Every older adult should have the opportunity to age successfully. And the growing older LGBTQ+ population is no exception. This group is diverse, with unique health and social needs. On average, LGBTQ+ older adults experience poorer physical and mental health, but this is by no means the case for all LGBTQ+ older adults. The adversity faced by many in this community has also led to resilience, strength, and joy.
A 2017 report estimated that there are around 2.7 million people over age 50 (including 1.1 million ages 65 and older) who self-identify as LGBT. By 2030, that number is expected to grow to around 7 million. The LGBT population experiences higher average rates of chronic conditions and disability, HIV, and mental health distress. Anti-LGBTQ laws may also negatively impact the health of LGBTQ people. And the COVID-19 pandemic likely had a disproportionate impact on LGBTQ+ older adults, increasing, for example, the already high rates of social isolation.
The ramifications of the HIV/AIDS epidemic of the 1980s has left the older LGBTQ+ community largely invisible. Since 1981, more than 700,000 people in the U.S. have died from HIV-related illness. A large percentage of those lives lost were those of gay men and transgender women. While people today are living with HIV, the disease is still highly stigmatized.
Strategies to promote successful aging
Aging is a natural part of life. Successful aging is the ability to manage challenges and remain active in all aspects of life. Intentionally designing programs and services from the margins is an important approach to supporting successful aging for older LGBTQ+ people and all older adults. This means that programs, policies, and services are designed (or redesigned) with and for people who have been historically left out – those at the margins of society – at the center of our planning. This framing ensures that everyone has equitable access to quality and culturally responsive care.
For example, we know that discrimination, prejudice, and bias affect physical and mental health. These negative experiences are often magnified for older LGBTQ+ adults of color and transgender older adults. Understanding the historical and current discrimination, stigma, and exclusion against LGBTQ+ people is essential to our work and success in public health and healthcare. Designing affirmative environments that promote well-being increase health for older LGBTQ+ adults. Ensuring that our services are accessible, inclusive, and culturally responsive benefits everyone.
Assessing the quality of health care, the impact of experiences of discrimination on access to physical and mental health care, as well as the protective and positive factors can facilitate positive health experiences of older LGBTQIA+ people. Cultivating families of choice and mutual aid networks, as well as involvement in community groups and networks, are essential to aging well.
The importance of chosen family and community
We all need social support to age well. Older LGBTQ+ people are twice as likely to be single and live alone, and four times less likely to have children than their heterosexual counterparts. For many, a lack of family acceptance has led to strained relationships and less contact with their families of origin. This rejection is a type of trauma that has lifelong impacts.
This underscores the need for “families of choice” and a strong, reliable community to provide mutual support and love. According to the SAGE Encyclopedia of Marriage, Family, and Couples Counseling, chosen families are “nonbiological kinship bonds, whether legally recognized or not, deliberately chosen for the purpose of mutual support and love.” Expanding the definition of family to include chosen family is a step in the right direction.
In 2018, for example, New York City began allowing workers to use paid time off to care for anyone they personally define as family, whether they’re “related by blood or affinity.” Chicago, San Francisco, and St. Paul, MN, as well as states like Arizona and Rhode Island, have also expanded these benefits to honor non-biological kinship. And doing so can dramatically expand the availability of caregivers for LGTBQ+ older adults.
Aging in the community
Despite the perception that older LGBTQ+ adults are wealthy, in reality they are more likely to struggle financially and to live in poverty. Lesbian and bisexual women, especially, may experience lower incomes attributable to the double whammy of sexism and homophobia throughout their lifetime. These facts underscore the need for more affordable, affirmative long-term care and housing options for this community. One such model that helps older LGBTQ+ folks age in their own homes with dignity is the Program of All-Inclusive Care for the Elderly (PACE). This comprehensive model of LGBTQ+ elder supports a range of at-home medical and social services for Medicare and Medicaid recipients aged 55+ who are eligible for nursing home care.
