Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis

Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.

Risk of impairment in cognitive instrumental activities of daily living for sexual and gender minority adults with reported Parkinson's disease

Objective: To investigate the risk of impairment in cognitive instrumental activities of daily living (IADL) for people with Parkinson's (PwP) identifying as sexual and/or gender minorities (SGM). Method: Data were obtained from Fox Insight, an online, longitudinal study with self/informant-report questionnaires from PwP and people without Parkinson's. Groups consisted of PwP without cognitive IADL impairment at baseline, identifying as (1) SGM with female sex assigned at birth (SGM-F, n = 75); (2) cisgender, heterosexual with female sex assigned at birth (CH-F, n = 2046); (3) SGM with male sex assigned at birth (SGM-M, n = 84); (4) cisgender, heterosexual with male sex assigned at birth (CH-M, n = 2056). Impairment in cognitive IADL was based on Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15). Group differences for PDAQ-15 and impairment likelihood during follow-up were assessed with unadjusted models and adjusting for variables that differed between the groups. Results: SGM-F were the youngest at Parkinson's diagnosis; SGM-M had the lowest PDAQ-15 at baseline (p ≤ .014 for all). Scores declined more for males than females in unadjusted and adjusted models (p < .001 for both). In unadjusted models, SGM-M had a higher impairment risk than PwP identifying as cisgender and heterosexual (p ≤ .018). In adjusted models, females had a lower impairment risk than males (p < .001). Age, education, and discrimination level were significant moderators (p < .001 for all). Conclusions: SGM-M can be at a higher risk for impairment in cognitive IADL, associated with social determinants. Female sex assigned at birth may be associated with a lower level of impairment risk, although this advantage can disappear with social determinants.

Medical Issues Affecting Older Lesbian and Bisexual Women

Lesbian and bisexual (LB) women are a growing and understudied population in the United States. LB women have unique histories and health experiences and encounter numerous resource and health care disparities that impact healthy aging. Despite LB population growth, little research has investigated the experiences of LB women separately from the broader lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) community. The research that does exist largely focuses on the experiences of younger LB women. Nonetheless, there are unique care considerations providers can enact to improve clinical care and address lifetimes of disparities and discrimination.

Cognitive Impairment in Sexual and Gender Minority Groups: A Scoping Review of the Literature

Purpose: The purpose of this review was to synthesize evidence on differences in cognitive impairment by sexual orientation/gender identity (SOGI) status. Methods: A scoping review of the literature was conducted. Five databases (PubMed/Medline, Cumulated Index to Nursing and Allied Health Literature, Web of Science, PsycInfo, and Embase) were searched for primary articles comparing incidence or prevalence of cognitive impairment among sexual and gender minority (SGM) groups versus non-SGM groups. Two reviewers independently screened articles and conducted risk-of-bias assessment on eligible articles. Results: Fifteen primary studies were eligible. Most studies (n = 13) were cross-sectional, with moderate to critical risk of bias. Among eight studies examining self-reported cognitive impairment, seven reported a higher prevalence among some SGM groups versus non-SGM groups. Among seven studies using objective measures of cognitive impairment, three examined prevalence of clinician-documented diagnosis of dementia, of which two reported a higher prevalence specifically among transgender versus cisgender individuals. Among the other four studies examining objective measures, two reported poorer cognitive performance or memory, one reported better performance, and another reported no difference. Comparisons across studies were challenging due to inconsistencies in how SOGI and cognitive impairment were operationalized, and the factors used for statistical adjustment; some studies adjusted for putative intermediary factors that potentially explain differences in cognitive impairment. Conclusions: Whereas most published studies identified a positive relationship between SOGI status and self-reported cognitive impairment, evidence is mixed with regard to objective cognitive performance. Well-designed longitudinal, observational studies are needed, using objective measures of cognitive function, with careful consideration of confounding versus intermediary risk factors.

