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Jordan M, Latham-Mintus K, Patterson SE. A Care Paradox: The Relationship Between Older Adults' Caregiving Arrangements and Institutionalization and Mortality. Res Aging 2024; 46:363-385. [PMID: 38253335 DOI: 10.1177/01640275241229416] [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] [Indexed: 01/24/2024]
Abstract
We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004-2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care.
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Affiliation(s)
- Meggan Jordan
- Department of Sociology, Gerontology, and Gender Studies, California State University Stanislaus, Turlock, CA, USA
| | - Kenzie Latham-Mintus
- Department of Sociology, Indiana University-Purdue University, Indianapolis, IN, USA
| | - Sarah E Patterson
- Institute of Social Research, University of Michigan, Ann Arbor, MI, USA
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Worrell S, Waling A, Anderson J, Lyons A, Pepping CA, Bourne A. 'It feels meaningful': How informal mental health caregivers in an LGBTQ community interpret their work and their role. CULTURE, HEALTH & SEXUALITY 2024; 26:808-823. [PMID: 37705445 DOI: 10.1080/13691058.2023.2256833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Many members of lesbian, gay, bisexual, trans and gender diverse, and queer (LGBTQ) communities provide informal mental health support to peers. This type of support is valuable for people who receive it - even helping to prevent suicide. It is also meaningful to those who provide it. In this article, we focus on how LGBTQ people derive meaning from their experiences of supporting peers. In-depth interviews with 25 LGBTQ people in Melbourne, Australia, indicate that those providing informal mental health support to fellow community members recognise their roles as meaningful in three main ways: in terms of self, relationships and communities. Recognising the meanings that LGBTQ caregivers derive from helping fellow community members provides useful information service providers and policymakers seeking to better address mental distress in LGBTQ communities and support caregivers. It is useful to understand this meaningful work in an LGBTQ context as caregiving that challenges gendered and heteronormative assumptions about what care is, and who provides it.
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Affiliation(s)
- Shane Worrell
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Gibb JK, Williams S, Mikelsteins K, Charles J, McKinnon L, Beach L, McKerracher L, Fields J. Queering food security research: A critical analysis of 2SLGBTQ+ People's experiences of food insecurity in Toronto during the COVID-19 pandemic. Soc Sci Med 2024; 345:116709. [PMID: 38422687 DOI: 10.1016/j.socscimed.2024.116709] [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: 05/29/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Household food insecurity (HFI), stress, isolation, and discrimination are major determinants of health that disproportionately affect 2SLGBTQ + people. The COVID-19 pandemic potentially exacerbated these inequities. This study investigates HFI rates among 2SLGBTQ + adults living in diverse household conditions during the pandemic and explores the idea that heteronormative conceptions of the "household" may affect measurement of HFI. METHODS Cross-sectional survey responses were collected from 437 self-identified 2SLGBTQ + people from Toronto, Canada between March and July 2021. The survey measured HFI, sexual/gender identities, socio-demographic factors, household composition, and psycho-social stress/distress. Multinomial logistic regression was used to assess variation in odds of marginal, moderate, and severe HFI in relation to sexual/gender identities, household composition, psycho-social distress, and socio-demographic covariates. RESULTS Forty-two percent of respondents reported some level of HFI, with severe HFI higher among respondents who were bisexual, transgender/gender diverse, and/or assigned-female-at-birth. Living alone was associated with decreased odds of reporting marginal HFI but increased odds of moderate or severe HFI compared to living with a partner, family, or roommates; living with children was associated with decreased odds of both marginal and severe HFI. One indicator of psycho-social distress (perceived discrimination) was associated with higher odds of all levels of HFI, while the other (isolation) was associated with decreased odds of marginal HFI. CONCLUSION These findings highlight the high prevalence of HFI linked with discrimination among 2SLGBTQ + individuals during the pandemic. The complicated results regarding household composition and social isolation may suggest a need to revise definitions of the household when measuring, monitoring, and seeking to mitigate HFI in 2SLGBTQ + communities.
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Affiliation(s)
- James K Gibb
- Department of Anthropology, Northwestern University, Evanston, USA; Department of Health & Society, University of Toronto Scarborough, Toronto, Canada.
| | - Sarah Williams
- Department of Anthropology, University of Connecticut, Storrs, USA
| | - Kaspars Mikelsteins
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada
| | - Jada Charles
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Leela McKinnon
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Laura Beach
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Luseadra McKerracher
- Aarhus Institute for Advanced Studies and Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jessica Fields
- Department of Health & Society, University of Toronto Scarborough, Toronto, Canada; Department of Sociology, University of Toronto, Toronto, Canada
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Zhang ZM, Smith-Johnson M, Gorman BK. Who Cares? Unpaid Caregiving by Sexual Identity, Gender, and Partnership Status Among U.S. Adults. Demography 2024; 61:115-140. [PMID: 38206071 DOI: 10.1215/00703370-11145841] [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: 01/12/2024]
Abstract
Recent scholarship indicates that sexual minority adults have higher caregiving rates than heterosexuals and that women are more likely to be caregivers than men. However, little research has addressed how gender and sexuality intersect in shaping caregiving status. This study uses data from the Behavioral Risk Factor Surveillance System and aggregates a probability-based sample of adults living in 36 U.S. states between 2015 and 2021. We examine who provides care among adult heterosexual, lesbian, gay, and bisexual men and women. Results reveal that women are more likely to be caregivers than men, but only among heterosexuals. We find little variation in caregiving by sexuality among women, but bisexual men are more likely than heterosexual men to be caregivers; the latter result appears to be driven by unpartnered, bisexual men. Lastly, we contextualize caregivers' experiences and reveal selected descriptive differences in patterns of care recipient-caregiver relationships across gender and sexual identity groups. Our findings advance understanding of caregiving and changing family ties in an era of population aging and increasing diversity in sexual identities.
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Affiliation(s)
- Zhe Meredith Zhang
- Department of Sociology, California State University, Los Angeles, CA, USA
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5
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Allison K, Power R, Ussher JM, Perz J. "Queer people are excellent caregivers, but we're stretched so very thin": Psychosocial wellbeing and impacts of caregiving among LGBTQI cancer carers. BMC Cancer 2024; 24:36. [PMID: 38182998 PMCID: PMC10768402 DOI: 10.1186/s12885-023-11732-2] [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: 06/06/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND LGBTQI (lesbian, gay, bisexual, transgender, queer and/or intersex) communities are increasingly recognized as a vulnerable and high-risk population in oncology. LGBTQI cancer carers, including carers who are LGBTQI and other carers of LGBTQI people, experience many of the same stressors as LGBTQI patients but their support needs are often overlooked in the cancer literature. METHOD This mixed-methods study examined distress and quality of life in LGBTQI cancer carers. Online surveys were completed by 129 carers and 31 carers took part in a one-to-one semi-structured interview. Analyses of variance (ANOVAs) tested for differences in psychosocial outcomes and carer experiences by gender, sexuality, age, carer relationship and carer/patient LGBTQI status. Reflexive thematic analysis of interviews and open-ended survey responses facilitated in-depth examination of subjective experiences. RESULTS 42.6% of participants reported high or very high distress. Distress was significantly positively correlated with discrimination in cancer care, health impact, financial impact and lack of family support; it was negatively correlated with comfort in LGBTQI sexuality and gender identity, social support and quality of life. Four themes were identified in thematic analysis of qualitative data: (1) Identity on the sidelines: LGBTQI sexuality and gender pushed aside during cancer caregiving; (2) Fear of being shut-out: rejection and exclusion of LGBTQI cancer carers; (3) Lack of support for LGBTQI caregivers; and (4) Closer and stronger relationships due to a culture of mutual caregiving. CONCLUSIONS LGBTQI cancer carers must contend with typical caregiving demands whilst also managing additional minority stressors, including discrimination, rejection from family, isolation from LGBTQI communities, and invisibility in healthcare and support services. Despite this, LGBTQI carers showed resilience in building their own mutually supportive networks to rally around the person with cancer, which were reported to ameliorate psychosocial vulnerabilities. Service providers need to recognize the needs of LGBTQI cancer carers through inclusive and reflective practices. This will facilitate trust and patient and carer sexuality and gender identity disclosure, with positive consequences for wellbeing and satisfaction with cancer care.
