As LGBTQ identified people, we have lots to celebrate as our population has made tremendous gains in recognition and rights in the recent past. Still, when it comes LGBTQ health, LGBTQ-identified older adults have special concerns that may not impact other aging individuals. Facing these issues head on is the best way to deal with them and make sure we can stay prideful and healthy for many years to come.
Access to health care
LGBTQ older adults are less likely then their heterosexual peers to reach out to providers for healthcare services. The primary reasons for this discrepancy are traumatic histories and fear of sexual orientation or gender-based discrimination or harrassment. In one survey of LGBTQ older adults 74% reported feeling ‘not very confident’ or ‘not very confident at all’ that mainstream health and social care services would provide sensitive and appropriate end of life care for them. LGBTQ older adults are also more likely to report nine of twelve chronic health conditions chronic health conditions, compared to heterosexuals of similar ages.
While it may be surprising to younger generations, LGBTQ older adults were born into and came of age in a very different, “pre-liberation” world. These individuals lived most of their lives in a country that considered their orientation a mental disorder and didn’t allow them to marry or adopt children. For example, in the early days of HIV gay men were routinely discriminated against and denied care by doctors and nurses who feared cathing the virus themselves. Other special concerns of LGBTQ older adults include aging while living with HIV, transgenered individuals receiving insensitive or inappropriate care, increased risk of substance abuse and increased risk of cancer.
Though we currently live in more accepting times, discrimination and harrasment are still happening at all levels of society, including the medical industry. Seeking medical help puts LGBTQ health for older adults in very vulnerable positions and often requires personal disclosures about sexual orientation or gender identity that can be very difficult for individuals to feel comfortable providing. Looking for accepting providers online and asking up front—before attempting to access care–is a great way to introduce the topic and find out if potential providers are accepting and affirming. If they’re not—or only offer inauthentic lip service on the topic—find another provider. LGTBQ older adults deserve excellent care and the medical industry needs to continue to educate themselves on the special needs of this unique community so that it can consistently provide it.
Combating social isolation is a top priority in ensuring the health and well being of LGBTQ elders. Social isolation is a potential problem for many older adults, but is a special concern for LQBTQ older adults for several reasons. Members of this population are more likely to have lived non-traditional family lives which includes not having biological children, not being married and being ostracized from families of origins due to discrimination. Gay and bi-sexual men are twice as likely as heterosexual men to live alone and also have fewer children. LQBTQ adults may also not feel comfortable using mainstream support services such as senior centers and other organizations. These factors combine to make some LGBTQ adults very vulnerable to the risk of social isolation which increases risk for a myriad of health problems including depression, dementia, heart disease and premature death. Promoting intergenerational connections and ensuring all social spaces for older adults are accepting and affirming are first steps in making sure LGBTQ elders don’t face growing old alone.
Despite the difficult and adverse condition that LGBTQ older adults have endured, many are thriving and staying healthy and independent in their later years. Partly this is because a history of marginalization has forced these individuals to cultivate extensive coping skills that help them navigate and succeed in the mainstream world. For example, many older LGBTQ adults have created extensive supportive social networks that serve many of the purposes that a more traditional biological might. LGBTQ adults who continue to engage positively with their communities are also more likely to stay healthy longer. LGBTQ adults who have worked hard to have a positive, affirming self-concept despite—despite living much of their lives in a society that marginalized them—are also much more likely to age well. Many older LGBTQ individuals have learned to strongly advocate for themselves—and the people they care about—which will serve them well as they face the challenges of getting older. These unique resiliencies combined with now living in a more affirming and accepting society can help LGBTQ elders live long, healthy and fulfilling lives.
It’s estimated that there are over one million older adults who identify as LGBTQ in the United States. Each of these individuals deserves access to supportive and culturally sensitive health care. While great gains have been made there is still work to be done as the Trump administration recently proposed rolling back protections for LGBTQ people under the Health Care Rights Law. Being aware of the challenges LGBTQ older adults face as well as the unique strengths they possess can help them and their allies navigate the obstacles of aging. As one LGBTQ elder said, “The LGBT community has stepped up in the past to address coming out, AIDS, and civil rights. The next wave has to be aging.”