Nearly three-quarters (76%) of older LGBTQ+ adults are concerned about having proper social support to rely upon as they age. Rising numbers of older LGBTQ+ adults need to rely on long term care communities (LTC). Yet, many do not feel safe being open about their sexual orientation due to a number of factors. These include potentially hostile residents and staff, refusal to allow same-sex partners to room together, and denial of visits from partners and family of choice.
To boot, most LTC communities lack LGBTQ+ inclusive non-discrimination policies. SAGE’s Long-Term Care Equality Index offers policy recommendations for long-term care communities. First is to ensure legal protections for LGBTQ+ residents and staff by developing written foundational policies and practices. Second, provide equal treatment and access to health-related benefits and policies for LGBTQ+ staff and residents. Third, support gender-affirming policies and adopt inclusive resident services. And lastly, publicly demonstrate organizational commitment to the LGBTQ+ community.
Loneliness and isolation
While loneliness is common among older adults of all identities, LGBTQ+ older adults experience loneliness and isolation at alarming rates. Discrimination can lead to loneliness and isolation, depression, and anxiety. There are many strategies to combat discrimination and strengthen connections to positive social activities. A sense of community and strong relationships are critical to successful aging for LGBTQ+ older adults.
Senior centers, volunteer centers, and places of worship can sometimes be unwelcoming and even hostile to LGBTQ+ older adults. Training and education on LGTBQ+ cultural competency for employers, service providers, home meal support programs, caregivers, and support networks can make these community gathering spaces more welcoming.
Offering LGBTQ+-focused programming is another way to make community settings more inclusive. Fostering connections with LGBTQ+ social groups and organizations can increase social support. Some examples are Oakland’s LGBTQ+ Community Center’s Elder Service Programs and Cafe Emmanuel in Jamaica Plain, Massachusetts, that offers a weekly luncheon for LGBTQ+ seniors and their friends.
Understanding intersectionality
Intersecting identities shape people’s experiences. Oppression, trauma, and poverty compounded with age, race, and disability, magnify health disparities. Discrimination, stigma, and structural inequities cause minority stress and weathering for marginalized populations, leading to poorer health outcomes. And older LGBTQ+ people often experience dual discrimination due to their age and LGBTQ+ identity. The trauma from bullying and violence in childhood, discrimination as adults, and experiences of homophobia all contribute to negative health outcomes.
Improving inclusive healthcare access and delivery system-wide
Due to bias and discrimination, LGBTQ+ older adults are less likely to seek preventative health screenings and routine health care. One study found that 13% of older LGBT adults were denied or provided inferior health care.
Access to affirming, inclusive, and respectful health care has been associated with better health outcomes, including an increase in preventative health screenings and better management of mental health conditions.
We can reduce disparities and improve health outcomes by expanding continuing education opportunities for providers. Adopting nondiscrimination policies for patients and employees, and ensuring that necessary care is covered by health insurance is essential, too. Specifically, we can improve inclusive and culturally responsive care for dementia services and supports for the growing numbers of LGBTQ+ older adults with dementia and Alzheimer’s disease. We can also improve the quality of end-of-life care for transgender older adults.
Recommendations for inclusive policy and practice
- The national advocacy and services organization for LGBTQ+ Elders (SAGE) also offers resources and guidance for identifying and securing LGBTQ+ elder affirming housing.
- Volunteer with SAGEConnect, a phone-buddy program that matches LGBTQ+ elders with volunteers for weekly phone calls.
- Provide gender affirming care, including mental health care, and training for healthcare providers to support transgender and nonbinary older adults, following the WPATH Standards of Care for the Health of Transgender and Gender Diverse People.
- Share this LGBTQ Healthcare Directory to find LGBTQ-friendly healthcare.
- Show Gen Silent, a documentary film about LGBT aging at your workplace and facilitate a discussion.
- Increase the body of culturally sound and affirmative research with older LGBTQ+ adults to expand knowledge and evidence-based practices.
- Listen to and amplify the needs, experiences, and voices of older LGBTQ+ adults.