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Affiliation(s)
- Kimberley Allison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Rosalie Power
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
| | - Jane M Ussher
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia.
| | - Janette Perz
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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Fredriksen-Goldsen K, Shuman A, Jen S, Jung HH. Stress and Resilience among Sexual and Gender Diverse Caregivers. Res Aging 2023; 45:654-665. [PMID: 36772866 PMCID: PMC10415531 DOI: 10.1177/01640275231156191] [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] [Indexed: 02/12/2023]
Abstract
Little is known about caregiving outcomes of sexual and gender diverse, including LGBT, caregivers. Informed by the Health Equity Promotion Model (HEPM) and Pearlin's Stress Process Model, we utilized data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), to examine perceived stress among a sample of 754 sexual and gender diverse caregivers using regressions on background and caregiving characteristics and risk and protective factors. Among caregivers, 38% were providing care to a spouse or partner and about one-third to a friend (29%). Higher stress was associated with younger age, lower income, higher education, partner/spouse care, personal care provision, longer caregiving hours, and caregiver cognitive impairment. After including the risk and protective factors from HEPM, victimization, social support, and community engagement significantly predicted perceived stress. Findings contribute to emergent research on caregiving in diverse populations.
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Affiliation(s)
| | - Abandon Shuman
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Sarah Jen
- School of Social Welfare, University of Kansas, Lawrence, KS, USA
| | - Hailey H Jung
- School of Social Work, University of Washington, Seattle, WA, USA
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Sideman AB, Merrilees J, Dulaney S, Kiekhofer R, Braley T, Lee K, Chiong W, Miller B, Bonasera SJ, Possin KL. "Out of the clear blue sky she tells me she loves me": Connection experiences between caregivers and people with dementia. J Am Geriatr Soc 2023; 71:2172-2183. [PMID: 36917135 PMCID: PMC10500033 DOI: 10.1111/jgs.18297] [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: 12/02/2022] [Revised: 01/17/2023] [Accepted: 02/02/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Dementia can impede the relationship and connection between the person with dementia (PWD) and their caregiver. Yet, caregiving in dementia also offers opportunities for connection, which has implications for caregiver and PWD well-being. In this qualitative study, we describe and characterize ways caregivers felt connected to the person with dementia they care for. METHODS We conducted a telephone-based survey with caregivers of people with dementia. For this paper, we analyzed responses to an open-ended question focused on when caregivers feel most connected to the person they are caring for. Responses were analyzed and coded and themes were identified through an iterative process involving a multidisciplinary team of researchers and clinicians. RESULTS 437 caregivers participated in this study. We identified two domains of connection: activity-based and emotion-based connections. Within activity-based connections, the following themes emerged: everyday activities; reminiscing; activities of caregiving; novel experiences; and time with family and friends. Within emotional connections, the following themes emerged: expressions of love, appreciation, and gratitude; physical affection; sharing an emotion or emotional experience; and times when the PWD seems like "themself" again. CONCLUSIONS Findings provide insights into ways caregivers experience a sense of connection with the person they care for. There is a call to shift away from focusing on reducing stress and toward optimizing positive experiences as a way to better support caregivers' health and well-being. Interventions that leverage these insights to foster caregiver - PWD connection could lead to better health and well-being for both members of the dyad. The amplification of a positive experience may be particularly important for caregivers who are struggling with limited support or respite. Clinicians may be interested in using a question about connection as a way to more fully understand a caregiver's current experience.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Humanities and Social Sciences, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Jennifer Merrilees
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Sarah Dulaney
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Rachel Kiekhofer
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Tamara Braley
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kirby Lee
- Department of Clinical Pharmacy, University of California, San Francisco, California, USA
| | - Winston Chiong
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Bruce Miller
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Stephen J. Bonasera
- Division of Geriatrics, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Medicine, Division of Geriatrics and Palliative Care, Baystate Health, Springfield, Massachusetts, USA
| | - Katherine L. Possin
- Global Brain Health Institute, Department of Neurology, University of California, San Francisco, California, USA
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
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Broom A, Williams Veazey L, Kenny K, Harper I, Peterie M, Page A, Cort N, Durling J, Lipp ES, Tan AC, Walsh KM, Hanks BA, Johnson M, Van Swearingen AE, Anders CK, Ashley DM, Khasraw M. The Enduring Effects of COVID for Cancer Care: Learning from Real-Life Clinical Practice. Clin Cancer Res 2023; 29:1670-1677. [PMID: 36920243 PMCID: PMC10150237 DOI: 10.1158/1078-0432.ccr-23-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
For three years, COVID-19 has circulated among our communities and around the world, fundamentally changing social interactions, health care systems, and service delivery. For people living with (and receiving treatment for) cancer, pandemic conditions presented significant additional hurdles in an already unstable and shifting environment, including disrupted personal contact with care providers, interrupted access to clinical trials, distanced therapeutic encounters, multiple immune vulnerabilities, and new forms of financial precarity. In a 2020 perspective in this journal, we examined how COVID-19 was reshaping cancer care in the early stages of the pandemic and how these changes might endure into the future. Three years later, and in light of a series of interviews with patients and their caregivers from the United States and Australia conducted during the pandemic, we return to consider the potential legacy effects of the pandemic on cancer care. While some challenges to care provision and survivorship were unforeseen, others accentuated and amplified existing problems experienced by patients, caregivers, and health care providers. Both are likely to have enduring effects in the "post-pandemic" world, raising the importance of focusing on lessons that can be learned for the future.
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Affiliation(s)
- Alex Broom
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Leah Williams Veazey
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Katherine Kenny
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Imogen Harper
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Michelle Peterie
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Alexander Page
- Sydney Centre for Healthy Societies, School of Social and Political Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Cort
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Jennifer Durling
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Eric S. Lipp
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | - Aaron C. Tan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - Kyle M. Walsh
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | - Brent A. Hanks
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Margaret Johnson
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | | | - Carey K. Anders
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - David M. Ashley
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
| | - Mustafa Khasraw
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina
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Miller LR. Queer Aging: Older Lesbian, Gay, and Bisexual Adults' Visions of Late Life. Innov Aging 2023; 7:igad021. [PMID: 37063703 PMCID: PMC10101047 DOI: 10.1093/geroni/igad021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 03/06/2023] Open
Abstract
Background and Objectives Diversity in aging has received increased attention in recent years in the field of gerontology. However, older lesbian, gay, and bisexual (LGB) people have largely been missing from these conversations. In this study, I examine older LGB people's subjective views on the aging process, focusing specifically on visions of late life. Research Design and Methods Life story interviews were conducted with 60 LGB individuals over the age of 55 who reside in the Southeastern and Midwestern portions of the United States. Inductive coding (e.g., line-by-line, focused) and analyses were conducted. Results Four major themes emerged from the data: (1) financial distress linked to past events of homophobic discrimination, (2) anxieties regarding staying in paid care settings, (3) desires to age in place or "in community" with other lesbian, gay, bisexual, transgender, and queer people, and (4) a prioritization of quality of life over longevity via plans to pursue assisted suicide. Discussion and Implications The findings of this study suggest that views of aging and visions of late life are tied to social group membership, highlighting the need for gerontologists to further consider cumulative inequality processes. The study also offers evidence of queer aging, wherein queer culture, history, and experience produce distinct meanings of aging.
