Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study.

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Lifetime Violence, Lifetime Discrimination, and Microaggressions in the Lives of LGBT Midlife and Older Adults: Findings from Aging with Pride: National Health, Aging, and Sexuality/Gender Study.

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimination, and contemporary microaggressions among LGBT adults, aged 50 and older, utilizing data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. We examined subgroup differences, the interrelationships between adverse experiences, and the association with health, taking into consideration interactions by age. Results: Distinct aspects of these experiences were effectively captured by tailored measures. Important subgroup differences emerged with high levels of lifetime violence among sexually diverse adults, gay and bisexual men, and transgender adults. Experiences of violence remained a significant predictor across all three health outcomes, after controlling for both lifetime discrimination and microaggressions. Microaggressions had a significant contribution to comorbidity for those with a low level of lifetime violence. The interaction effects suggest that comorbidity increases as the number of lifetime violence experiences increases for those who are younger. As age increased, the lifetime violence effect on comorbidity diminished whereas the microaggressions effect became stronger. Conclusion: Greater attention to the sequelae of lifetime violence and other adverse events among midlife and older adults is needed as well as the development and testing of both downstream and upstream interventions to reduce and mitigate the impact of these experiences on the well-being of LGBT midlife and older adults.

Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners.

BACKGROUND: Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE: This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS: IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS: IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION: IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.

Sexual Minority Disparities in Subjective Cognitive Impairment: Do They Persist After Accounting for Psychological Distress?

Objectives: Sexual minority older adults are a health disparate group with disproportionate rates of subjective cognitive impairment (SCI) and psychological distress. This study estimated risks of SCI by sexual orientation and gender, accounting for variations in psychological distress. Methods: We aggregated National Health Interview Survey data (2013-2018) of adults aged 45 and older and implemented logistic regressions of SCI indicators on sexual orientation and psychological distress, adjusting for covariates. Results: Sexual minority adults showed higher likelihoods of SCI in terms of status, severity, frequency, extent, and activity limitations than heterosexuals, even after controlling for psychological distress. SCI risk was significantly higher among sexual minority vs. heterosexual women, with no significant difference among men. Conclusions: Public health initiatives should address this health disparity in SCI and support informal care networks for sexual minorities. Future research is needed that further investigates SCI at-risk groups, with attention to sexual minority women.

Identifying Latent Patterns and Predictors of Health Behaviors and Healthcare Barriers Among LGBT Older Adults.

Heightened risk of adverse health behaviors is of major concern among lesbian, gay, bisexual, and transgender (LGBT) older adults. Yet, no previous research has investigated heterogeneity of LGBT older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to identify latent classes of the behavior and barrier patterns and examine differences in physical and psychological health-related quality of life (HRQOL) by the specified latent classes while exploring predictors of the class membership. Three-step latent class analysis applying survey weights was conducted with 14 indicators of health-risk behavior, health-promoting behavior, preventive care use, and healthcare barriers from baseline data of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS, N = 2450). The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) less healthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), and (4) optimal health behaviors with risks of limited healthcare access (C4, 11%). Compared to C1, C2 and C3 had lower physical HRQOL and C2 also had lower psychological HRQOL. C4 did not differ in HRQOL from C1. C2 was associated with more day-to-day discrimination, lower mastery, and lower social support. Efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and reduce marginalization. Positive relationships between LGBT older adults and healthcare need to be established via trust-building and cultural competency.

Stress and Resilience among Sexual and Gender Diverse Caregivers.

Little is known about caregiving outcomes of sexual and gender diverse, including LGBT, caregivers. Informed by the Health Equity Promotion Model (HEPM) and Pearlin's Stress Process Model, we utilized data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), to examine perceived stress among a sample of 754 sexual and gender diverse caregivers using regressions on background and caregiving characteristics and risk and protective factors. Among caregivers, 38% were providing care to a spouse or partner and about one-third to a friend (29%). Higher stress was associated with younger age, lower income, higher education, partner/spouse care, personal care provision, longer caregiving hours, and caregiver cognitive impairment. After including the risk and protective factors from HEPM, victimization, social support, and community engagement significantly predicted perceived stress. Findings contribute to emergent research on caregiving in diverse populations.

Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment.

Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.

