The Aging and Health Report
Disparities and Resilience among LGBT Older Adults
National Health, Aging, and Sexuality Project
Karen I. Fredriksen-Goldsen, PhD
Grantmakers In Health Webinar  October 30, 2013
Funded in part by the National Institutes of Health and the National Institute on Aging
R01 AG026526 (Fredriksen-Goldsen, PI)
© Institute for Multigenerational Health
Making it
Possible

Project support and development
National Institutes of Health/National Institute on Aging
Pilot funding Hartford Foundation and Gerontological Society of America

11 community-based agencies across the country
Center on Halsted, FORGE, GLBT Generations, LA Gay and Lesbian Center,
LGBT Aging Project, Milwaukee/SAGE, New Leaf, Openhouse, SAGE,
SAGE Metro St. Louis, and Senior Services

Report sponsors
AARP, Gerontological Society of America, National Gay and Lesbian Task
Force, National Gero-Ed Center, and Pride Foundation
© Institute for Multigenerational Health
Changing Social Context
From
Peter Wichern
one of the first out
businessmen
to
Fortune Magazine:
Queer Inc.
How Corporate
America fell in love
with gays and
lesbians. It's a
movement.
© Institute for Multigenerational Health
Across the Generations

Who is still invisible: elders, people of color, diverse cultures,
different abilities, incomes, and education levels

An alarming and tragic number of LGBT teen suicides

Among LGBT elders 33% considered taking their lives over lifetime
“LGBT's read of youth suicide. How many LGBT elders kill themselves
because of isolation, grieving, and lack of reliable resources?”
63-year-old gay CAP participant
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Closing the Gap

Behavioral Risk Factor Surveillance System (BRFSS-WA)
Random-digit-dial telephone survey of adults
2% adults, 50 and older self-identity as lesbian, gay, or bisexual

Caring and Aging with Pride (CAP): Community-based
Surveys distributed through 11 aging agencies across the country
2,560 LGBT older adults participated, age 50 to 95
“Isolation, finding friend support, caregiving and health issues are the
biggest issues old gay people face. Who will be there for us,
who will help us without judgment?”
66-year-old lesbian CAP participant
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Health Disparities – BRFSS WA
LGB older adults compared to heterosexuals of similar age

Higher rates of disability

More mental distress

Higher risks of smoking and excessive drinking

Less likely to be married or partnered
►
Those living alone are at serious risk of social isolation, which is
linked to poor health and premature death
Fredriksen-Goldsen K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health
Disparities Among Lesbian, Gay, and Bisexual Older Adults – Results from a Population-Based
Study. American Journal of Public Health, 103(10), 1802–1809. doi:10.2105/AJPH.2012.301110
© Institute for Multigenerational Health
Distinct Risks – BRFSS WA
Lesbians and bisexual women compared to heterosexual women
 CVD risk
 Obesity
Gay and bisexual men compared to heterosexual men
 More likely to live alone
 Poor physical health
►
“LGBT” is often used in research and services yet they are distinct
groups with specific needs
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Survey Sample Characteristics
Age, y, M(SD)
Gender, Male
Gay men
Lesbians
Bisexuals
Transgender
Income, ≤ 200% FPL
Education, ≤ high school
People of color
Chronic conditions, M(SD)
Living with HIV
Total (N=2,560)
66.5 (9.1)
63%
58%
32%
7%
7%
31%
8%
13%
2.0 (1.4)
9%
© Institute for Multigenerational Health
CAP Survey: Risks

82% victimized at least once

64% victimized 3 or more times

LGBT racial and ethnic minorities, those with lower incomes, and
those with less education experience heightened, cumulative risks
►
Victimization and discrimination are linked with poor health
outcomes
Fredriksen-Goldsen, K. I., Emlet, C. A., Kim, H.-J., Muraco, A., Erosheva, E. A., Goldsen, J., & HoyEllis, C. P. (2012). The physical and mental health of lesbian, gay male and bisexual (LGB) older
adults: The role of key health indicators and risk and protective factors. The Gerontologist.
Editors’ Choice. Advance online publication. doi: 10.1093/geront/gns123
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CAP Survey: Resilience

91% wellness activities

82% moderate physical activities

38% spiritual or religious activities
►
Recognize societal contributions: many have actively served in the
US military.
“When the AIDS crisis began we took a hold of our own community
to help ourselves survive and showed the rest of the world how to do it.
We need to keep doing it.”
58-year-old gay CAP participant
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Lack of Access

13% were denied healthcare or received inferior healthcare

21% do not disclose sexual or gender identity to physician

Bisexual older adults less likely to disclose
►
The American Medical Association warns physicians’ failure to
recognize, and patients’ reluctance to disclose, can lead to failure
to diagnosis serious medical problems
“I have had an overwhelmingly positive experience with my gender
transition so far, but my primary concern about the future is with access
to healthcare and potential discrimination as a senior, especially when
the need arises for emergency or long-term care.”
56-year-old transgender woman CAP participant
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Unique Support


►
Rely heavily on friends and partners
Most of similar age
There may be limits in friends’ ability to provide care over the longterm, especially if decision-making is required
“I need to know if there are resources for someone to bury me with my
Mom and Dad. How do I make arrangements, what type of
arrangements, where do I turn for help? I have no siblings, no family.”
63-year-old bisexual CAP participant
Muraco, A., & Fredriksen-Goldsen, K. I. (2011). That’s what friends do: Informal caregiving for
chronically ill lesbian, gay and bisexual elders. Journal of Social and Personal Relationships,
28(8), 1073-1092. doi: 10.1177/0265407511402419
© Institute for Multigenerational Health
Services Needed



►
Senior housing, transportation, legal services, social events, and
support groups most important services needed
Caregivers: Supportive long-term care facilities
30% no will; 36% no durable power of attorney for healthcare
Most services fail to take into account the unique needs facing
LGBT older adults and their caregivers
“My partner died and I’m alone. But I make myself go out and attend
events at the local center. On a lighter note, I just recently realized I’m in
the love with the piano player. She hasn’t noticed me yet, but she will.”
81-year-old lesbian CAP participant
© Institute for Multigenerational Health
Limitations

Potential underreporting in a state level population-based
telephone survey (BRFSS)

Older adults connected with service agencies may have more
health and aging needs than non-service users (CAP)

Community survey is not generalizable
►
Convergence of findings across different data sources
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Moving Forward

Development of services tailored to unique needs

Prevention and intervention development

Responsive policies

Appropriate measures for public health surveys

Investigate health and aging of LGBT older adults over time
“The LGBT community has stepped up in the past to address coming
out, AIDS, and civil rights. The next wave has to be aging.”
63-year-old gay CAP participant
© Institute for Multigenerational Health
Moving Forward

National Health, Aging and Sexuality Study:
Caring and Aging with Pride Over Time
Longitudinal study to identify health trajectories over time
and potentially modifiable factors
Demographically diverse sample of LGBT older adults
Investigate cohort differences
Baby Boom Generation vs. Silent Generation
© Institute for Multigenerational Health
Resources

Website: CaringAndAging.org

The LGBT Aging and Health Report:
http://depts.washington.edu/agepride/wordpress/wpcontent/uploads/2012/10/Full-report10-25-12.pdf

Publication list: http://caringandaging.org/wordpress/publishedarticles/
Research reported in this presentation was supported by the National Institute On Aging of the National Institutes of
Health under Award Number R01AG026526. The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of Health.
© Institute for Multigenerational Health