Sexual Minority Seniors: Coping Strategies for Health Needs in Late Life

Background/purpose

Compared to their heterosexual counterparts, lesbian, gay and bisexual (LGB) adults experience notable health disparities, including higher rates of obesity among lesbians, higher rates of eating disorders among gay men, and higher rates of depression among bisexuals. As LGB individuals age, health disparities continue, intensifying general age-related physical decline. Planning for aging-related care is particularly challenging for LGB persons, as many face rejection from their family of origin, discrimination from service providers, and a lower likelihood of having family members who will care for them in late life.

Despite older LGB persons’ unique needs, little research has examined how this population makes decisions concerning aging-related care. This mixed methods study addresses the research question: What coping strategies are used by older LGB adults (age 65+) to manage barriers related to aging, health care needs, and end-of-life care?

Methods

Semi-structured interviews were conducted with nine adults, age 65 or older, identifying as LGB or same-gender-loving and residing in a city in the Southeast U.S. Interviews focused on aging-related care, end-of-life wishes, and current health. Discussions were audio-recorded and transcribed, and lasted for about 30-90 minutes. After the interview, participants filled out a survey containing items related to demographics, depression, life purpose, and social support.

Results

Participants’ ages ranged from 65 to 77, with a mean of 71. Three participants were Black/African-American and six were White. 56% of participants were cisgender men, and 44% were cisgender women. Just over half (56%) were partnered/married. Median monthly income was $1,800.

This presentation will focus on the qualitative findings analyzed through narrative analysis. Two broad narratives were identified within the data. First, participants described how they make an effort to be proactive when aging-related decisions are within their control. They told stories of taking action to prepare for their health and aging-related needs, wanting control over the course of their lives and their care, and wanting their wishes respected, all of which drove motivation for organizing advance care directives and having conversations with partners, family and friends about aging-related care and end-of-life plans. They also discussed ways they actively manage LGB-specific barriers (such as homophobia) and use coping strategies to address concerns such as isolation and being HIV+.

A second narrative thread focused on vulnerability and “letting go” when situations are perceived as outside of one’s control. Key topics included having an optimistic temperament in the face of life’s challenges, emotionally adapting to obstacles, finding strength in spirituality, and being willing to reveal feelings of vulnerability to trusted others.

Conclusions and Implications

This sample of older LGB adults demonstrated remarkable resilience in handling difficulties encountered across the life course, including LGB-specific barriers. While not everyone had an advance care directive, many were motivated to organize such documents after witnessing illness or death of a loved one. Social workers are key resources who can affirm LGB older adults, challenge homophobia in service settings, and support these adults in developing active coping strategies for preparing for health care and aging needs in late life.