Midlife Satisfaction Disparities by Sexual Orientation: Findings from the Health and Retirement Study

Midlife is a pivotal stage shaping healthy aging, and sexual minorities may face more challenges in midlife than heterosexual individuals, due to cumulative social, economic, and health disadvantages. Yet, few studies have examined how life satisfaction in midlife varies by sexual identity. Using data from the 2016 Health and Retirement Study (N=3,630), we conducted logit regressions and Karlson-Holm-Breen (KHB) decomposition analysis to examine how health-related, socioeconomic, and sociopsychological factors contribute to disparities in life satisfaction across sexual orientation groups in middle adulthood. The results show that bisexual individuals, but not gay or lesbian individuals, reported significantly lower life satisfaction than their heterosexual peers because of their poorer health status and behaviors, fewer social resources, and lower socioeconomic status. Our findings suggest that public policies should target continuing the reduction in sexuality-based stigma, particularly biphobia, to mitigate the health, social, and economic disparities linked to diminished well-being among middle-aged bisexual individuals.

Coping with Discrimination: A Longitudinal Study of Health Outcomes in Lesbian, Gay, and Bisexual and Heterosexual Midlife and Older Adults

OBJECTIVES

This study explored how coping moderates the association between discrimination and health outcomes in lesbian, gay, and bisexual (LGB) and heterosexual midlife and older adults.

METHODS

This study analyzed longitudinal data from 163 LGB and 326 propensity-matched heterosexual midlife and older adults over approximately 20 years, using the Midlife in the United States study.

RESULTS

Discrimination was associated with slower chronic condition accumulation over time for LGB individuals. Problem-focused and avoidance coping moderated discrimination's impact on mental health in LGB participants over time, and in heterosexual participants, they moderated the association between discrimination and chronic conditions.

DISCUSSION

The results suggest a potential "steeling" effect in LGB midlife and older adults facing higher discrimination levels. Furthermore, the findings suggest that effective coping strategies for mitigating the adverse impacts of discrimination on physical and mental health may vary by sexual orientation.

Frailty Among Sexual and Gender Minority Older Adults: The All of Us Database

BACKGROUND

Despite known disparities in health status among older sexual and gender minority adults (OSGM), the prevalence of frailty is unknown. The aim of this study was to develop and validate a deficit-accumulation frailty index (AoU-FI) for the All of Us database to describe and compare frailty between OSGM and non-OSGM participants.

METHODS

Developed using a standardized approach, the AoU-FI consists of 33 deficits from baseline survey responses of adults aged 50+. OSGM were self-reported as "not straight" or as having discordant gender and sex assigned at birth. Descriptive statistics characterized the AoU-FI. Regression was used to assess the association between frailty, age, and gender. Validation of the AoU-FI used Cox proportional hazard models to test the association between frailty categories (robust <0.15, 0.15 ≤ pre-frail ≤ 0.25, frail >0.25) and mortality.

RESULTS

There were 9 110 OSGM and 67 420 non-OSGM with sufficient data to calculate AoU-FI; 41% OSGM versus 50% non-OSGM were robust, whereas 34% versus 32% were pre-frail, and 26% versus 19% were frail. Mean AoU-FI was 0.19 (95% confidence interval [CI]: 0.187, 0.191) for OSGM and 0.168 (95% CI: 0.167, 0.169) for non-OSGM. Compared to robust, odds of mortality were higher among frail OSGM (odds ratio [OR] 6.40; 95% CI: 1.84, 22.23) and non-OSGM (OR 3.96; 95% CI: 2.96, 5.29).

CONCLUSIONS

The AoU-FI identified a higher burden of frailty, increased risk of mortality, and an attenuated impact of age on frailty among OSGM compared to non-OSGM. Future work is needed to understand how frailty affects the OSGM population.

Disparities in physical activity between sexual minority and heterosexual women: A systematic review and meta-analysis

Research examining potential differences in physical activity (PA) between sexual minority women (SMW) and heterosexual women have yielded inconsistent results.

OBJECTIVE

Therefore, the purpose of this systematic review and meta-analysis is to examine potential differences in PA between SMW and heterosexual women and to identify potential moderators that may partially explain observed differences in PA.

