Mental health disparities in older LGBTQ+ populations: A research roundup

The Journalist’s Resource by Naseem S. Miller, July 5, 2023: While resilient, older LGBTQ+ adults face significant health and mental health disparities compared with their cisgender, heterosexual counterparts, a growing body of research shows.

In 2017, researchers estimated that 2.4% of the U.S. population 50 years and older identified as LGBTQ+, accounting for 2.7 million people. By 2060, they say, that number is expected to double to 5 million.

Even though some health concerns affect many older adults, older LGBTQ+ adults face particular challenges stemming from years of discrimination, stigma and social exclusion, and lack of access to health care, as explained in a 2020 report by the National Academies of Sciences, Engineering, and Medicine.

Mental health disparities in the LGBTQ+ population appear as early as adolescence and may persist into older age, according to the NASEM report, “Understanding the Well-Being of LGBTQI+ Populations.”

When covering the older LGBTQ+ community, it’s important not to imply that these disparities affect everyone, says Dr. Karen Fredriksen-Goldsen, one of the leading researchers in this area and director of the Goldsen Institute at the University of Washington, specializing in health equity research among underserved communities.

“Older LGTBQ adults have significant health disparities, but they’re a highly resilient community,” Fredriksen-Goldsen says. “Many enjoy good health. I don’t want to leave you with the impression that they’re all not doing well, because that just isn’t the case.”

With that said, members of the LGBTQ+ community are at increased risk for several health and mental health conditions compared with their heterosexual peers, studies have shown.

Older LGBTQ+ adults have higher rates of anxiety, depression, eating disorders, loneliness and suicidal thoughts, compared with their heterosexual counterparts, studies show. They are also disproportionately affected by substance use disorders, including tobacco, alcohol and other drugs, according to academic research. And, they’re at a higher risk of developing chronic health conditions.

Older LGBTQ+ also adults face dual discrimination based on their age and their sexual or gender identities, according to the American Psychological Association. In addition, bias and misunderstanding from health-care providers may prevent some older LGBTQ+ adults from getting care, the association explains.

In addition, older LGBTQ+ adults are less likely to have caregiver support compared with their cisgender heterosexual counterparts, says Darcy Connors, executive director of SAGEServes, a division of SAGE, a nonprofit that provides advocacy and services for older LGBTQ+ adults.

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“That leads to reduced supports for health care needs and quality outcomes,” Connors says. “They’re also more likely to live alone; that social isolation does affect their mental stability.”

This diverse population also faces economic disparities, as explained in a 2022 study by Fredriksen-Goldsen and colleagues, resulting from discriminatory practices and lack of access to benefits of marriage until marriage equality became law in 2015.

“There’s a myth that LGBT older adults are more likely to be wealthy or have economic resources, when in fact, because of some of the conditions of their early life, they’re actually more likely to have a disability and live in poverty,” Fredriksen-Goldsen says.

She is the principal investigator of the Aging with Pride: National Health, Aging and Sexuality/Gender Study, which is the first federally-funded national longitudinal study of LGBTQ+ adults 50 years and older. The long-term study began in 2009 and includes 2,450 individuals across the U.S. The participants are surveyed every two years.

Fredriksen-Goldsen and her team, in addition to other researchers, have published more than one-hundred studies based on findings from the Aging with Pride cohort, paving the way to better understand health disparities in LGBTQ+ adults and each subgroup, highlighting the importance of remembering that the LGBTQ+ community is not a monolith.

“Even though we might use the LGBTQ acronym, these are very different groups and they often have unique life experiences and differing risks and protective factors,” she says.

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