Identifying Patterns and Predictors of Health Behaviors and Healthcare Barriers Among LGBTQ+ Older Adults

Background and Purpose: Health behaviors and healthcare access are significant predictors of health outcomes among LGBTQ+ older adults, and their heightened odds of health risk behaviors and limited access to care are of major concern. Yet, no previous research has investigated the heterogeneity of LGBTQ+ older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to (1) identify latent classes of the behavior and barrier patterns, (2) examine differences in physical and psychological health-related quality of life (HRQOL) by the specified latent classes, and (3) explore risk and protective predictors of the class membership drawn from the Health Equity Promotion Model (HEPM).

Methods: Three-step latent class analysis applying survey weights was conducted with 14 indicators of risk-taking behavior, health-promoting behavior, preventive care, and healthcare barriers from the baseline National Health, Aging, and Sexuality/Gender Study data (N = 2,450), The three-step method was employed to examine the relationships between the latent class memberships and physical and psychological HRQOLs as well as risk and protective factors from bias, psychological, and social domain (e.g., marginalization, identity stigma, and social support) of the HEPM after adjusting for background characteristics, disability, and depression.

Results: The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) less healthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), (4) optimal health behaviors with risks of limited healthcare access (C4, 11%). Compared to C1, C2 and C3 had lower physical HRQOL, and C2 also had lower psychological HRQOL. C4 did not differ in both HRQOLs from C1. C2 was associated with more day-to-day discrimination, lower mastery, and lower social support in addition to younger age, higher education, people of color, women, disability, and depressive symptomatology.

Conclusions and Implications: Findings elucidate different patterns of health behaviors and healthcare barriers among LGBTQ+ older adults. Over 60% reported healthcare barriers and efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and to reduce marginalization. Positive relationships between LGBTQ+ older adults and healthcare need to be established via trust-building and cultural competency. Expansion of this line of research on other potentially influencing variables based on the HEPM framework is warranted to better understand modifiable variables and implement interventions addressing them.