METHODS

All studies were peer reviewed, published in English, and included a continuous measure of PA for SMW and heterosexual women. A standardized mean difference effect size (ES) was used to compare groups, with random effects models used to estimate a mean ES and 95% CI using a 3-level meta-analysis model to adjust for the correlation between effects nested within studies.

RESULTS

The cumulative results of 24 effects gathered from 7 studies indicated there was no difference in PA between SMW (n = 1619) and heterosexual women (n = 103,295) (ES = -0.038, 95%CI -0.179 to 0.102, p = 0.576). Despite no mean differences, moderate-high heterogeneity was observed, indicating that the results were not consistent across effects (I2 = 64.8%, Q23 = 36.7, p = 0.035). The difference in PA was associated with age (β = -0.018, 95%CI -0.034 to -0.003, p = 0.022) and BMI (β = -0.145, 95%CI -0.228 to -0.061, p = 0.002), with a quadratic relationship observed for both variables.

CONCLUSIONS

Although the results of the current analysis did not indicate significant differences in PA behaviors between SMW and heterosexual women, age and BMI modify the association and are curvilinear in nature; such that smaller differences in PA were observed between SMW and heterosexual women when samples were middle-aged and overweight.

Identifying Healthcare Stereotype Threat in Older Gay Men Living with HIV

Healthcare stereotype threat (HCST) is defined as "being reduced to group stereotypes within an individual's healthcare encounter," leading to experiences of stigma and discrimination. This current study explores how older gay men living with HIV attribute their healthcare experiences to their social identities. Using HCST as a guiding framework, a content and structural coding analysis was conducted on transcripts from 11 interviews of older gay men living with HIV. The majority of HCST experiences were connected to the social identities of sexual orientation, HIV status, and age. Many of the healthcare experiences that participants discussed were related to interactions with healthcare providers and the attitudes of healthcare providers. This study illustrates how participants attributed social identities to healthcare experiences that showed qualities of HCST. These outcomes highlight how marginalized social identities impacted the lifetime healthcare experiences of this group of older gay men living with HIV.

Making Home: The Role of Social Networks on Identity, Health, and Quality of Life Among Rural Lesbian and Gay Older Adults

Background and Objectives

Gay and lesbian older persons face a host of health inequalities related to their identity as they age. Challenges to health access and appropriate social support may be even more exacerbated for those living in rural environments; this may be due to the lack of supportive and affirming social connections. This project aimed to explore and describe the social networks and the relationship of these social networks to identity, health, and quality of life of gay and lesbian individuals in rural communities.

Research Design and Methods

Social network data on network type, size, and social capital were collected and supplemented by quantitative questionnaires relating to health, quality of life, marginalization, and identity.

Results

Participants (N = 25) were recruited from three states. Thirteen participants self-identified as gay and 12 as lesbian. All but one identified as non-Hispanic White. The average age of all participants was 60.32 years. Findings indicate that rural gay and lesbian individuals develop networks with little consideration for network members' acceptance of their identity. Participants reported an average network size of 9.32 individuals. Gay men reported higher perceptual affinity (.69) than lesbian participants (.62). Lesbian networks showed significantly (p = .0262) greater demographic similarity (.58) than aging gay men's networks (.55). Aging gay men (.89) reported statistically stronger (p = .0078) network ties than aging lesbian females (.78). Among participants in this study, network size is not correlated with the health and quality of life of rural aging lesbian and gay individuals. Still, personal identity congruence does appear to relate to health and quality of life.

Discussion and Implications

The findings highlight the collective need to continue research into sexual minority aging and rural sexual minority aging, particularly employing novel methods.

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.

Inclusive Care Practices and Policies Among Sexual and Gender Minority Older Adults

As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [Journal of Gerontological Nursing, 48(12), 6-15.].

Divergent patterns of cognitive deficits and structural brain alterations between older adults in mixed-sex and same-sex relationships

Background

Sexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR.

Methods

Data were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse/partner, and availability of T1-MRI brain volumes/thickness. Participants were labeled as either SSR or MSR based on their/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR-555 cognitively unimpaired [CU]; 36 SSR-23 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (n = 939; 908 MSR-494 CU; 31 SSR-22 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.

