Predictors of Physical Functioning Among LGBTQ Midlife and Older Adults Living with Cognitive Impairment

Background

Up to 400,000 Lesbian, gay, bisexual, transgender, queer (LGBTQ) midlife and older adults are living with cognitive impairment, and according to a recent population-based study (Fredriksen Goldsen, et al., in press), they are at heightened risk of cognitive impairment when compared to their straight and cisgender counterparts. Maintaining physical functioning is important for independent living and quality of life for those with cognitive impairment. It is essential to identify modifiable factors associated with physical functioning considering unique challenges and social injustice experienced by the historically and socially marginalized populations. Risk and protective factors predicting physical functioning among LGBTQ midlife and older adults with cognitive impairment are not clearly understood. Guided by the Health Equity Promotion Model, this study examines the relationship of physical functioning with social stigma and social and behavioral factors.

Methods

This study analyzed a subset of the longitudinal data (T₀ to T₂, N=646) from the National Health, Aging, and Sexuality/Gender Study (NHAS), the first national longitudinal study of LGBTQ adults born in 1964 or earlier and tested a multilevel mixed model to examine risk and protective factors predicting changes in physical functioning over time controlling for background characteristics. Predictors entered in the model were the number of chronic conditions, cognitive difficulty, living arrangement, lifetime discrimination and victimization, physical activity, recreational activity, community engagement, and nutrition. Participants mean age was 66.16; 15% had a high school of less education; 50% were living at or below 200% poverty level; 57% were living alone; and 37% were partnered or married.

Results

The overall level of physical functioning among LGBTQ midlife and older adults living with cognitive impairment was positively associated with physical activity (b = 0.14, p < .01), recreational activity (b = 0.14, p < .001), and nutrition (b = 0.09, p < .001) and negatively associated with number of chronic conditions (b = -0.04, p < .001) and cognitive difficulty (b = -0.01, p < .001). The association between lifetime discrimination and victimization and physical functioning was explained away when the other predictors were entered in the model. Physical functioning significantly decreased over two years (b = -0.12, p < .001), and the decline of physical functioning was attenuated for those who had physical activity regularly (b _{Physical activity X Time} = 0.06, p < .05).

Conclusion and implications

Many LGBTQ midlife and older adults with cognitive impairment are living alone and have experienced social stigma. It is imperative that social work research address the needs of historically marginalized populations. The findings suggest that enhancing participations in physical, social, community, and recreational activities would improve their physical functioning. In order to achieve health equity and social justice for LGBTQ midlife and older adults living with cognitive impairment, it is important to translate these findings into practice.