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Fredriksen-Goldsen KI, Nelson CL, Kim HJ, Romanelli M. Sexual and Gender Identity Properties and Associations With Physical and Mental Health Among SGM Midlife and Older Adults: Findings From Aging With Pride: National Health, Aging, and Sexuality/Gender Study. Res Aging 2025; 47:3-20. [PMID: 39540597 DOI: 10.1177/01640275241256989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Objectives: Unidimensional measures of sexual and gender identity are most often used in research. Yet, sexuality and gender are defined by complex characteristics. Guided by the Health Equity Promotion Model, we assess multidimensional properties of sexual and gender identity. Methods: This study utilizes 2016 survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) to investigate properties of identity (affirmation, visibility, centrality, integration, congruence, continua, transformation) and their association with multimorbidity, disability, general health, depression, quality of life among SGM adults (N = 2233), 50 and older. Results: Higher affirmation, centrality, congruence, and transformation were associated with better health, while identity integration and continua were associated with some adverse health outcomes. Bisexual men, sexually diverse and transgender individuals had the lowest identity centrality and visibility. Discussion: The findings necessitate a multidimensional approach to identity and the use of measures that are comprehensive and responsive to sexual and gender diversity.
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Affiliation(s)
| | - Christi L Nelson
- School of Social Work, Goldsen Institute, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- School of Social Work, Goldsen Institute, University of Washington, Seattle, WA, USA
| | - Meghan Romanelli
- School of Social Work, Goldsen Institute, University of Washington, Seattle, WA, USA
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Nelson CL, Oswald AG, Jung HH, Fredriksen-Goldsen KI. Racial and Ethnic Variations in Resilience Factors Among Sexual and Gender Minority Midlife and Older Adults. THE GERONTOLOGIST 2024; 64:gnae100. [PMID: 39132715 PMCID: PMC11407853 DOI: 10.1093/geront/gnae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to understanding strengths in the SGM community in the context of aging. RESEARCH DESIGN AND METHODS Using weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this research investigates distinct risk and protective factors associated with resilience among SGM midlife and older adults. Subgroup variations were assessed using regression models. Factors moderated by race/ethnicity were integrated into final interaction models. RESULTS Hispanic and Black individuals showed significantly higher resilience than non-Hispanic Whites. Lifetime victimization and day-to-day discrimination were negatively associated with resilience. Positive associations were found for higher income, identity affirmation, larger network size, greater social participation, increased physical activity, and sufficient food intake. Interaction models revealed nuanced patterns by subgroups; education negatively impacted resilience among Black individuals, while income positively influenced Hispanic individuals' resilience. The Other racial/ethnic group demonstrated unique associations between optimal sleep and resilience. DISCUSSION AND IMPLICATIONS This study shifts from a deficit-based to a resilience-focused approach among SGM midlife and older adults, revealing key strengths within diverse subgroups. Results underscore the significance of recognizing racial/ethnic differences in factors promoting resilience and posing risks for SGM midlife and older adults. Tailoring interventions to address the intersectional needs of SGM aging populations is essential for enhancing their abilities to bounce back from adverse events.
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Affiliation(s)
- Christi L Nelson
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Austin G Oswald
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Hailey H Jung
- Goldsen Institute, School of Social Work, University of Washington, Seattle, Washington, USA
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Stinchcombe A, Oueis J, Wilson K, Wright DK. Safer dementia care spaces: Perspectives from LGBTQ+ people with cognitive impairment and caregivers. DEMENTIA 2024:14713012241284691. [PMID: 39293818 DOI: 10.1177/14713012241284691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
The number of caregivers and people living with dementia and other related forms of cognitive impairment is increasing worldwide. Compared to heterosexual and cisgender individuals, studies suggest that lesbian, gay, bisexual, queer, or other sexual and/or gender minority people (LGBTQ+) are at a higher risk for known risk factors for cognitive impairment and dementia, stemming from minority stress experiences. Limited research has explored the distinct obstacles that LGBTQ+ people with cognitive impairment and caregivers encounter, especially within dementia care. The purpose of this study was to deepen our understanding regarding LGBTQ+ people with cognitive impairment and caregivers' experiences with dementia care spaces, and to identify the strategies that they perceive as effective in creating safer and more inclusive spaces. Fourteen LGBTQ+ participants aged 27-78 (M = 58.07), consisting of two individuals with cognitive impairment and 12 caregivers, were interviewed about the care needs of LGBTQ+ people with cognitive impairment and caregivers, and their experiences with dementia care spaces. Using reflexive thematic analysis, we identified three overarching themes from the data, indicating that LGBTQ+ people with cognitive impairment and caregivers feel left "on the margins" of dementia care and express a desire for their identities to be celebrated and recognized. Additionally, they proposed recommendations for policy change to foster safer and more inclusive spaces for dementia care. The findings call attention to the negative experiences of LGBTQ+ people with cognitive impairment and caregivers with dementia care, but also highlight the ways in which care practices can be transformed to effectively address their care needs.