Results

Multivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.

Conclusion

In our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation.

A Comparative Analysis of Family Quality of Life Between Heterosexual and Sexual Minority Caregivers of People with Dementia

Providing care for someone with Alzheimer's disease or related dementias (ADRD) is associated with significant physical and mental strain affecting quality of life among caregivers. However, little attention has been given to sexual minority (SM; lesbian, gay, bisexual, queer) people caring for those with ADRD. In this cross-sectional study, we used psychosocial measures to describe the characteristics and family quality of life of SM and heterosexual caregivers for people with ADRD. SM caregivers were significantly younger and more frequently reported full or part-time employment compared with their heterosexual counterparts. Lesbian and bisexual caregivers reported more difficulty in paying for everyday basics. After controlling for demographic covariates, SM caregivers had significantly higher family quality of life scores compared with heterosexual caregivers. This study is among the first to compare family quality of life between SM and heterosexual caregivers. Findings can guide development of targeted interventions for SM caregivers.

Functional Limitations and Access to Long-Term Services and Supports Among Sexual Minority Older Adults

Objective: Little is known about sexual minority (SM) older adults' activities of daily living (ADL) and instrumental activities of daily living (IADL) limitations and their subsequent access to long-term services and supports (LTSS). Methods: We analyzed cross-sectional data from the 2016 Health and Retirement Study limited to individuals ≥50 years old. Bivariate analyses were performed to examine 1) sexual identity differences in the prevalence of ADL/IADL limitations and 2) associations of sexual identity with having ADL/IADL limitations and having access to help with ADL/IADL limitations. Results: Our sample consisted of 3833 older adults, 6% (n = 213) were SM. Compared to heterosexual participants, bisexual older adults had greater reports of ADL/IADL limitations (20.9% vs. 35.9%, p = 0.013). Among those who reported having ADL/IADL limitations (n = 803), there were no sexual identity differences in accessing help for ADL/IADL limitations (p = .901). Discussion: Our findings contribute to the limited research on LTSS access among SM older adults.

Disparities in Mental Health and Well-Being between Heterosexual and Sexual Minority Older Adults during the COVID-19 Pandemic

Objectives: This study examines disparities in older adults’ mental health and well-being during the pandemic by sexual minority status. Methods: This study analyzed data on older adults from the Health and Retirement Study’s COVID-19 Module (N = 3142 for heterosexuals and N = 75 for sexual minorities). Weighted regressions linked concern about COVID-19, depression, pandemic emotional stress, and changes in loneliness, in-person contacts, income, and work to sexual minority status, controlling for sociodemographic characteristics. Results: Compared to heterosexuals, sexual minority older adults had more concern about the pandemic and emotional stress and showed a decrease in in-person contact during the pandemic—these differences were not explained by sociodemographic characteristics. Sexual minority older adults were also more likely to have changes in income and work during the pandemic, but these differences were explained by sociodemographic characteristics. Discussion: Sexual minority older adults have experienced worse mental health outcomes than heterosexuals during the COVID-19 pandemic, which merits intervention.

Prospective Associations between Physical Activity and Memory in the Canadian Longitudinal Study on Aging: Examining Social Determinants

Objectives

To examine associations between physical activity (PA) and prospectively assessed memory in a cohort of cognitively healthy adults, after accounting for understudied social determinants.

Methods

We used data from the Canadian Longitudinal Study on Aging (CLSA). PA (exposure) and memory (outcome) were assessed using validated measures in 2013–2015 and 2015–2018, respectively. Respondents reported their daily number of hours spent engaging in five different PAs. We conducted multiple imputation and used linear regression (n = 41,394), adjusting for five categories of covariates: demographics, sensory health characteristics, health behaviors, health status, and social determinants (sex/gender, education, income, social support, perceived social standing, race, and sexual orientation).

