbian, gay, bisexual, and transgender (LGBT) Baby Boomers and members of the Silent generation in the greater St. Louis region in relation to perceived barriers to service use, LGBT identity disclosure, experiences of violence and victimization, and mental health. An online survey was completed by 118 Baby Boomers and 33 Silents. Baby Boomers were found to perceive more barriers to health care and legal services, have fewer legal documents in place, feel less safe in their communities, and have experienced an increased rate of verbal harassment compared to their predecessors. Differences may be attributed to higher levels of LGBT identity disclosure among Baby Boomers across their lifetime. These findings support the current work of Services and Advocacy for GLBT Elders Metro St. Louis, with implications for other communities, and shed light on the need for continued advancement in the development and implementation of programs as LGBT Baby Boomers age.

Do LGBT aging trainings effectuate positive change in mainstream elder service providers?

This study aims to provide empirical evidence regarding whether attitudes, beliefs, and intentions of elder-service providers can be positively affected as a result of attending cultural competency training on the unique challenges of sexual and gender minorities. Stigmatization throughout the lifespan may have a causal influence on barriers to care, social isolation, and concomitant health disparities. Data were collected for this study at 4 Massachusetts training events to pilot a cultural competency workshop on lesbian, gay, bisexual, and transgender (LGBT) aging for mainstream elder service providers. This quasi-experimental study included the analysis of pre- and posttest surveys completed by the service-provider attendees (N = 76). The analytic strategy included descriptive statistics, paired t tests, chi-square analyses, and repeated measures analyses of variance. Findings revealed statistically significant improvement in numerous aspects of providers' knowledge, attitudes, and behavioral intentions subsequent to the training sessions. These included (p = .000) awareness of LGBT resources, policy disparities, spousal benefits for same-sex couples, and the intention to challenge homophobic remarks. This study concludes that mainstream elder-service provider training on LGBT aging issues results in positive change. Recommendations include long-term follow up of participants, the inception of agency-level surveys to appraise institutional culture change, and increased curriculum on transgender older adults.

Aging well and gay in rural America: a case study

Using person-environment-fit theory as a theoretical framework, this qualitative case study examined, through in-depth interviews and thematic analysis, the lived experience of an older gay man who has lived solely in rural communities. An overarching theme of life satisfaction clearly emerged, along with themes regarding supportive social networks and disclosure management of his sexual orientation. The findings suggest that although it is important to understand the challenges faced by the lesbian, gay, bisexual, and transgender community in rural environments, it is equally important to shed light on the ways in which older adults age well within these communities.

Stress and mental health among midlife and older gay-identified men

OBJECTIVES

We investigated associations between stress and mental health (positive affect, depressive symptoms) among HIV-negative and HIV-positive midlife and older gay-identified men, along with the mediating and moderating effects of mastery and emotional support. We also studied the mental health effects of same-sex marriage.

METHODS

We obtained data from self-administered questionnaires completed in 2009 or 2010 by a subsample (n = 202; average age = 56.91 years; age range = 44-75 years) of participants in the University of California, Los Angeles component of the Multicenter AIDS Cohort Study, one of the largest and longest-running natural-history studies of HIV/AIDS in the United States.

RESULTS

Both sexual minority stress (perceived gay-related stigma, excessive HIV bereavements) and aging-related stress (independence and fiscal concerns) appeared to have been detrimental to mental health. Sense of mastery partially mediated these associations. Being legally married was significantly protective net of all covariates, including having a domestic partner but not being married. Education, HIV status, and race/ethnicity had no significant effects.

CONCLUSIONS

Sexual minority and aging-related stress significantly affected the emotional lives of these men. Personal sense of mastery may help to sustain them as they age. We observed specific mental health benefits of same-sex legal marriage.

A lesbian older adult managing identity disclosure: a case study

The aim of this study was to explore the experience of an older lesbian in managing the disclosure of her sexual identity. Specifically, the team wanted to better understand the ways she managed her identity in an assisted living facility. Using a qualitative case study methodology, 2 in-depth interviews were conducted. The following 5 themes were identified in the data: keeping her own counsel, maintaining "family" connection, celebrating second chances, living outside the L box, and staying morally centered. Practice and research implications are offered and the case study is used to expand understanding of disclosure management and resiliency theory.