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Affiliation(s)
- Lisa R Miller
- Department of Sociology, Behavioral Sciences, Eckerd College, Saint Petersburg, Florida, USA
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Kittle KR, Lee R, Pollock K, Song Y, Wharton W, Anderson JG, Dowling NM, Flatt JD. Feasibility of the Savvy Caregiver Program for LGBTQ+ Caregivers of People Living with Alzheimer's Disease and Related Dementias. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15102. [PMID: 36429819 PMCID: PMC9690560 DOI: 10.3390/ijerph192215102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Nearly 350,000 lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) adults in the U.S. are currently living with Alzheimer's disease and related dementias (ADRD). Informal caregivers face challenges impacting their ability to access and receive adequate and inclusive care for LGBTQ+ persons living with ADRD. The purpose of this study was to determine the feasibility and acceptability of the Savvy Caregiver Program for caregivers of LGBTQ+ individuals living with ADRD. Data for this secondary analysis come from caregivers (n = 17) who completed 6 sessions of the Savvy program. Caregivers were very satisfied with tailored program activities. Analyses of trends suggest non-significant increases in positive aspects of caregiving and decreases in caregiver burden and depressive symptoms. This is the first known study assessing the feasibility of the Savvy Caregiver Program for caregivers of LGBTQ+ individuals living with ADRD. Future research on the Savvy Caregiver Program for caregivers of LGBTQ+ people living with ADRD is needed.
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Affiliation(s)
- Krystal R. Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
| | - Rebecca Lee
- School of Public Health, Boston University, Boston, MA 02118, USA
| | | | - Yeonsu Song
- School of Nursing, University of California, Los Angeles, CA 90095, USA
| | | | - Joel G. Anderson
- College of Nursing, University of Tennessee Knoxville, Knoxville, TN 37996, USA
| | - N. Maritza Dowling
- School of Nursing, George Washington University, Washington, DC 20006, USA
| | - Jason D. Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA
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Power R, Ussher JM, Perz J, Allison K, Hawkey AJ. "Surviving Discrimination by Pulling Together": LGBTQI Cancer Patient and Carer Experiences of Minority Stress and Social Support. Front Oncol 2022; 12:918016. [PMID: 35814403 PMCID: PMC9263127 DOI: 10.3389/fonc.2022.918016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background Lesbian, gay, bisexual, transgender, queer and/or intersex (LGBTQI) people with cancer and their carers report poorer psychological outcomes than the general non-LGBTQI cancer population. There is growing acknowledgement that these health inequities can be explained by minority stress, which can be buffered by social support. Study Aim To examine subjective experiences of minority stress and social support for LGBTQI people with cancer and their carers, drawing on qualitative findings from the Out with Cancer study. Method An online survey including open ended items was completed by 430 LGBTQI cancer patients and 132 partners and other carers, representing a range of tumor types, sexual and gender identities, age and intersex status. A sub-sample of 104 patients and 31 carers completed an interview, with a follow-up photovoice activity and second interview completed by 45 patients and 10 carers. Data was thematically analysed using an intersectional theoretical framework. Results Historical and present-day experiences of discrimination, violence, family rejection and exclusion created a legacy of distress and fear. This impacted on trust of healthcare professionals and contributed to distress and unmet needs in cancer survivorship and care. Social support, often provided by partners and other chosen family, including intimate partners and other LGBTQI people, buffered the negative impacts of minority stress, helping LGBTQI patients deal with cancer. However, some participants lacked support due to not having a partner, rejection from family of origin and lack of support within LGBTQI communities, increasing vulnerability to poor psychological wellbeing. Despite the chronic, cumulative impacts of minority stress, LGBTQI patients and carers were not passive recipients of discriminatory and exclusion in cancer care, demonstrating agency and resistance through collective action and advocacy. Conclusion LGBTQI people have unique socio-political histories and present-day psycho-social experiences that contribute to distress during cancer. Social support serves to buffer and ameliorate this distress. There is a need for cancer healthcare professionals and support services to be aware of and responsive to these potential vulnerabilities, including the intersectional differences in experiences of minority stress and social support. There is also a need for recognition and facilitation of social support among LGBTQI people with cancer and their carers.
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Waling A, Lyons A, Alba B, Minichiello V, Barrett C, Hughes M, Fredriksen-Goldsen K, Edmonds S, Bath N. Experiences of informal caregiving among older lesbian and gay adults in Australia. Australas J Ageing 2022; 41:424-430. [PMID: 35560859 PMCID: PMC9544417 DOI: 10.1111/ajag.13076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Abstract
Objective This study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving. Methods Interviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach. Results Most participants were caring for a friend or partner and regarded caregiving as a form of love and did not seek external support despite noting several impacts. Some participants found that they too were beginning to require care. For some, formal care was being considered, but with a degree of reluctance. Conclusions Older lesbian and gay adult caregivers experience a range of challenges and support needs in relation to their experiences with the caregiving role. This research highlights a need for ensuring that caregiving policies and practices be responsive to the experiences and challenges faced by older lesbian and gay people.
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Affiliation(s)
- Andrea Waling
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony Lyons
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Beatrice Alba
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Victor Minichiello
- School of Psychology and Public Health, Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,School of Justice, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Mark Hughes
- Faculty of Health, Southern Cross University, Gold Coast, Queensland, Australia
| | | | | | - Nicky Bath
- LGBTIQ+ Health Australia, Sydney, New South Wales, Australia
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Singleton MC, Enguidanos SM. Exploration of Demographic Differences in Past and Anticipated Future Care Experiences of Older Sexual Minority Adults. J Appl Gerontol 2022; 41:2045-2055. [PMID: 35503678 DOI: 10.1177/07334648221098996] [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: 11/17/2022] Open
Abstract
Care experiences of sexual minority (SM) adults are largely characterized by the need for receiving care and providing care to their chosen family. This is due, in part, to the lack of family and social support and higher rates of health disparities. Using data from the "Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans" AARP survey (N = 1694), we examined factors associated with past and anticipated future care experiences among older SMs. Older SM individuals reported high rates of providing care (70%), anticipating future provision of care (71%), and needing care from a loved one (73%). Being older, identifying as female, and having a disability were highly associated with past care experiences. Being female, being in a relationship, and having better self-rated health were highly associated with future anticipated care experiences. These outcomes indicate the importance of having services that are inclusive in serving the SM community.
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Affiliation(s)
- Mekiayla C Singleton
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Susan M Enguidanos
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
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Chen JH. Disparities in Mental Health and Well-Being between Heterosexual and Sexual Minority Older Adults during the COVID-19 Pandemic. J Aging Health 2022; 34:939-950. [PMID: 35430925 PMCID: PMC9014338 DOI: 10.1177/08982643221081965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Jen-Hao Chen
- Department of Sociology & Department of Psychology, National Chengchi University, Taipei, Taiwan
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15
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Grassau P, Stinchcombe A, Thomas R, Wright DK. Centering sexual and gender diversity within Compassionate Communities: insights from a community network of LGBTQ2S+ older adults. Palliat Care Soc Pract 2021; 15:26323524211042630. [PMID: 34589707 PMCID: PMC8474303 DOI: 10.1177/26323524211042630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022] Open
Abstract
Background and Rationale: The Compassionate Communities movement emphasizes the importance of
illness, disability, dying, caregiving, and grief across the
lifespan and highlights the communal responsibility of caring
for one another. There is a need to recognize and incorporate
the needs of diverse communities within this movement and
research on dying, caregiving and grief. An important axis of
this diversity is related to individuals’ sexual orientation and
gender identity. Methods: As part of the early phases of Healthy End of Life Project Ottawa,
a Compassionate Communities, community-based, participatory
action research project, we held focus groups with older members
of lesbian, gay, bisexual, transgender, queer, and two-spirit
communities. Nine older lesbian, gay, bisexual, transgender,
queer, and two-spirit people participated in the focus groups
(mean age = 72 years). Data were analysed using an inductive,
reflexive thematic approach. Results: Through an iterative analysis process, we identified themes related
to lifecourse experiences of trauma, the need for safety within
care contexts, the importance of relationships and connection,
as well as participants’ ability to ask for and receive help. A
core tenet of Compassionate Communities involves responding to
the needs of diverse communities with respect to aging,
end-of-life, and grief. Our findings emphasize the importance of
incorporating the voices of diverse sexual and gender identities
and promoting health equity within Compassionate Community
initiatives.
