The Health of Lesbian, Gay, Bisexual, and Transgender People Building a Foundation for Better Understanding (2011) / Chapter Skim
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6 Later Adulthood
6 Later Adulthood
Pages 251-292
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From page 251... ...
These areas of research are certainly not restricted to heterosexual persons; the experiences of aging LGBT persons may be similarly characterized, with the addition of the legacies and experiences of stigma. In fact, studies of aging among LGBT elders will generate new knowledge about aging in general as questions are framed and concepts considered that fall outside of traditional "heteronormative" perspectives.
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From page 252... ...
In so doing, it highlights the continuous nature of the life course while at the same time elucidating the particular circumstances of the later years. In general, LGBT elders have not been the subject of extensive research; a recent publication reviews some of the extant literature and echoes this statement (see Fredriksen-Goldsen and Muraco, 2010)
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From page 253... ...
DEVELOPMENT OF SEXUAL ORIENTATION AND GENDER IDENTITY Although the age at which gay men and lesbians come out appears to be earlier today than in previous cohorts, there remains great variability in the time of coming out and evidence that the process may extend over the life course (Brown et al., 2001; de Vries and Blando, 2004)
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From page 254... ...
In both of these studies, those with lower disclosure reported greater happiness and life satisfaction, leaving open questions about the time/cohort and/or life-course consequences of coming out. Transgender persons who are visibly gender role nonconforming in childhood tend to come out at an early age (Bockting and Coleman, 2007)
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From page 255... ...
. For many transsexual women, however, the cross-gender identity develops more gradually over the life course and increases in intensity, and after years of compartmentalizing this identity privately, these transsexual women come out during midlife or beyond to transition and pursue hormone therapy and/or surgery to feminize.
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From page 256... ...
. MENTAL HEALTH STATUS Some significant literature examines the potential challenges faced by LGBT persons in later life; there have been few empirical studies in this area, however.
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From page 257... ...
Thirty-one percent of the LGBT persons in this sample were depressed; transgender persons reported significantly higher levels of depression than nontransgender persons, although the exact percentages were not known. Suicide/Suicidal Behavior The National Institute of Mental Health (NIMH, 2007)
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From page 258... ...
Compared with women, men reported significantly more internalized homophobia, alcohol abuse, and suicidality related to their sexual orientation. Less lifetime suicidal ideation was associated with lower internalized homophobia, less loneliness, and more people knowing about participants' sexual orientation (D'Augelli and Grossman, 2001)
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From page 259... ...
PHYSICAL HEALTH STATUS The now well-known health concomitants of aging are similarly represented among heterosexual and LGBT older adults, although they may be exacerbated by factors associated with gender identity and sexual orientation. These factors are rarely studied, and thus are fertile ground for subsequent research.
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From page 260... ...
Little empirical research has explored sexual functioning among older lesbians, bisexuals, and transgender persons. In terms of reproductive
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From page 261... ...
Their results demonstrate similarities in oral contraceptive use and rates of pregnancy and hormone replacement therapy among the five sexual orientation groups. The rate of oral contraceptive use was highest for bisexual women (54.6 percent)
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From page 262... ...
Clearly, this is an area that merits greater examination with many issues being unaddressed, including, for example, sexual functioning after sex reassignment surgery and the impact of long-term hormone use on sexual functioning. This area takes on even greater importance in the context of abuse against transgender persons more generally, which is noted to be high (e.g., Witten and Whittle, 2004)
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From page 263... ...
. There are no known data on incidence rates of prostate cancer among gay or bisexual men; information on sexual orientation is not collected in the Surveillance Epidemiology and End Results database.
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From page 264... ...
Beyond case studies, little research exists on the risk for cancer among transgender elders, even though they may be at increased risk for breast, ovarian, uterine, or prostate cancer as a result of hormone therapy (Feldman and Goldberg, 2007; Van Kesteren et al., 1997)
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From page 265... ...
Fredriksen-Goldsen and colleagues (2011) found that 45 percent of the older LGBT persons in their large study reported having high blood pressure; 43 percent reported high cholesterol and 6 percent reported having had a heart attack.
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From page 266... ...
identifies nine areas of interest: • age-related changes in immune function; • age-related differences in response to treatment; • age-related changes in pharmacokinetics, pharmacodynamics, and pharmacogenomics; • metabolic complications of HIV/AIDS; • neurologic complications of HIV/AIDS; • neuropsychiatric complications of HIV/AIDS; • HIV-related malignancies; • frailty and functional status; and • complexity of care. Systematic research examining HIV among older transgender persons also is lacking in the literature, although several authors and reports have suggested a higher prevalence of HIV among transgender persons generally, in particular male-to-females (e.g., Kenagy and Hsieh, 2005)
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From page 267... ...
found that historical and current discrimination as experienced by chronically ill LGB adults and their caregivers appeared to manifest in higher levels of psychological distress, leading to cumulative mental and physical health problems, for both members of the caregiving dyad. No studies have specifically studied the issues transgender elders may face in terms of availability of appropriate caregivers.