Results

In crude models, nearly every intensity and duration of PA was associated with better memory. In fully adjusted models, protective associations were attenuated; however, some associations held: all durations of walking, most durations of light activities, moderate activities for ≥1 hour, and strenuous activities for 1 to <2 hours.

Discussion

Some forms of PA may be associated with better memory. The benefits of higher intensity PA may only be realized after social determinants are addressed.

Sexual Identity and Self-Rated Health in Midlife: Evidence from the Health and Retirement Study

Purpose: This study examined health disparities among U.S. sexual minority people in midlife—a critical life course stage that is largely overlooked in the sexual minority health literature.

Methods: Data were drawn from the 2016 Health and Retirement Study. We restricted the analysis to respondents aged 50–65. The final sample consisted of 3623 respondents, including 3418 self-identified heterosexual individuals, 99 self-identified gay/lesbian individuals, 38 self-identified bisexual individuals, and 68 respondents who identified as “something else.” Ordinal logistic regression models were estimated to predict the odds of reporting better health.

Results: Bisexual midlifers reported significantly worse health than their heterosexual counterparts after age, gender, and race-ethnicity are controlled for (OR=0.43, 95% CI=0.25–0.76); this health disparity is mostly explained by marital status, socioeconomic status, and health behaviors (in particular smoking and exercising). We did not find evidence of a self-rated health disadvantage among gay and lesbian midlifers relative to their heterosexual counterparts.

Conclusion: These findings highlight the diversity of the sexual minority population in midlife. Public policies and programs should be designed and implemented at the interpersonal and institutional levels to eliminate health and other social disadvantages among sexual minority people, in particular bisexual people, in midlife.

Characteristics of Sexual and Gender Minority Caregivers of People With Dementia

Objectives: Given what little is known about the experiences of sexual and gender minority (SGM) caregivers of people with Alzheimer's disease and related dementias (ADRD), the aim of the current study was to describe psychosocial measures among these caregivers. Methods: We used an online survey and social media recruitment strategies. Results: Of 286 caregivers, the majority were gay men. Most respondents were white, with a third identifying as Latino American. The plurality of caregivers identified as a spouse/partner and were providing care for someone who identified as a sexual minority; one-fifth cared for someone transgender. Sexual orientation, perceived stress, caregiver stigma, and microaggressions were psychosocial factors associated with family quality of life and depressive symptoms in the caregivers. Discussion: This study is the first to provide a focused description of the characteristics and psychosocial needs of SGM caregivers of someone with ADRD, supporting development of targeted interventions for this population.

Same-Sex Couples and Cognitive Impairment: Evidence From the Health and Retirement Study

OBJECTIVES

We provide the first nationally representative population-based study of cognitive disparities among same-sex and different-sex couples in the United States.

METHODS

We analyzed data from the Health and Retirement Study (2000-2016). The sample included 23,669 respondents (196 same-sex partners and 23,473 different-sex partners) aged 50 and older who contributed to 85,117 person-period records (496 from same-sex partners and 84,621 from different-sex partners). Cognitive impairment was assessed using the modified version of the Telephone Interview for Cognitive Status. Mixed-effects discrete-time hazard regression models were estimated to predict the odds of cognitive impairment.

RESULTS

The estimated odds of cognitive impairment were 78% (p < .01) higher for same-sex partners than for different-sex partners. This disparity was mainly explained by differences in marital status and, to a much lesser extent, by differences in physical and mental health. Specifically, a significantly higher proportion of same-sex partners than different-sex partners were cohabiting rather than legally married (72.98% vs. 5.42% in the study sample), and cohabitors had a significantly higher risk of cognitive impairment than their married counterparts (odds ratio = 1.53, p < .001).

DISCUSSION

The findings indicate that designing and implementing public policies and programs that work to eliminate societal homophobia, especially among older adults, is a critical step in reducing the elevated risk of cognitive impairment among older same-sex couples.

Elevated Risk of Cognitive Impairment Among Older Sexual Minorities: Do Health Conditions, Health Behaviors, and Social Connections Matter?