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Affiliation(s)
- Pamela Grassau
- School of Social Work, Carleton University, Ottawa, ON K1S 5B6, Canada
| | | | - Roanne Thomas
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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16
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Hsieh N, Liu H. Social Relationships and Loneliness in Late Adulthood: Disparities by Sexual Orientation. JOURNAL OF MARRIAGE AND THE FAMILY 2021; 83:57-74. [PMID: 34326557 PMCID: PMC8317792 DOI: 10.1111/jomf.12681] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This is the first national study to examine disparities in loneliness and social relationships by sexual orientation in late adulthood in the United States. BACKGROUND Prior studies have shown that lesbian, gay, and bisexual (LGB) individuals often struggle with social relationships across the life course, likely because of stigma related to sexual orientation. However, little is known about whether loneliness is more prevalent among LGB people than among other groups in late adulthood, and if so, which relationships contribute to the loneliness gap. METHOD We analyzed data from a nationally representative sample of older adults from the 2015-2016 National Social Life, Health, and Aging Project (N = 3,567) to examine the disparity in loneliness by sexual orientation and identify links between this disparity and multiple dimensions of social relationships, including partner, family, friend, and community relationships. RESULTS Older LGB adults were significantly lonelier than their heterosexual counterparts, primarily due to a lower likelihood of having a partner and, to a lesser extent, lower levels of family support and greater friend strain. While they were also disadvantaged in the size of close family and frequency of community participation, these factors were less relevant to their loneliness. Overall, the conventionally defined inner layers of relationships (partnership and family) contributed more to the loneliness disparity than the outer layers of relationships (friends and community). CONCLUSION These findings suggest that strengthening the partnerships and family relationships of sexual minorities is essential to reducing the loneliness gap.
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17
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Ermer AE, Matera KN. Older women's friendships: illuminating the role of marital histories in how older women navigate friendships and caregiving for friends. J Women Aging 2020; 33:214-229. [PMID: 33297892 DOI: 10.1080/08952841.2020.1860632] [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: 10/22/2022]
Abstract
The present study explores the role of marital histories in how older women navigate their friendships and how they provide care for, receive care from, and help friends. Nineteen semi-structured interviews with older women (mean age = 75.89) were conducted. All participants had at least a high-school education and identified as non-Hispanic White (N = 19). Three major themes emerged: 1) similarities and differences in friendship among marrieds and unmarrieds, 2) shifts in friendships after marital loss, and 3) caregiving and helping friends. These findings have implications for how older women view friendship and for policies concerning caregiving and friendship.
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Affiliation(s)
- Ashley E Ermer
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey, USA
| | - Kristin N Matera
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey, USA
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18
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Marino VR, Badana ANS, Haley WE. Care Demands and Well-Being of Primary and Secondary Non-Spousal Caregivers of Aging Adults. Clin Gerontol 2020; 43:558-571. [PMID: 32414302 DOI: 10.1080/07317115.2020.1759748] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Compare care demands, strain, and health across 912 primary and secondary caregivers of parents, other family, and friends aged 50 and older. METHODS Data came from the nationally representative Caregiving in the U.S. 2015 data set. Two by three factorial ANOVAs and binary logistic regression examined the effects of primary caregiver status and relationship type on care demands and well-being. RESULTS Primary caregivers provided more hours of care for a longer duration and were more likely to report financial stress, and that caregiving made their health worse. Primary caregivers did not differ from secondary caregivers in emotional stress, and physical strain was comparable in primary and secondary caregivers of parents and other family. Caregivers of parents generally reported the highest levels of demands and stress/strain. Controlling for amount of care provided attenuated some of these differences. CONCLUSIONS Secondary caregivers provide less care but report emotional stress comparable to primary caregivers. Primary caregivers of friends provide high levels of assistance that may increase their physical strain. CLINICAL IMPLICATIONS Caregiver research and intervention should include greater attention to needs of secondary caregivers, and caregivers of friends, and ways to strengthen their potentially critical roles.
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Affiliation(s)
- Victoria R Marino
- School of Aging Studies, University of South Florida , Tampa, Florida, USA
| | - Adrian N S Badana
- Graduate Medical Education, Wellstar Atlanta Medical Center , Atlanta, Georgia, USA
| | - Wiliam E Haley
- School of Aging Studies, University of South Florida , Tampa, Florida, USA
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19
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Nelson CL, Andel R. Does Sexual Orientation Influence Trajectories of Change in Health? A 20-Year Follow-Up Study. LGBT Health 2020; 7:385-392. [PMID: 32808869 DOI: 10.1089/lgbt.2020.0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Christi L Nelson
- School of Aging Studies, University of South Florida, Tampa, Florida, USA
| | - Ross Andel
- School of Aging Studies, University of South Florida, Tampa, Florida, USA.,International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Department of Neurology, Charles University and Motol University Hospital, Prague, Czech Republic
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20
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Boehmer U, Clark MA, Lord EM, Fredman L. Caregiving Status and Health of Heterosexual, Sexual Minority, and Transgender Adults: Results From Select U.S. Regions in the Behavioral Risk Factor Surveillance System 2015 and 2016. THE GERONTOLOGIST 2020; 59:760-769. [PMID: 30215703 DOI: 10.1093/geront/gny109] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Insufficient research attention has been paid to the diversity of informal caregivers, including sexual and gender minority caregivers. This study examined health effects of caregiving separately from sexual orientation or gender identity status, while stratifying by gender among cisgender adults. We hypothesized that compared with heterosexual cisgender noncaregivers, heterosexual caregivers and lesbian/gay/bisexual (LGB), and transgender (T) noncaregivers would report poorer health outcomes (i.e., self-reported health, and poor mental health days and poor physical health days), and LGBT caregivers would report the worst health outcomes. RESEARCH DESIGN AND METHODS This is a secondary data analysis of the 2015 and 2016 Behavioral Risk Factor Surveillance System data from 19 U.S. states. RESULTS After adjusting for covariates and stratifying by gender among the cisgender sample, heterosexual caregivers, LGB noncaregivers and LGB caregivers had significantly higher odds of self-reported fair or poor health (adjusted odds ratios [aORs] 1.3-2.0 for women and 1.2 for men), poor physical health days (aORs 1.2-2.8 for women and 1.3-2.8 for men), and poor mental health days (aORs 1.4-4.7 for women and 1.5-5.6 for men) compared with heterosexual noncaregivers (reference group). By contrast, transgender caregivers did not have significantly poorer health than cisgender noncaregivers. DISCUSSION AND IMPLICATIONS LGB caregivers reported the worst health compared with other groups on multiple measures, signifying they are an at-risk population. These results suggest the necessity to develop LGB appropriate services and programs to prevent poor health in LGB caregivers. Existing policies should also be inclusive of LGBT individuals who are caregivers.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Massachusetts
| | - Melissa A Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Emily M Lord
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
| | - Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Massachusetts
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21
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Alba B, Lyons A, Waling A, Minichiello V, Hughes M, Barrett C, Fredriksen-Goldsen K, Edmonds S. Health, well-being, and social support in older Australian lesbian and gay care-givers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:204-215. [PMID: 31518034 DOI: 10.1111/hsc.12854] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Informal care-givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care-giver is known to be associated with poorer health and well-being, and lesbian and gay care-givers report experiences of stigma and discrimination in the care-giving context. This study involved a survey of 230 lesbian women and 503 gay men aged 60 years and over living in Australia, of which 218 were care-givers. We compared care-givers to non-caregivers on a range of health and well-being measures, including psychological distress, positive mental health, physical health and social support. While we found no significant differences between these two groups, we further compared care-givers who were caring for an LGBTI person to those who were caring for a non-LGBTI person. Among the lesbian women, care-givers of an LGBTI person reported feeling less supported in their carer role and reported lower levels of social support more generally. They were also lower on positive mental health and physical health indicators. Among the gay men, care-givers of an LGBTI person also reported feeling less supported in their carer role, but there were no differences in reported levels of social support more generally or health and well-being compared to those caring for a non-LGBTI person. Overall, results from this study suggest that older lesbian and gay care-givers may be facing some challenges related to their well-being and feeling supported, especially if they are caring for another LGBTI person.