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Affiliation(s)
| | - Jeremy Oueis
- School of Psychology, University of Ottawa, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Canada
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Emmanuelli B, Knorst JK, Amaral-Júnior OLD, Fagundes MLB, Giordani JMDA, Ardenghi TM. Discrimination due to sexual orientation and oral health-related quality of life among adolescents. Braz Oral Res 2024; 38:e085. [PMID: 39292124 PMCID: PMC11404854 DOI: 10.1590/1807-3107bor-2024.vol38.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 06/14/2024] [Indexed: 09/19/2024] Open
Abstract
To evaluate the association between discrimination based on sexual orientation and oral health-related quality of life (OHRQoL) in adolescents. This was a cross-sectional study nested in a cohort performed in southern Brazil. The baseline assessment was carried out in 2010 with a sample of preschoolers (1 to 5 years). Subsequently, these individuals were reassessed, and for the present study, only the data from the final follow-up in 2020 were considered. OHRQoL was assessed by the short version of the Child Perceptions Questionnaire 11-14 (CPQ11-14). The discrimination due to sexual orientation was measured using item 10 of the Olweus Bully/Victim Questionnaire. Sociodemographic (sex, age, skin color, maternal education, household income) psychosocial (sense of coherence), and clinical variables (untreated dental caries) were also evaluated. Multilevel Poisson regression analysis was performed to verify the associations. Results are present as rate ratio (RR) and 95% confidence interval (95% CI). A total of 429 adolescents were evaluated - about 67.1% of those assessed at baseline. The prevalence of discrimination due to sexual orientation was 3.3%. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented overall CPQ11-14 scores 16% higher (RR 1.16, 95%CI 1.01-1.36) than their counterparts. Adolescents who reported suffering episodes of discrimination due to sexual orientation presented poorer OHRQoL.
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Affiliation(s)
- Bruno Emmanuelli
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | - Jessica Klöckner Knorst
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
| | | | | | | | - Thiago Machado Ardenghi
- Universidade Federal de Santa Maria - UFSM, School of Dentistry, Department of Stomatology, Santa Maria, RS, Brazil
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LaManna JB, Loerzel V, Conner NE. Lived experiences of older male caregivers: "That was the Worst!". Geriatr Nurs 2024; 55:277-285. [PMID: 38104439 DOI: 10.1016/j.gerinurse.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Although caregiving is a traditional female role, older men represent an increasing proportion of family caregivers. This study's aim was to describe lived experiences of men who engaged in later-life caregiving. METHOD Streubert's phenomenological method, inclusive of unstructured interviews and respondent validation of a single formalized description, was applied to explore lived experiences of eight older male caregivers. RESULTS Three overarching themes characterized older male caregiving: 1) role and life changes, 2) "taking care of business," and 3) getting over "the worst". All caregivers spent extensive time in anticipatory planning for potential problems and were dissatisfied with existing resources and services. Each man described a profound, mentally-challenging caregiving crisis that triggered important caregiving decisions. DISCUSSION Study findings support an urgent need for research to clarify the mental health needs of older male caregivers and to test interventions that better meet the unique needs of this growing caregiver demographic.
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Affiliation(s)
| | - Victoria Loerzel
- University of Central Florida College of Nursing, Orlando, FL, United States
| | - Norma E Conner
- University of Central Florida College of Nursing, Orlando, FL, United States
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Fredriksen-Goldsen K, Teri L, Kim HJ, La Fazia D, McKenzie G, Petros R, Jung HH, Jones BR, Brown C, Emlet CA. Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners. Contemp Clin Trials 2023; 128:107143. [PMID: 36893987 PMCID: PMC10639124 DOI: 10.1016/j.cct.2023.107143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.
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Affiliation(s)
| | - Linda Teri
- University of Washington, School of Nursing, Box 357260, Seattle, WA 98195, USA.
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - David La Fazia
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Glenise McKenzie
- Oregon Health & Sciences University, School of Nursing, 3076, 3455 SW US Veterans Hospital Rd, Portland, OR 97239, USA.
| | - Ryan Petros
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Hailey H Jung
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Brittany R Jones
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Char Brown
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
| | - Charles A Emlet
- University of Washington, School of Social Work, 4101 15(th) Ave NE, Seattle, WA 98105, USA.
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Turpin R, Giorgi S, Curtis B. Pandemic distress associated with segregation and social stressors. Front Public Health 2023; 11:1092269. [PMID: 37033081 PMCID: PMC10080044 DOI: 10.3389/fpubh.2023.1092269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background Racial/ethnic minorities are disproportionately impacted by the COVID-19 pandemic, as they are more likely to experience structural and interpersonal racial discrimination, and thus social marginalization. Based on this, we tested for associations between pandemic distress outcomes and four exposures: racial segregation, coronavirus-related racial bias, social status, and social support. Methods Data were collected as part of a larger longitudinal national study on mental health during the pandemic (n = 1,309). We tested if county-level segregation and individual-level social status, social support, and coronavirus racial bias were associated with pandemic distress using cumulative ordinal regression models, both unadjusted and adjusted for covariates (gender, age, education, and income). Results Both the segregation index (PR = 1.19; 95% CI 1.03, 1.36) and the coronavirus racial bias scale (PR = 1.17; 95% CI 1.06, 1.29) were significantly associated with pandemic distress. Estimates were similar, after adjusting for covariates, for both segregation (aPR = 1.15; 95% CI 1.01, 1.31) and coronavirus racial bias (PR = 1.12; 95% CI 1.02, 1.24). Higher social status (aPR = 0.74; 95% CI 0.64, 0.86) and social support (aPR = 0.81; 95% CI 0.73, 0.90) were associated with lower pandemic distress after adjustment. Conclusion Segregation and coronavirus racial bias are relevant pandemic stressors, and thus have implications for minority health. Future research exploring potential mechanisms of this relationship, including specific forms of racial discrimination related to pandemic distress and implications for social justice efforts, are recommended.
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Affiliation(s)
- Rodman Turpin
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, United States
| | - Salvatore Giorgi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
| | - Brenda Curtis
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
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