The number of Americans over the age of 65 is estimated to more than double by year 2060. As our healthcare system adapts to an aging population, it must incorporate the perspectives of older LGBT Americans to address specific needs.
Last month, AARP released a report of nearly 2,000 older LGBT-identified Americans following a 2017 survey on health, community, and social determinants. The study sample was derived from a research panel of 85,000+ LGBT individuals developed over a 20-year period to support LGBT research initiatives. Although the panel skews to more educated and socially engaged elders, the study identified a number of concerns in healthcare for older LGBT Americans.
Long-Term Care Concerns
Individuals were asked about concerns surrounding their or their partner's future long-term care needs. In all categories—Neglect, Abuse, Refused or Limited Service Access, Harassment, and Identity Suppression—gender expansive elders expressed the greatest concern about future long-term care (gender expansive (*GE) here meaning transgender or non-binary individuals). In nearly every minority sexual orientation and gender identity group, over half of the participants expressed at least moderate future long-term care concerns.
Family support in individual health and wellness is critical, and health systems are increasingly integrating family-centered care and engagement. However, LGBT survey participants, especially transgender and non-binary elders, did not readily see their family members as parts of their social support networks. In working with LGBT populations, it is important to acknowledge and adapt to an expanded definition of "family" as the primary source of social support. LGBT family care models should consider friend and neighborhood networks as potential social support substitutes for more traditional biological or nuclear family units.
Access to Services
Access to LGBT specific and affirming spaces was limited for survey participants, especially those living in small communities. Nearly half of all respondents from small communities said that they did not have access to any LGBT organizations where they live. Outside of big cities, LGBT elders had very limited access to specific senior services and health centers. With high rates of access to community centers, social organizations, bars and faith centers outside of small communities, there is reason to consider alternative locations for LGBT senior wellness services and programing.
Primary Care Provider Relationships
Although many survey participants said they were out to their primary care providers, bisexual individuals disproportionately reported withholding their sexual orientation from their provider and feeling reluctant to discuss some issues for fear of being judged. However, of all participants who had a primary care provider, almost none reported having difficult or negative experiences with their provider.
Summary and Future Action
Of the near 2,000 survey respondents, many reported a number of affirming support systems in their lives and communities. However, there were identified, specific concerns for long-term care plans for gender expansive elders, as well as provider barriers for bisexual patients. Additionally, access to LGBT services in smaller, more rural communities was reported to be greatly limited. With the number of Americans over the age of 65 projected to more than double by year 2060, these needs should be met with community development and capacity building efforts alongside evidence-based interventions and service provision models specifically tailored to older LGBT Americans.
Report and Images Source
Houghton, Angela. Maintaining Dignity: Understanding and Responding to the Challenges Facing Older LGBT Americans. Washington, DC: AARP Research, March 2018. https://doi.org/10.26419/res.00217.001