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Affiliation(s)
- Beatrice Alba
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
| | - Victor Minichiello
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Vic., Australia
- Faculty of Law, School of Justice, Queensland University of Technology, Brisbane, Qld., Australia
| | - Mark Hughes
- School of Arts and Social Sciences, Southern Cross University, Gold Coast, Qld., Australia
| | | | | | - Samantha Edmonds
- Silver Rainbow, National LGBTI Health Alliance, Sydney, NSW, Australia
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22
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Seelman KL, Lewinson T, Engleman L, Allen A. Motivations for advance care and end-of-life planning among lesbian, gay, and bisexual older adults. QUALITATIVE SOCIAL WORK : QSW : RESEARCH AND PRACTICE 2019; 18:1002-1016. [PMID: 33343234 PMCID: PMC7747803 DOI: 10.1177/1473325018792396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Lesbian, gay, and bisexual (LGB) older adults are more likely than their heterosexual peers to experience health disparities, discrimination from healthcare providers based on sexual orientation, and rejection from their family of origin, all of which can complicate medical care and decision making, as well as end-of-life arrangements. Yet, relatively few studies of LGB seniors have looked at motivations for advance care and end-of-life planning, which are strategies that can help ensure that healthcare treatment and end-of-life wishes are enacted as desired. The present qualitative study investigated this topic with a purposive sample of nine LGB and same-gender-loving adults in a metropolitan region of the Southeastern United States. The study involved in-depth face-to-face interviews, followed by a brief pen-and-paper survey. Participants' ages ranged from 65 to 77; the sample included five men and four women. Six individuals were white/Caucasian, while three were African American/Black. We identified three themes related to motivations for advance care and end-of-life planning: wanting a sense of agency, learning from others, and reducing conflict and confusion for loved ones. We discuss the importance of these findings for social work practice with LGB older adults and for social work education, as well as implications for future research.
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23
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de Vries B, Gutman G, Humble Á, Gahagan J, Chamberland L, Aubert P, Fast J, Mock S. End-of-Life Preparations Among LGBT Older Canadian Adults: The Missing Conversations. Int J Aging Hum Dev 2019; 88:358-379. [PMID: 30871331 DOI: 10.1177/0091415019836738] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LGBT (lesbian, gay, bisexual, and transgender) older adults are more likely than their heterosexual peers to age with limited support in stigmatizing environments often poorly served by traditional social services challenging their preparedness for end of life. Fourteen focus groups and three individual interviews were conducted in five Canadian cities with gay/bisexual men (5 groups; 40 participants), lesbian/bisexual women (5 groups; 29 participants), and transgender persons (3 interviews, 4 groups; 24 participants). Four superordinate themes were identified: (a) motivators and obstacles, (b) relationship concerns, (c) dynamics of LGBT culture and lives, and (d) institutional concerns. Several pressing issues emerged including depression and isolation (more common among gay and bisexual men), financial/class issues (lesbian and bisexual women), and uncomfortable interactions with health-care providers (transgender participants). These findings highlight the challenges and complexities in end-of-life preparation within LGBT communities.
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Affiliation(s)
- Brian de Vries
- 1 Gerontology Program, San Francisco State University, CA, USA
| | - Gloria Gutman
- 2 Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Áine Humble
- 3 Family Studies and Gerontology Department, Mount Saint Vincent University, Halifax, NS, Canada
| | | | - Line Chamberland
- 5 Department of Sexology, University of Quebec, Montreal, QC, Canada
| | - Patrick Aubert
- 2 Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Janet Fast
- 6 Human Ecology, University of Alberta, Edmonton, AB, Canada
| | - Steven Mock
- 7 Recreation and Leisure Studies, University of Waterloo, ON, Canada
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24
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Blieszner R, Ogletree AM, Adams RG. Friendship in Later Life: A Research Agenda. Innov Aging 2019; 3:igz005. [PMID: 30949589 PMCID: PMC6441127 DOI: 10.1093/geroni/igz005] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Indexed: 11/24/2022] Open
Abstract
Friendship is a relationship that can endure across the entire lifespan, serving a vital role for sustaining social connectedness in late life when other relationships may become unavailable. This article begins with a description of the importance of studying friendship in late life and the benefits of friendship for older adults, pointing to the value of additional research for enhancing knowledge about this crucial bond. Next is discussion of theoretical approaches for conceptualizing friendship research, followed by identification of emerging areas of late-life friendship research and novel questions that investigators could explore fruitfully. We include a presentation of innovative research methods and existing national and international data sets that can advance late-life friendship research using large samples and cross-national comparisons. The final section advocates for development and assessment of interventions aimed at improving friendship and reducing social isolation among older adults.
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Affiliation(s)
| | | | - Rebecca G Adams
- Gerontology Program, University of North Carolina at Greensboro
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25
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26
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Putney JM, Keary S, Hebert N, Krinsky L, Halmo R. "Fear Runs Deep:" The Anticipated Needs of LGBT Older Adults in Long-Term Care. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2018; 61:887-907. [PMID: 30102141 DOI: 10.1080/01634372.2018.1508109] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults' anticipated needs and fears related to nursing homes and assisted living. METHODS This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.
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Affiliation(s)
- Jennifer M Putney
- a Simmons College School of Social Work , Boston , Massachusetts , USA
- b The Fenway Institute , Boston , Massachusetts , USA
| | - Sara Keary
- c Department of Psychiatry , Mount Auburn Hospital , Cambridge , Massachusetts , USA
| | - Nicholas Hebert
- a Simmons College School of Social Work , Boston , Massachusetts , USA
| | - Lisa Krinsky
- b The Fenway Institute , Boston , Massachusetts , USA
| | - Rebekah Halmo
- a Simmons College School of Social Work , Boston , Massachusetts , USA
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27
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Muraco A, Putney J, Shiu C, Fredriksen-Goldsen KI. Lifesaving in Every Way: The Role of Companion Animals in the Lives of Older Lesbian, Gay, Bisexual, and Transgender Adults Age 50 and Over. Res Aging 2018; 40:859-882. [PMID: 29357737 PMCID: PMC6027597 DOI: 10.1177/0164027517752149] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study uses mixed-methods data and a life-course perspective to explore the role of pets in the lives of lesbian, gay, bisexual, and transgender (LGBT) adults age 50 and over and addresses the following research questions: (1) How does having a pet relate to perceived social support and social network size? and (2) how do LGBT older adults describe the meaning of pets in their lives? The qualitative data ( N = 59) were collected from face-to-face interviews, and the quantitative data ( N = 2,560) were collected via surveys from a sample across the United States. Qualitative findings show that pets are characterized as kin and companions and provide support; we also explore why participants do not have pets. The quantitative findings show that LGBT older adults with a pet had higher perceived social support; those with a disability and limited social network size, who had a pet had significantly higher perceived social support than those without a pet.