BACKGROUND AND OBJECTIVES

Little research has examined cognitive health disparities between sexual minority and heterosexual populations. Further, most extant studies rely on subjective measures of cognitive functioning and non-probability samples. This study uses a performance-based cognitive screening tool and a nationally representative sample of older Americans to examine the disparity in cognitive impairment by sexual orientation and the potential mechanisms producing this disparity.

RESEARCH DESIGN AND METHODS

Using data from the 2015-2016 National Social Life, Health, and Aging Project (N = 3,567), we analyzed respondents' scores on the survey-adapted Montreal Cognitive Assessment. We estimated ordinal logit regressions to examine the relationship between sexual orientation and cognitive impairment and used the Karlson-Holm-Breen method to assess how mental and physical conditions, health behaviors, and social connections mediate this relationship.

RESULTS

The prevalence of cognitive impairment is significantly higher among sexual minority older adults than among heterosexual older adults when sociodemographic factors are adjusted for. Depressive symptoms explain some of this prevalence gap. Although anxiety symptoms, physical comorbidity, health behaviors, and social connections may contribute to cognitive impairment, they do not explain the cognitive disparity by sexual orientation.

DISCUSSION AND IMPLICATIONS

The findings indicate that depressive symptoms are an important link between minority sexual orientation and cognitive impairment and highlight the importance of studying other potential mechanisms that we could not explore in this study. Future research should further investigate how minority stress processes may unfold to accelerate cognitive decline among sexual minorities over the life course.

Predictors of Mind-Body Therapy Use Among Sexual Minority Older Adults

Introduction: Sexual minority (SM; lesbian, gay, bisexual) older adults age 50+ experience a higher prevalence of chronic disease and disability, as well as a poorer physical and mental health status, compared with their heterosexual peers. Many adults use complementary and integrative therapies, particularly mind-body therapies, as health-enhancing approaches and to support well-being. However, no study to date has examined the use of mind-body therapies among SM older adults. Materials and Methods: Data were from the 2017 National Health Interview Survey. Descriptive and summary statistics were calculated to describe use of mind-body therapies by SM older adults (aged 50+). The authors also tested associations between use of mind-body therapies and health and well-being among SM older adults and compared associations with their non-SM counterparts. Results: SM older adults reported higher usage (36%) of mind-body therapies compared with heterosexual adults (22%), with lesbian women reporting the highest use (39.4%). Having a SM identity was associated with mind-body therapy use; SM older adults were 57% more likely to use a mind-body therapy. Conclusion: Mind-body therapies may be a useful tool for SM older adults to enhance their health and well-being. Future qualitative research is needed to investigate more deeply the reasons SM older adults use mind-body therapies. To advance the health and well-being of SM older adults, the authors also need intervention studies that explore the effectiveness of mind-body interventions and the possible need for tailoring these to the unique needs of this population.

Does Sexual Orientation Influence Trajectories of Change in Health? A 20-Year Follow-Up Study

Purpose: We examined the differences in physical health outcomes over a 20-year period between lesbian, gay, and bisexual (LGB) adults and heterosexual adults. We also examined whether the associations were moderated by social support and affect. Methods: The analytical sample included 168 LGB adults and 336 1:2 propensity-matched heterosexual adults from the Midlife in the United States (MIDUS) study. Using negative binomial generalized estimating equations and mixed effect analyses, data from three waves of MIDUS, spanning from 1995 to 2014, were used to examine the associations between sexual orientation and the health outcomes (number of chronic conditions and functional limitations). Social support and affect were added to the models to test for moderation. Results: LGB participants reported almost one more chronic condition at baseline and scored significantly higher for functional limitations. However, the number of chronic conditions for LGB participants increased less over time than compared to heterosexual participants, and there were no significant differences in terms of changes in functional limitation over time. Positive affect reduced the strength of the relationship between sexual orientation and functional limitations for LGB participants. No other moderating effects were significant. Conclusion: The results of this study suggest that LGB individuals may become resilient to the negative health effects of minority stressors over time. Interventions should focus on improving the health of LGB individuals when they are younger and more at risk of negative health outcomes.