The Aging and Health Report Disparities and Resilience among LGBT Older Adults National Health, Aging, and Sexuality Project Karen I. Fredriksen-Goldsen,

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 AgingR01 AG026526 (Fredriksen-Goldsen, PI)

© Institute for Multigenerational Health

Making it Possible

Project support and developmentNational 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


Changing Social Context

From Peter Wichern

one of the first out businessmen

toFortune Magazine:

Queer Inc.How Corporate

America fell in love with gays and lesbians. It's a

movement.


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

Across the Generations

“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


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-basedSurveys 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


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


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


Survey Sample Characteristics


Total (N=2,560)

Age, y, M(SD) 66.5 (9.1)

Gender, Male 63%

Gay men 58%

Lesbians 32%

Bisexuals 7%

Transgender 7%

Income, ≤ 200% FPL 31%

Education, ≤ high school 8%

People of color 13%

Chronic conditions, M(SD) 2.0 (1.4)

Living with HIV 9%

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., & Hoy-Ellis, 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


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.”



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


Unique Support Rely heavily on friends and partners Most of similar age

► There may be limits in friends’ ability to provide care over the long-term, 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


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


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


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.”



Moving Forward

National Health, Aging and Sexuality Study:

Caring and Aging with Pride Over Time

Longitudinal study to identify health trajectories over timeand potentially modifiable factors

Demographically diverse sample of LGBT older adults

Investigate cohort differences

Baby Boom Generation vs. Silent Generation


Resources

Website: CaringAndAging.org

The LGBT Aging and Health Report: http://depts.washington.edu/agepride/wordpress/wp-content/uploads/2012/10/Full-report10-25-12.pdf

Publication list: http://caringandaging.org/wordpress/published-articles/


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.

Documents

The Aging and Health Report Disparities and Resilience among LGBT Older Adults National Health, Aging, and Sexuality Project Karen I. Fredriksen-Goldsen,