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Affiliation(s)
- Anna Muraco
- Department of Sociology, Loyola Marymount University, Los Angeles, CA, USA
| | | | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle, WA, USA
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28
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Understanding the structure, experiences and challenges of social support for older lesbian, gay and bisexual people: a systematic review. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThe psycho-social contexts of older lesbian, gay and bisexual (LGB) individuals suggest that they may face unique strengths and barriers in accessing social support. The present review aimed to explore what is known about this by providing a synthesis of this area of research and a methodological critique. The Applied Social Sciences Index (ASSIA), Psychinfo and Medline databases were searched and 22 relevant articles were identified. Key findings were extracted and quality was assessed using a standardised rating scale. The findings indicated that although many older LGB people report similar-sized support networks to older heterosexuals, more support came from friends and less from biological family members. Many reported not receiving enough support; it is possible that differences in care-giving between friends and family and anticipated social support difficulties due to previous LGB-stigma experiences partially account for this. Current recruitment strategies may mean that more-connected older LGB people are over-represented in research. There is a lack of research with the ‘old-old’ population, bisexual people, those with significant health needs, those outside the United States of America and those with additional characteristics associated with discrimination. Practical and research implications are discussed and it is suggested that friendship–carer dyads may need support to have more explicit discussions about care-giving roles due to a lack of societal templates for these kinds of relationships.
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29
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Thomeer MB, LeBlanc AJ, Frost DM, Bowen K. Anticipatory Minority Stressors among Same-sex Couples: A Relationship Timeline Approach. SOCIAL PSYCHOLOGY QUARTERLY 2018; 81:126-148. [PMID: 32863497 DOI: 10.1177/0190272518769603] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors build on previous stress theories by drawing attention to the concept of anticipatory couple-level minority stressors (i.e., stressors expected to occur in the future that emanate from the stigmatization of certain relationship forms). A focus on anticipatory couple-level minority stressors brings with it the potential for important insight into vulnerabilities and resiliencies of people in same-sex relationships, the focus of this study. The authors use relationship timelines to examine stressors among a diverse sample of same-sex couples (n = 120). Respondents in same-sex relationships anticipated stressors that are likely not unique to same-sex couples (e.g., purchasing a home together) but labeled many of these anticipatory stressors as reflecting the stigmatization of their same-sex relationship. Respondents rated anticipatory minority stressors as more stressful than other anticipatory stressors. Moreover, stressors varied by gender, age, and relationship duration although not race/ethnicity or geographic site. This analysis is a preliminary step in examining how unique anticipatory couple-level minority stressors function as determinants of relationship quality, mental and physical health, and health disparities faced by sexual minority populations. Attempts to understand current stress levels should consider anticipatory stressors alongside past and current life events, chronic strains, daily hassles, and minority stressors, as these processes are impossible to disentangle and may be consequential for current well-being.
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Affiliation(s)
| | | | | | - Kayla Bowen
- University of California Hastings College of Law
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Supporting Lesbian, Gay, Bisexual, & Transgender Inclusivity in Long-Term Care Homes: A Canadian Perspective. Can J Aging 2018; 37:121-132. [PMID: 29553004 DOI: 10.1017/s0714980818000077] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTIt is critical to ensure that long-term care (LTC) homes are sensitive to the needs of lesbian, gay, bisexual, and transgender (LGBT) older adults. However, the extent to which the LTC home sector has adopted recommended strategies is unknown. This qualitative study reports findings from two initiatives: Semi-structured telephone interviews with Canadian LTC home administrators on strategies adopted to support LGBT inclusivity (n = 32), and discussions with participants attending a 2-day meeting on supporting LGBT inclusivity in LTC (n = 25). We found that LGBT inclusivity training was the most commonly adopted strategy among the LTC homes surveyed. Study findings further suggested that practices more visible to residents and families, such as LGBT-themed programming, inclusive language and symbols, or joint initiatives with LGBT communities, were less commonly adopted because of anticipated negative resident/family reactions. The importance and benefits of comprehensive strategies that include staff, residents, and family are discussed.
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Cloyes KG, Hull W, Davis A. Palliative and End-of-Life Care for Lesbian, Gay, Bisexual, and Transgender (LGBT) Cancer Patients and Their Caregivers. Semin Oncol Nurs 2018; 34:60-71. [PMID: 29306523 PMCID: PMC5863535 DOI: 10.1016/j.soncn.2017.12.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify the unique needs of lesbian, gay, bisexual, and transgender (LGBT) cancer patients and caregivers, and review recommendations supporting more effective and inclusive palliative and end-of-life care. DATA SOURCES Published research and clinical guidelines. CONCLUSION Transitions in care raise particular challenges for LGBT patients, including provider communication, perceptions of safety and acceptance, and assessing and respecting patients' definitions of family and spirituality. IMPLICATIONS FOR NURSING PRACTICE LGBT patients and their caregivers need competent nurses to support them, especially during transitions. Implementing LGBT-inclusive education, training, and practice will improve outcomes for LGBT cancer patients and their caregivers - and potentially all patients.
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Boehmer U, Clark MA, Heeren TC, Showalter EA, Fredman L. Differences in Caregiving Outcomes and Experiences by Sexual Orientation and Gender Identity. LGBT Health 2018; 5:112-120. [PMID: 29364755 DOI: 10.1089/lgbt.2017.0144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this study was to determine whether caregiving experiences and their health-related outcomes differ by sexual orientation and gender identity in a representative U.S. caregiver sample. METHODS A secondary data analysis was performed of the cross-sectional, nationally representative National Alliance for Caregiving online survey that was conducted in 2014. To account for the study design, we used sampling weights and then added propensity score weighting to account for imbalances between LGBT respondents and their heterosexual and cisgender counterparts, that is, non-LGBT caregivers. Outcomes consisted of caregivers' self-reported health, financial strain, physical strain, and emotional stress. RESULTS LGBT caregivers were significantly younger, more racially and ethnically diverse, less likely to be married, and more likely to be of low socioeconomic status than their non-LGBT counterparts. Caregiving experiences and intensity were similar, but after controlling for demographic and caregiving characteristics, LGBT caregivers were significantly more likely to report financial strain and showed trends toward elevated levels of poor health and emotional stress. Physical strain was similar by LGBT status. CONCLUSION Caregiving itself is universal, yet LGBT caregivers differed demographically and were more likely to report financial strain compared with non-LGBT caregivers.
