Aging with Pride: Navigating Healthcare Challenges for LGBTQ+ Older Adults

Background

Pride Month is an annual celebration that recognizes the LGBTQ+ community's accomplishments and advocates for equal rights and acceptance. Traditionally celebrated in June, Pride Month commemorates the Stonewall Uprising of 1969, a pivotal event in LGBTQ+ history. It serves as a time to celebrate the achievements and contributions of the LGBTQ+ community while promoting equality, acceptance, and visibility. While it is essential to celebrate progress, it is equally crucial to acknowledge the unique challenges faced by aging older adults who identify with Pride communities in the USA. This post explores the intersectionality of aging and LGBTQ+ identity, highlighting the impact on healthy aging, healthcare disparities, and options for inclusive care.

Challenges

One of the many challenges that face aging LGBTQ+ older adults in our communities today is healthcare disparities. LGBTQ+ older adults face higher rates of certain health conditions, such as cardiovascular disease, cancer, depression, and substance abuse, compared to their heterosexual counterparts. Discrimination, stigma, and a history of marginalization contribute to these disparities.

The outcome of these contributors leads to another challenge: social isolation. Aging can often lead to increased social isolation, and this is particularly true for LGBTQ+ older adults who may have faced rejection from family or lack support networks.

& finally, lack of continuous support in all aspects throughout one’s life can lead to another challenge highly prevalent specifically within these communities: financial insecurity. LGBTQ+ older adults are more likely to experience financial challenges due to unreliable or complete lack of familial support, workplace discrimination, limited access to healthcare, and disparities in retirement benefits.

With these systemic barriers and challenges in mind, let’s take a look at three areas of impact on aging in these communities: mental health, chronic illness, and substance abuse.??

1. Mental Health: LGBTQ+ older adults may experience higher rates of depression, anxiety, and suicidal ideation due to the cumulative effects of discrimination, stigma, and social isolation.
2. Chronic Illness: The prevalence of chronic illnesses is higher in LGBTQ+ older adults. Managing these conditions becomes more complex when compounded by discrimination and access to appropriate healthcare.
3. Substance Abuse: LGBTQ+ older adults have higher rates of substance abuse, often as a coping mechanism for the challenges they face. This can lead to further health complications and exacerbate existing conditions.

Top 3 Chronic Conditions

A recent report by the National Council on Aging provides information on the three chronic conditions that disproportionately impact these populations: cancer, mental health, and cardiovascular diseases. A few highlights from the article include:?

• Lesbian, gay, and bisexual older adults are more likely to have risk factors associated with breast, cervical, testicular, prostate, and colon cancer.?
• Gay and bisexual men are at higher risk of HPV, and while often under-estimated, HPV is very serious - often leading to cervical and anal cancer.?
• In the latest research, 59% of LGBT older adults report lack of companionship, and 53% report feeling isolated.?
• The article also makes an important special note about heart disease for people in the transgender community, stating that it is unclear if the use of hormones can put one at greater risk of a stroke or heart attack. More information is in the article linked on our blog.?

Impact

When looking into the true impact on help-seeking and healthcare utilization within this population, a stark contrast can be seen when compared to the heterosexual population.?

• Health Insurance Coverage: According to HHS , there are significant disparities in insured status and types of insurances between LGBTQ+ adults and non-LGBTQ+ adults.
• Delayed or Avoided Care: LGBTQ+ individuals often face barriers to healthcare, leading to delayed or avoided care. A 2010 survey found that 33% of transgender respondents postponed necessary medical care due to discrimination or mistreatment.
• Mental Health Services: LGBTQ+ individuals are more likely to seek mental health services compared to their heterosexual counterparts. According to a study published in JAMA Internal Medicine, LGBTQ+ adults were more likely to report depression, anxiety, and substance use disorders than heterosexual adults.
• Preventive Services: LGBTQ+ individuals may be less likely to receive recommended preventive screenings. The National Health Interview Survey found that lesbian and bisexual women were less likely to receive mammograms and Pap tests compared to heterosexual women.
• Health Disparities: Numerous studies have highlighted health disparities experienced by LGBTQ+ individuals, including higher rates of certain health conditions, mental health challenges, and substance abuse.

While specific percentages may vary across studies and populations, these statistics indicate disparities in healthcare access and utilization among LGBTQ+ communities. It's important to note that collecting data on sexual orientation and gender identity in healthcare settings is still limited, which can affect the availability of comprehensive statistics.

Access to Care

Knowing all of this information is of course important, but what about the access to and quality of care? Due to centuries of discrimination, these communities are hesitant to pursue certain healthcare needs. While the push for healthcare providers to receive training on LGBTQ+ health issues, cultural competency, and inclusive language is ongoing, there are resources available to find and access sensitive and culturally informed care.?

• LGBTQ+ Health Centers: These centers are specifically designed to cater to the unique needs of LGBTQ+ individuals, providing a safe and inclusive environment where healthcare professionals are knowledgeable about LGBTQ+ health issues.
• LGBTQ+ Community Referrals: Local LGBTQ+ community organizations and support groups can often provide recommendations for culturally-sensitive healthcare providers in the area.
• SAGE runs a national resource center on LGBT aging. They have an excellent healthy aging toolkit with many resources for LGBT older adults.

A Call to Action for Healthcare Providers & Administrators

Before closing out this episode, I want to reach out to any healthcare providers and administrators listening in. We each have a role to play in ensuring sustainable change in the ability for all individuals to have equal access to safe, appropriate, and informed care.?

• Healthcare Access: Ensure equal access to healthcare services for LGBTQ+ older adults through legislation that prohibits discrimination based on sexual orientation or gender identity.
• Affordable Care: Advocate for comprehensive healthcare coverage that includes gender-affirming care, mental health services, and preventive screenings without discrimination.
• Provider Education: Promote LGBTQ+ cultural competency training for all healthcare professionals, equipping them with the necessary knowledge and skills to provide inclusive care.
• Supportive Aging Services: Develop programs that address the unique needs of LGBTQ+ older adults, including social support, mental health services, and access to affordable housing.
• Community Outreach: Increase awareness of LGBTQ+ aging issues through community outreach and education campaigns, fostering acceptance and reducing stigma.

Pride Month serves as a reminder of the ongoing journey towards equality and acceptance for LGBTQ+ individuals. Aging older adults who identify with Pride communities face unique challenges that can impact their health and well-being. By addressing healthcare disparities, promoting LGBTQ+ cultural competency, and implementing systemic changes, we can ensure that healthcare environments become safe, inclusive, and culturally-sensitive for all.