Physical and Mental Health Needs of Ethnic and Sexual Minority Older Adults

Background and Purpose:

By 2060, older Latinos and African-Americans will make up approximately 1/3rd (33 million) of the total US older adult population. Currently, approximately 2-6% US adults identifies lesbian, gay or bisexual (LGB). With the projected aging of the US, the number of older Latino and African-American LGB adults will also increase significantly. Although a recent growing yet extremely limited body of literature has examined ethnic and sexual minority elders, no study has explored the particular health needs of older adults with intersecting ethnic and sexual minority identities. Thus, in order to develop and implement relevant culturally sensitive health interventions, we followed Community Based Participatory Research (CBPR) principles to explore critical physical and mental concerns of ethnic and sexual minority elders.

Methods:

Guided by Intersectionality Theory, we collaborated with GRIOT Circle in Brooklyn, NY to qualitatively assess physical and mental health needs of ethnic and sexual minority adults 60 years and older via focus groups and in-depth interviews with community stakeholders (i.e., community members, providers). Focus groups and interviews were conducted by a self-identified bilingual and bi-cultural Latino gay man with extensive clinical social work experience and trained in qualitative methods. We conducted a Thematic Analysis of our transcriptions and field notes. We also conducted member checking via an onsite community forum to ensure we adequately captured stakeholders’ thoughts and experiences.

Results:

Focus groups were conducted in English and primarily composed of U.S. born African-American gay men and lesbian women; with an average age of 66, with two chronic conditions, and retired and receiving social security benefits. All providers had extensive experience working with older ethnic and sexual minorities; with training in health promotion, psychology and social services. Our thematic analyses revealed that community members face multiple challenges including: 1) unrecognized or untreated mental health conditions including depression, anxiety, trauma and loneliness; 2) mistrust of medical care providers given historically oppressive practices against racial and sexual minorities; 3) financial struggles that include paying for medical care (e.g., co-pays, medication) while on a fixed income, chronic food insecurity and affordable housing instability; 4) concerns about victimization including identify theft, discrimination and financial abuse. Participants also highlighted the critical role of social support; an urgent need for safe and accepting senior social service programs; and provided recommendations for enhancing the quality of physical and mental health care of ethnic and sexual minority elders.

Conclusions and Implications:

Ethnic and sexual minority older adults are a growing population with challenges stemming from racism, homophobia and ageism. To date, researchers have largely ignored their health care needs and experiences. Further research is critically needed to: 1) document the experiences of older sexual minority mono-lingual Spanish speaking Latino adults, 2) qualitatively and quantitatively examine important health challenges (e.g., trauma, loneliness, anxiety etc.) and their effects on ethnic and sexual minority elders’ health, 3) identify health engagement strategies that facilitate the development and implementation of high quality culturally sensitive health care and social service interventions.