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Affiliation(s)
- Ulrike Boehmer
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| | - Melissa A Clark
- 2 Department of Quantitative Sciences and Center for Health Policy and Research, University of Massachusetts Medical School , Worcester, Massachusetts
| | - Timothy C Heeren
- 3 Department of Biostatistics, Boston University School of Public Health , Boston, Massachusetts
| | - Elizabeth Ann Showalter
- 1 Department of Community Health Sciences, Boston University School of Public Health , Boston, Massachusetts
| | - Lisa Fredman
- 4 Department of Epidemiology, Boston University School of Public Health , Boston, Massachusetts
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Abstract
The box-office as well as critical success of the 2014 major motion picture Still Alice, starring Julianne Moore in the title role and based on the bestselling novel of the same name by the Harvard-trained neuroscientist Lisa Genova (Still Alice. Simon & Schuster, New York, 2009), marked an important moment in public cultural representations of people with dementia. Still Alice tells the story of Alice Howland, an eminent scientist whose increasing memory lapses are eventually diagnosed as early-onset Alzheimer's, and chronicles the transformations in her family relationships as her husband and three children respond to her decline in different ways. Alice's husband, her son, and her older daughter all respond by turning toward science, while her younger daughter Lydia seeks to engage her mother as she is now, and turns toward art and relationships. Taking Still Alice and the figure of Lydia as an entry point, I discuss arts-focused efforts to improve the lives of people with dementia, and draw upon ongoing interview-based research on the topic of dementia and friendship, to offer an account of some of the ways that people I have spoken with are actively experimenting with art and with relationships in the face of dementia. I argue that these efforts can be understood as "moral experiements," in the sense articulated by Cheryl Mattingly (Moral Laboratories: Family Peril and the Struggle for a Good Life. University of California Press, Berkeley, 2014). Although Lydia is a fictional character, her response to Alice's dementia points toward the kinds of moral experimentation that are in fact possible, and quietly being practiced, by ordinary people every day.
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Fredriksen-Goldsen KI, Kim HJ, Bryan AEB, Shiu C, Emlet CA. The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults. THE GERONTOLOGIST 2017; 57:S72-S83. [PMID: 28087797 PMCID: PMC5241752 DOI: 10.1093/geront/gnw170] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/08/2016] [Indexed: 12/31/2022] Open
Abstract
PURPOSE OF THE STUDY Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes. DESIGN AND METHODS Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes. RESULTS Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes. IMPLICATIONS Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services.
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Affiliation(s)
| | - Hyun-Jun Kim
- School of Social Work, University of Washington, Seattle
| | | | - Chengshi Shiu
- School of Social Work, University of Washington, Seattle
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Capistrant BD, Torres B, Merengwa E, West WG, Mitteldorf D, Rosser BRS. Caregiving and social support for gay and bisexual men with prostate cancer. Psychooncology 2016; 25:1329-1336. [PMID: 27530377 PMCID: PMC5524199 DOI: 10.1002/pon.4249] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 06/11/2016] [Accepted: 08/12/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Prostate cancer, the second most common cancer among men, typically onsets in middle or older age. Gay/bisexual men have different social networks and unique social support needs, particularly as it pertains to health care access and prostate side effects. Few studies have investigated the availability and provision of social support for gay and bisexual men with prostate cancer (GBMPCa). METHODS This study used qualitative data from in-depth, semistructured, one-on-one telephone interviews with 30 GBMPCa recruited from a national cancer support group network, Malecare. Inductive and deductive codes were used to identify themes about social support provided to GBMPCa during diagnosis and treatment. RESULTS GBMPCa reported help from friends, family (parents and siblings), ex-partners, and paid caregivers. Men in relationships reported varying levels of reliance on their partners for support, in part due to relationship dynamics and living arrangements. Single men showed a theme of independence ("I turned down all help," "My friends don't want to be bothered"). After diagnosis, many men reported seeking informational and emotional support from prostate cancer support groups; most expressed wanting more support groups specifically for GBMPCa. During or after treatment, men reported receiving a range of instrumental support, largely a function of relationship status and treatment type. CONCLUSIONS GBMPCa received variable, but generally low, social support during diagnosis and treatment and from a diverse social network, including a prominence of friends and family. Clinicians should be aware of GBMPCa's distinct patterns of social support needs and providers.
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Affiliation(s)
- Benjamin D Capistrant
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Beatriz Torres
- Department of Communication Studies, Gustavus Adolphus College, St. Peter, MN, USA
| | | | - William G West
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | | | - B R Simon Rosser
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Abstract
Friends are important companions and serve as sources for diverse dimensions of social support, including elderly care. Rather than researching populations that have already established care arrangements including friends, the author seeks to understand relationship systems with a focus on the inner logic friendship to consequently describe and understand involved care arrangements, be it with family members or friends. To illustrate the diversity of friendship repertoires, qualitative interviews with older adult Germans are analyzed regarding cognitive concepts of friendships in contrast to familiar ties as well as social practices around relationship systems. While some repertoires successfully include chosen ties in their care arrangements, others not only focus on family, they do not wish to receive care from friends. The article's praxeological approach highlights the need to reflect habitual differences when thinking about elderly informal care arrangements.
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Affiliation(s)
- Julia Hahmann
- Gerontology Department, University of Vechta, Vechta, Germany
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Stols A, Roos V, Hoffman J. Middle Adolescents’ Motivations to Care for Older Persons in an Economically Vulnerable Community. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2016. [DOI: 10.1080/15350770.2016.1195244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reczek C, Umberson D. Greedy Spouse, Needy Parent: The Marital Dynamics of Gay, Lesbian, and Heterosexual Intergenerational Caregivers. JOURNAL OF MARRIAGE AND THE FAMILY 2016; 78:957-974. [PMID: 27672229 PMCID: PMC5034933 DOI: 10.1111/jomf.12318] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
It is well established that married heterosexual women do more intergenerational caregiving for aging parents and parents-in-law than married heterosexual men do. However, gay men and lesbian women's recent access to marriage presents new questions about the gendered marital dynamics of intergenerational caregiving. We use dyadic data with gay, lesbian, and heterosexual spouses to examine the marital dynamics of intergenerational caregivers. Results show that gay and lesbian spouses provided intensive time and emotional support for an intergenerational caregiver. In contrast, heterosexual women described their intergenerational caregiving as rarely supported and at times even undermined by their spouse. Dyadic data on heterosexual men corroborate women's accounts; heterosexual men rarely reported providing intergenerational caregiving, and thus heterosexual women rarely described providing spousal support. These findings provide new insight into the intermingled roles of "greedy" marriages and "needy" parents, wherein marital negotiations around caregiving vary by gender for gay, lesbian, and heterosexual marital dyads.
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Affiliation(s)
- Corinne Reczek
- Department of Sociology, Ohio State University, 164 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210 ( )
| | - Debra Umberson
- Department of Sociology, Ohio State University, 164 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210 ( )
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Shiu C, Muraco A, Fredriksen-Goldsen K. Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults. JOURNAL OF THE SOCIETY FOR SOCIAL WORK AND RESEARCH 2016; 7:527-546. [PMID: 28367277 PMCID: PMC5373808 DOI: 10.1086/687325] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. METHOD Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver-care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. RESULTS On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. CONCLUSIONS Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships.
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40
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Abstract
Demographic and social trends lead to a variety of micro-level and internal structural contexts that influence caregiving in families with older members. The results of macro-level changes have received little focused attention in the aging literature, where much of the caregiving research has addressed issues within the context of traditional family structure. Yet the conventional nuclear family model is increasingly uncommon as new, pluralistic models of family life are emerging in contemporary society. The majority of elder care is provided by relatives, albeit with varying patterns of involvement and responsibility across family structures. Both conventional and pluralistic families face challenges in meeting the care needs of their oldest members, leaving some older adults at risk of having unmet needs. Additional research on family risk and resilience related to the care of older relatives is warranted, particularly with respect to pluralistic models of family life.
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Bradford JB, Putney JM, Shepard BL, Sass SE, Rudicel S, Ladd H, Cahill S. Healthy Aging in Community for Older Lesbians. LGBT Health 2016; 3:109-15. [PMID: 27046541 DOI: 10.1089/lgbt.2015.0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE In Boston and Outer Cape, Massachusetts, we explored the expectations of lesbians 60 years and older regarding healthy aging and community importance. METHODS Focus groups were conducted with participants after completing an anonymous demographic questionnaire. Thematic analysis was used to generate themes and identify how they varied by urban versus rural settings. RESULTS Group discussions focused on community, finances, housing, and healthcare. Primary concerns included continued access to supportive and lesbian communities as a source of resilience during aging. CONCLUSION Concerns about discrimination and isolation mirror themes found in national research. The study findings suggest a need for more research into the housing and transportation needs of lesbians approaching later life, with a focus on how those needs relate to affordability, accessibility, and proximity to social support and healthcare. These findings also suggest the need for substantial investments in strengthening the LGBT-related cultural competence of providers of services for the elderly.
