Dementia Care and Sexual Orientation: Are There Differences between LGB and Non-LGB Caregivers?

Background/Purpose: 

Despite a dearth of literature regarding health outcomes of lesbian, gay and bisexual (LGB) caregivers (CGs) of people with Alzheimer’s and related dementias, available studies show there may be unique stressors facing LGB CGs of people with dementia compared to their heterosexual counterparts that contribute to disparate negative health outcomes for LGB CGs (e.g., Anderson & Flatt, 2018).  The combination of higher levels of dementia caregiving strain among LGB CGs (Boehmer, Clark, Lord, & Fredman, 2018) and minority stress (Meyer, 1995) may contribute to LGB CGs of people with Alzheimer’s being more vulnerable to negative outcomes. The purpose of the current study is to examine the extent to which dementia caregiving varies by sexual orientation using a nationally representative dataset from the United States. 

 

Methods:  The current study selected caregivers of people with dementia from the pooled data from the 2015 – 2017 Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) N=1,677). The Stress Process Model (SPM) was used to investigate the risk factors (stressors: help with activities of daily living, help with instrumental activities of daily living, length of dementia care, resources: emotional support, background: Age, Income, Race/Ethnicity-Non-Hispanic White vs others) associated with mental health. T-tests and chi-square tests were used to compare SPM domain differences and ordinary least-square multiple regression analyses were used to investigate predictors of CGs' outcomes.

Results:  LGB CGs of people with dementia (n=55) were more likely to be younger, have higher BMI, more depressed and more engaging in non-kinship care compared to non LGB CGs of people with dementia (n=1,625). In general, lower emotional support and lower income were significantly associated with poorer mental health for both LGB and non LGB CG groups. For LGB CGs of people with dementia, being older, being non-Hispanic White, helping with activities of daily living (ADL), and higher BMI were significant associated with poorer mental health. For non LGB CGs of people with dementia, being non-Hispanic was statistically associated with poorer mental health. 

Conclusions and Implications:  

Our findings are consistent with national data regarding LGB CGs of older adults including CG’s non-kinship relationship to persons with dementia, and LGB CGs having poorer mental health outcomes compared to their heterosexual counterparts. In particular, the additional general challenges of providing care for people with Alzheimer’s and other related dementia’s, which includes more help with activities of daily living, and poorer physical health may contribute to this finding.  Also, LGB CGs may face the additional challenges related to minority stress. Interventions for CGs should be LGB affirming- and address some of the additional social isolation, marginalization, and additional stressors of being an LGB CGs.  Future studies on the cumulative effects of minority stress and caregiver strain among LGB CGs of individuals with Alzheimer’s and other dementias, should be conducted to inform evidenced-based interventions and respite care for LGB CGs of people with dementia. .