This report is a review of the existing literature of lesbian, gay, bisexual, and transgender (LGBT) older adults and provides recommendations for future research and policy needs.
Although definitions vary, LGBT older adults include the population of sexual and gender minorities over the age of 50. With no census count available of LGBT older adults residing in the United States, investigators have used various methods to estimate the size of the population. One study estimates that there are over 2.4 million LGBT adults over age 50 in the United States, with the expectations that this number will double to over 5 million by 2030. Another study estimated that there are between 1.75 to 4 million LGBT adults above age 60. Without a national probability sample, accurate characterization of this population is difficult. However, numerous community-based, non-probability studies provide invaluable insight into the experiences of LGBT older adults and show that LGBT older adults face unique challenges to aging that their heterosexual, cisgender peers do not. Key findings from this review include the following:
- LGBT older adults face barriers to receiving formal health care and social support that heterosexual, cisgender adults do not. Several studies report LGBT older adults avoid or delay health care, or conceal their sexual and gender identity from health providers and social service professionals for fear of discrimination due to their sexual orientation and gender identity.
- Compared to heterosexual cisgender adults, LGBT older adults have fewer options for informal care. LGBT older adults are more likely to be single or living alone and less likely to have children to care for them than non-LGBT elders. Studies find resilient LGBT older adults often rely on “families of choice” (families composed of close friends), LGBT community organizations, and affirmative religious groups for care and support.
- Financial instability and legal issues are major concerns among LGBT seniors. Lifetime disparities in earnings, employment, and opportunities to build savings as well as discriminatory access to legal and social programs that are traditionally established to support aging adults, put LGBT older adults at greater financial risk than their non-LGBT peers.
- LGBT older adults have experienced and continue to experience discrimination due to their sexual orientation and gender identity. Studies find LGBT older adults experienced high rates of lifetime discrimination and physical and verbal abuse in relation to their sexual and gender minority identity. One study found that LGB seniors searching for retirement homes experienced unfavorable differential treatment (less housing availability, higher pricing, etc.) compared to non-LGB seniors.
- LGBT older adults have worse mental and physical health compared to heterosexual and cisgender older adults. LGB older adults have higher risks of mental health issues, disability, and higher rates of disease and physical limitations than their heterosexual counterparts. Compared to their cisgender peers, transgender older adults also face a higher risk for poor physical health, disability, and depressive symptoms, many of which are associated with experiences of victimization and stigma.
- Studies also find that LGBT older adults have a higher prevalence of engaging in risky health behavior, such as smoking, excessive alcohol consumption, and risky sexual behavior compared to non-LGBT older adults. However, LGBT older adults have higher rates of HIV testing than non-LGBT seniors.
- Among LGBT older adults, HIV-positive LGBT elders have worse overall mental and physical health, disability, and poorer health outcomes, and a higher likelihood of experiencing stressors as well as barriers to care, than HIV-negative LGBT elders.
Future Research and Policy Needs
- While community-based, non-probability studies provide important insight, they may not accurately represent the LGBT older adult population. Probability-based studies are needed to accurately characterize this population and generalize findings. Only two studies in this review used representative samples (both studies used state-level data) to characterize LGB older adults. To our knowledge, no probability sample of transgender older adults exists.
- Subgroups within the LGBT older adult population are understudied. In particular, we know little about bisexual, transgender, and intersectional subgroups (ie. older Black lesbians; Latina transwomen). Age-group specific analysis is also needed to provide better-targeted interventions.
- From a policy perspective, LGBT older adults need to be recognized by the Older Americans Act (OAA) as a “greatest social need” group. This designation would open important funding avenues to prioritize services for and research of LGBT older adults. Other policy needs important to LGBT older adults are anti-discrimination legislation and expanding the definition of family to include families of choice.
- LGBT older adults are a growing population likely in need of more frequent health care and social support. From a service perspective, culturally sensitive training for health care and social service agencies and professionals that provide support to elders could be critical in alleviating expectations of and experiences of discrimination that many LGBT older adults fear when seeking healthcare and professional help.