Changing attitudes about LGBTQ+ older adults: the Gen Silent Survey Project.

OBJECTIVES: Lesbian, gay, bisexual, transgender, queer, and more (LGBTQ+) older adults may experience challenges accessing services due to stigma. Aging service providers seeking to create an inclusive culture need training tools. This study examined if a film (Gen Silent) could increase provider's knowledge of and empathy for LGBTQ+ older adults. METHODS: A pretest - posttest survey was administered at film screenings in New Hampshire to assess knowledge and attitudes of participants (N = 108). Data were analyzed descriptively, Wilcoxon signed-rank test was used to compare matched samples, and linear and logistic regression models compared group differences. RESULTS: Scores on eight of the nine measures improved after watching Gen Silent. Most participants (83%) indicated their thoughts and views had changed after watching the film. Statistically significant between group differences are discussed. CONCLUSIONS: The documentary Gen Silent was found to be an adequate, introductory training tool about LGBTQ+ aging.

HIV Stigma and Older Men's Psychological Well-Being: Do Coping Resources Differ for Gay/Bisexual and Straight Men?

OBJECTIVES: This study investigated whether sexual orientation moderated the mediation effects of coping resources (i.e., spirituality and complementary and integrative health [CIH] use) in the relationship between HIV stigma and psychological well-being (PWB) among older men with HIV (MWH). METHOD: Data from the Research of Older Adults with HIV (ROAH) study was used (N = 640, Age 50+). Structural equation modeling (SEM) was employed to examine a coping resource mediation model. We used a multiple-group procedure to test moderation effects by sexual orientation. RESULTS: HIV stigma was negatively associated with spirituality and PWB. HIV stigma accounted for a significant amount of variance in PWB, with significant indirect effects via spirituality, indicating a partial mediation. Chi-square difference tests supported the hypothesis that this mediation effect was moderated by sexual orientation. CIH use was not statistically significant. DISCUSSION: HIV stigma's negative relationship with PWB was salient in both groups. Spirituality's buffer between HIV stigma and PWB was stronger in older gay/bisexual MWH compared to their heterosexual counterparts. With respect to HIV stigma, older gay/bisexual MWH exhibited a "crisis competence" in coping with stigma, perhaps through overcoming past homophobia related to their sexual minority status (i.e., homophobia).

Stigma and Psychological Well-being Among Older Adults With HIV: The Impact of Spirituality and Integrative Health Approaches.

Purpose of the Study: The National Institutes of Health calls for research that explores what it means to age optimally with HIV/AIDS as half of the U.S. people with HIV are aged 50 or older. This study applied the stress process model to examine the association between HIV stigma and psychological well-being and mediating resources (i.e., spirituality and complementary and integrative health [CIH]) approaches) in older adults with HIV. Design and Methods: Using data from the Research on Older Adults with HIV (ROAH) study, structural equation modeling was used to estimate these relationships within a latent variable model. Namely, a direct negative association between HIV stigma and psychological well-being was hypothesized that would be mediated by spirituality and/or CIH use. Results: The analyses showed that the model fits the data well [χ2 (137, N = 914) = 561.44, p = .000; comparative fit index = .964; root mean square error of approximation = .058, 95% confidence interval = .053 to .063]. All observed variables significantly loaded on their latent factor, and all paths were significant. Results indicated that spirituality and CIH use significantly mediated the negative association between HIV stigma and psychological well-being. Implications: Findings highlight the importance of spiritual and CIH interventions for older adults with HIV/AIDS. Practice recommendations are provided at the micro- and mesolevel.

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults.

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

A State-Level Review of Diversity Initiatives in Congregate Meal Programs Established Under the Older Americans Act.

The Older Americans Act (OAA) congregate meal program (CMP) targets those most at risk for nutritional deficiencies, social isolation, and institutionalization. Social minorities (racial, ethnic, cultural, and sexual minorities) are at high risk for all three. This study explores state-level diversity initiatives to welcome these social minorities in CMPs. A national survey was distributed to each State Unit on Aging, all but three states participated. The majority of states (64.6%) target CMPs to a specific racial, ethnic, or cultural minority; five states target sexual minorities (lesbian, gay, bisexual, and transgender [LGBT]). Negative binomial regression results find state minority population percentage is a significant predictor of the number of diversity initiatives at CMPs. States with LGBT CMPs reported the highest levels of racial/ethnic/cultural diversity initiatives and high levels of statewide LGBT protective policies. Recommendations are suggested that build upon the diversification success of states to further the mission of OAA in reaching high-risk older adults.

Substance use and sexual risk differences among older bisexual and gay men with HIV.

Bisexual and gay men are disproportionately affected by HIV/AIDS. Research typically combines these groups into the category of men who have sex with men, and little is known about between-group differences. HIV-positive populations are aging and have high rates of substance use compared to non-infected peers, while substance use among older adults has increased and is associated with unprotected intercourse. Among a sample of 239 HIV-positive bisexual and gay men aged 50 and older, bisexual men were more likely to report cigarette, cocaine, crack, and heroin use compared with gay men. However, bisexual men were less likely to use crystal meth, club drugs, poppers (nitrate inhalers), and erectile dysfunction (ED) medications compared to gay men. While bisexual men reported lower rates of unprotected sex, logistic regression analysis found that current use of poppers and ED drugs, which were higher among gay men, explained this difference. Implications for education and prevention programs are discussed.

Do LGBT aging trainings effectuate positive change in mainstream elder service providers?

This study aims to provide empirical evidence regarding whether attitudes, beliefs, and intentions of elder-service providers can be positively affected as a result of attending cultural competency training on the unique challenges of sexual and gender minorities. Stigmatization throughout the lifespan may have a causal influence on barriers to care, social isolation, and concomitant health disparities. Data were collected for this study at 4 Massachusetts training events to pilot a cultural competency workshop on lesbian, gay, bisexual, and transgender (LGBT) aging for mainstream elder service providers. This quasi-experimental study included the analysis of pre- and posttest surveys completed by the service-provider attendees (N = 76). The analytic strategy included descriptive statistics, paired t tests, chi-square analyses, and repeated measures analyses of variance. Findings revealed statistically significant improvement in numerous aspects of providers' knowledge, attitudes, and behavioral intentions subsequent to the training sessions. These included (p = .000) awareness of LGBT resources, policy disparities, spousal benefits for same-sex couples, and the intention to challenge homophobic remarks. This study concludes that mainstream elder-service provider training on LGBT aging issues results in positive change. Recommendations include long-term follow up of participants, the inception of agency-level surveys to appraise institutional culture change, and increased curriculum on transgender older adults.

"Chemo brain"--is cancer survivorship related to later-life cognition? Findings from the health and retirement study.

OBJECTIVE: Studies have shown a correlation between cancer and cognition referred to as "chemo brain." This study investigated the relationship between cancer and later-life cognition using nationally representative data. METHOD: Analysis of the 2006 Health and Retirement Study investigated the (a) effects of cancer survivorship on the total cognition score using linear regression in adults age 65+ (n = 9,814) and (b) the effects of cancer treatment on the total recall index using linear regression in adults age 50+ (n = 657). RESULTS: Total cognition score is not associated with cancer survivorship. The association between long-term cancer survivorship and cognition score was significant (p < .05; b = .276). Total recall index is not associated with chemotherapy. DISCUSSION: These results support other research suggesting that chemo brain may be biased by expectation as well as favored by research that relies upon self-reported cognitive measures versus cognitive testing. The study was limited by the cross-sectional design.