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Affiliation(s)
| | - Jennifer M Putney
- 1 The Fenway Institute , Boston, Massachusetts.,2 Simmons College , Boston, Massachusetts
| | | | | | - Sally Rudicel
- 3 Outer Cape Health Services , Wellfleet, Massachusetts
| | - Holly Ladd
- 1 The Fenway Institute , Boston, Massachusetts
| | - Sean Cahill
- 1 The Fenway Institute , Boston, Massachusetts
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Cloyes KG. The Silence of Our Science: Nursing Research on LGBT Older Adult Health. Res Gerontol Nurs 2016; 9:92-104. [DOI: 10.3928/19404921-20151218-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 11/17/2015] [Indexed: 11/20/2022]
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Burkhalter JE, Margolies L, Sigurdsson HO, Walland J, Radix A, Rice D, Buchting FO, Sanchez NF, Bare MG, Boehmer U, Cahill S, Griebling TL, Bruessow D, Maingi S. The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities. LGBT Health 2016. [PMCID: PMC4770841 DOI: 10.1089/lgbt.2015.0118] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.
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Affiliation(s)
- Jack E. Burkhalter
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Hrafn Oli Sigurdsson
- Nursing Professional Development, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jonathan Walland
- The Office of General Counsel, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Asa Radix
- Callen-Lorde Community Health Center, New York, New York
| | | | - Francisco O. Buchting
- Buchting Consulting, Oakland, California; Horizons Foundation, San Francisco, California
| | - Nelson F. Sanchez
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | | | - Tomas L. Griebling
- Department of Urology, School of Medicine, University of Kansas, Kansas City, Kansas
| | | | - Shail Maingi
- St. Peter's Health Partners Cancer Care, Troy, New York
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Caceres BA, Frank MO. Successful ageing in lesbian, gay and bisexual older people: a concept analysis. Int J Older People Nurs 2016; 11:184-93. [DOI: 10.1111/opn.12108] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 07/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | - Mayu O. Frank
- New York University College of Nursing; New York NY USA
- Rockefeller University; New York NY USA
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45
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Erosheva EA, Kim HJ, Emlet C, Fredriksen-Goldsen KI. Social Networks of Lesbian, Gay, Bisexual, and Transgender Older Adults. Res Aging 2015; 38:98-123. [PMID: 25882129 DOI: 10.1177/0164027515581859] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study examines global social networks-including friendship, support, and acquaintance networks-of lesbian, gay, bisexual, and transgender (LGBT) older adults. DESIGN AND METHODS Utilizing data from a large community-based study, we employ multiple regression analyses to examine correlates of social network size and diversity. RESULTS Controlling for background characteristics, network size was positively associated with being female, transgender identity, employment, higher income, having a partner or a child, identity disclosure to a neighbor, engagement in religious activities, and service use. Controlling in addition for network size, network diversity was positively associated with younger age, being female, transgender identity, identity disclosure to a friend, religious activity, and service use. IMPLICATIONS According to social capital theory, social networks provide a vehicle for social resources that can be beneficial for successful aging and well-being. This study is a first step at understanding the correlates of social network size and diversity among LGBT older adults.
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Affiliation(s)
- Elena A Erosheva
- Department of Statistics and School of Social Work, University of Washington, Seattle, WA, USA
| | - Hyun-Jun Kim
- University of Washington, School of Social Work, Seattle, WA, USA
| | - Charles Emlet
- University of Washington, Tacoma, School of Social Work, Tacoma, WA, USA
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46
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Grigorovich A. Restricted Access: Older Lesbian and Bisexual Women's Experiences With Home Care Services. Res Aging 2014; 37:763-83. [PMID: 25651592 DOI: 10.1177/0164027514562650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article reports on the findings of a study that explored older lesbian and bisexual women's access to publicly funded home care in Ontario. Recent health reforms have increasingly shifted the bulk of care of individuals from health care institutions to private homes and communities. Although these reforms have had consequences for all individuals, they may be particularly problematic for this population of older adults who face added health risks and barriers. Sixteen women participated in a qualitative case study with semistructured interviews. Iterative thematic analysis was used to analyze the data along with the use of a feminist political economy framework. The analysis shows that older lesbian and bisexual women experience barriers to accessing needed care and lack additional supports with which to supplement publicly funded home care. This study deepens existing knowledge by demonstrating how chronic illness and sexual minority status can further exacerbate the consequences of rationing public care.
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Affiliation(s)
- Alisa Grigorovich
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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47
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Muraco A, Fredriksen-Goldsen KI. The highs and lows of caregiving for chronically ill lesbian, gay, and bisexual elders. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:251-72. [PMID: 24224896 PMCID: PMC4065790 DOI: 10.1080/01634372.2013.860652] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/26/2013] [Indexed: 05/27/2023]
Abstract
This study examines informal caregivers' and LGB care recipients' best and worst experiences of care within their relationship. Communal relationship theory guides the research. The work uses qualitative interview data from a sample of 36 care pairs (N = 72), divided between committed partners and friends, to understand the similarities and differences in the care norms employed in varied relationship contexts. Findings from the study show that relationship context influences the experiences that caregivers and care recipients identify as best and worst, but often focus on the relationship and needs met at bests, and conflict and fear of worsening health as worsts.
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Affiliation(s)
- Anna Muraco
- a Department of Sociology , Loyola Marymount University , Los Angeles , California , USA
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Portz JD, Retrum JH, Wright LA, Boggs JM, Wilkins S, Grimm C, Gilchrist K, Gozansky WS. Assessing capacity for providing culturally competent services to LGBT older adults. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:305-21. [PMID: 24798180 PMCID: PMC4416410 DOI: 10.1080/01634372.2013.857378] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 10/16/2013] [Indexed: 05/26/2023]
Abstract
This qualitative, interview-based study assessed the cultural competence of health and social service providers to meet the needs of LGBT older adults in an urban neighborhood in Denver, Colorado, known to have a large LGBT community. Only 4 of the agencies were categorized as "high competency"; 12 were felt to be "seeking improvement" and 8 were considered "not aware." These results indicate significant gaps in cultural competency for the majority of service providers. Social workers are well-suited to lead efforts directed at improving service provision and care competencies for the older LGBT community.
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49
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Cooney TM, Proulx CM, Snyder-Rivas LA, Benson JJ. Role ambiguity among women providing care for ex-husbands. J Women Aging 2014; 26:84-104. [PMID: 24483284 DOI: 10.1080/08952841.2014.859502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Twenty-one women were interviewed regarding their caregiving experiences for ill or dying ex-husbands. Emergent in the analyses was the variety of ways in which they experienced role ambiguity as ex-wife caregivers. This article describes the role ambiguity ex-wife caregivers encountered interpersonally through interactions with network members, institutionally in dealing with professionals and the workplace, and intrapersonally in confusion over their roles and feelings. Consequences of role ambiguity are discussed, and recommendations for policy and practice are made in light of the aging population, changing family forms, and women's care roles.
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Affiliation(s)
- Teresa M Cooney
- a Department of Sociology, University of Colorado Denver , CO
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Fredriksen-Goldsen KI. Promoting Health Equity Among LGBT Mid-Life and Older Adults: Revealing how LGBT mid-life and older adults can attain their full health potential. GENERATIONS (SAN FRANCISCO, CALIF.) 2014; 38:86-92. [PMID: 25983387 PMCID: PMC4431582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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