Key Determinants of Physical and Psychological Health-Related Quality of Life Over Time Among Midlife and Older LGBTQ and Sexual and Gender-Diverse Caregivers.

BACKGROUND AND OBJECTIVES: Prior research has shown informal caregiving among older adults can negatively affect the caregiver's physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers. RESEARCH DESIGN AND METHODS: Informed by the Health Equity Promotion Model and Caregiver Stress Process Model and utilizing longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this analysis examined modifiable risk and protective factors associated with psychological and physical HRQOL over time among 754 LGBTQ caregivers aged 50-98. RESULTS: Psychological and physical HRQOL declined over a 3-year period. After controlling for background characteristics, mastery, social support, socialization, LGBTQ community engagement, and physical activity were positively associated with psychological HRQOL while day-to-day discrimination, identity stigma, and insufficient food intake were negatively associated. Steeper declines were observed for older and with no physical activity. Mastery, social support, socialization, and physical activity were positively associated with physical HRQOL while day-to-day discrimination and insufficient food intake were negatively associated. Steeper declines were found for those with high mastery and no physical activity. DISCUSSION AND IMPLICATIONS: Although generalized factors including mastery, socialization, and social support are protective for HRQOL among LGBTQ caregivers, factors including day-to-day discrimination and identity stigma are more unique to historically disadvantaged populations and should be considered in future research and practice. Caregiving interventions incorporating physical activity are promising given its buffering effect for decreased physical and psychological HRQOL over time.

Generational and Social Forces in the Life Events and Experiences of Lesbian and Gay Midlife and Older Adults Across the Iridescent Life Course.

ObjectivesUtilizing Iridescent Life Course, we examine life events among three generations of lesbian and gay adults: Invisible (born 1920-1934), Silenced (born 1935-1949), and Pride (born 1950-1964) Generations. Methods: We utilized a subsample (n = 2079) from the 2014 wave of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). Demographic characteristics, life events, and gender and generational interactions were compared. Results: Compared to other generations, the Invisible Generation disclosed their identity at older ages, were more likely to be retired, served in the military, and survived a partner's death. Compared to the other generations, the Pride Generation was more likely to have disclosed their identities earlier and experienced higher levels of victimization/discrimination. Discussion: This paper is the first to examine the lived experiences of the oldest lesbians and gay men and compare them to other generations. The findings illustrate the heteronormative nature of most life course research.

Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study.

We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence by gender identity for background characteristics, economic, social and health indicators. We performed regressions of these indicators on gender identity, including transgender versus cisgender adults and transgender nonbinary adults compared to cisgender adults, followed by subgroup analyses: transgender women and men compared to each cisgender group and to one another, adjusting for covariates. Compared to cisgender adults, transgender adults overall were significantly younger and lower income with less education; more likely single with fewer children; and had several elevated health risks, including poor physical and mental health, and higher rates of chronic conditions and disability. Alternatively, transgender men and women had higher rates of flu vaccination than cisgender men. Between transgender subgroups, transgender men and transgender nonbinary adults were younger than transgender women; transgender men were significantly less likely married or partnered than transgender women; and, transgender women were more likely to live alone than nonbinary respondents. This is one of the first population-based studies to examine both between and within subgroup disparities among cisgender, transgender binary, and transgender nonbinary adults, revealing patterns of inequities across subgroups. More research understanding the mechanisms of these disparities and the development of targeted interventions is needed to address the unique needs of subgroups of transgender people.

Disparities in Subjective Cognitive Impairment by Sexual Orientation and Gender in a National Population Based Study of U.S. Adults, 2013-2018.

Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013-2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, applying logistic regressions adjusting for age, income, education, race/ethnicity, and survey years. Results: Sexual minorities (24.5%) were more likely to have subjective cognitive impairment than heterosexuals (19.1%). Sexual minority women had higher odds of greater severity, frequency, and extent of subjective cognitive impairment. Sexual minorities were also more likely to report activity limitations resulting from cognitive impairment and were no more likely to attribute limitations to dementia or senility. Discussion: Cognitive health disparities are of particular concern in this historically and socially marginalized population. The investigation of explanatory factors is needed, and targeted interventions and policies are warranted to address cognitive challenges faced by sexual minorities.