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From page 268... ...
Stigma, discrimination, and victimization; violence; substance use; and childhood abuse have all been documented as risk factors for LGBT elders. Much less research has been conducted on protective factors, although crisis competence and social support have been identified.
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From page 269... ...
found that older LGBT adults reported an average of four incidents of victimization and discrimination over the course of their lives due to their sexual orientation or gender identity; these experiences typically took the form of verbal insults (65 percent) and physical violence (40 percent)
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From page 270... ...
Violence Another area that is substantially underresearched is LGBT elders' experiences of violence. In a previously mentioned study involving LGB adults, D'Augelli and Grossman (2001)
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From page 271... ...
In D'Augelli and Grossman's (2001) research with 416 LGB adults aged 60 or older, the earlier a person was aware of her or his sexual orientation and first disclosed it to others, the more likely he or she was to report incidences of physical assault.
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From page 272... ...
felt that "being LGBT has helped them prepare for aging." Among those who saw benefits, two broad categories of benefit were identified: personal/interpersonal strengths, including being more accepting of others, being more resilient, and having greater self-reliance, and overcoming adversity. Still, more than a quarter of respondents said their sexual orientation and/or gender identity had not helped them prepare for aging (MetLife, 2010)
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From page 273... ...
As discussed in Chapter 2, however, the effect of education may not be the same across racial and ethnic groups; some groups may be less likely to disclose sexual orientation with increasing education (Kennamer et al., 2000)
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From page 274... ...
of 646 transgender adults living in California, including 80 respondents over age 55, found that even when covered by insurance, 42 percent of respondents had delayed seeking care because they could not afford it, and 26 percent reported health conditions that had worsened because they postponed care. Some evidence from earlier studies suggests that older lesbians and bisexual women obtain fewer cervical cancer screenings (Price et al., 1996)
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From page 275... ...
. Observations from a variety of community groups and community-based needs surveys suggest that LGBT elders delay seeking health care for fear of discrimination and provider bias.
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. CONTEXTUAL INFLUENCES In addition to sociodemographic and familial factors, which influence the health of LGBT people across the life course, LGBT elders face a number of end-of-life issues.
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From page 277... ...
Regional surveys of LGBT elders have found even more dramatic differences in partnering between older LGBT and heterosexual adults. In San Francisco, for example, more than 70 percent of gay and bisexual men and almost 50 percent of lesbian and bisexual women over age 65 reported not having a partner (Adelman et al., 2006)
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From page 278... ...
Among LGBT elders, social support networks have been shown to be associated with physical health (Grossman, 2006; Masini and Barrett, 2008)
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From page 279... ...
For example, one man said, "I think for gay people -- many of whom are disowned by their families because of their sexual orientation -- their friendships are stronger" (p.
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From page 280... ...
This observation raises the issue of relational quality and its effect on the well-being of older LGBT adults: What is the utility of relational ties in addressing the healthrelated needs of LGBT elders? The answer to this question is unknown, and this is a central issue meriting future research.
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From page 281... ...
Similarly, those living in states with no recognition of same-sex relationships also expressed greater fear of dying in pain and being the object of discrimination because of their sexual orientation than those residing in states where same-sex relationships are recognized. State recognition was the only significant predictor of fear of dying alone in these analyses.
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From page 282... ...
Physical Health Status • It appears that rates of hysterectomy, oral contraceptive use, and hormone replacement therapy may be similar for lesbians, bisexual women, and heterosexual women. • Lesbians and bisexual women may have higher rates of breast cancer than heterosexual women.
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From page 283... ...
Both cross-sectional and longitudinal research is especially needed to explore the demographic realities of LGBT aging in an intersectional and social ecology framework, to allow an understanding of the mechanisms of both risk and resilience in LGBT elders, and to identify appropriate interventions for working effectively with this cohort. These parameters could be brought to bear in research in the following areas: • Demographic and descriptive information, including the percentage of elders who are LGBT and how that percentage varies by such de mographic characteristics as race, ethnicity, socioeconomic status, geography, and religion; also, the general experiences and health status of older LGBT adults and how these vary by demographic characteristics, the percentage of LGBT elders who are parents, and the trajectory of LGBT identity and experiences (particular bisexual identity)
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From page 284... ...
• Physical health, including cancer rates, risks, and treatment (par ticularly for prostate cancer among older gay and bisexual men and transgender women and anal cancer among older men who have sex with men) ; the effects of long-term hormone use among older transgender persons; and the effects of disabilities among older LGBT persons.
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From page 285... ...
Jour nal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research 13(4)
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From page 286... ...
2001. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention.
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2010. Aging and sexual orientation: A 25-year review of the literature.
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2007. Sexual orientation and mental health.
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2010. Psychiatric impact of gender-related abuse across the life course of male-to-female transgender persons.
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2006b. Lesbian and bisexual women as grandparents: The centrality of sexual orientation in the grandparent-grandchild relationship.
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2010. Risk factors for reproductive and breast cancers among older lesbians.
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