Session: Assessing Complex Processes of Health Outcomes Toward Building Health Equity Among LGBTQ+ Older Adults (Society for Social Work and Research 27th Annual Conference - Social Work Science and Complex Problems: Battling Inequities + Building Solutions)

Sexual and gender minority older adults have gone through diverse experiences over their life courses. Research has shown that they face disparities in physical and mental health, bear heightened risks of social isolation, experience barriers to social and health care resources, and have higher odds for health-risk behaviors. Prior studies also suggest that these disparities are not separated from their lifelong experiences of marginalization and bias from the larger social context that they have had to encounter for who they are, i.e., their identity. Nonetheless, the lack of adequate instruments that can capture their unique life experiences has been a significant challenge in conducting rigorous quantitative research to understand complex mechanisms of health and well-being among LGBTQ+ older adults. To fill this critical gap, a national longitudinal survey, Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS), was launched in 2014 with subsequent biennial data collection from 2,450 LGBTQ+ participants aged 50 and older in the U.S. The NHAS has developed new measures or adapted existing ones that cover both unique and general properties embedded in the lives of LGBTQ+ older adults and been able to validate their utilities by conducting empirical research using them. The Health Equity Promotion Model (HEPM) provided the conceptual framework, overviewing the complex multi-layered dimensions and processes of health outcomes and well-being among LGBTQ+ older adults. Highlighting structural and environmental influences, the HEPM posits that experienced or perceived marginalization from larger social context affects health disparities in the long run and it is conjoined by the other processes in psychological, social, behavioral, and biological domains. This symposium discusses how the core components of the HEPM were operationalized and utilized in the NHAS. We probe into psychometric properties of the measures and their underlying factors. We aim to share the complexities and uniqueness associated with achieving health equity among LGBTQ+ older adults. Furthermore, we stress modifiable factors to construct solutions since many LGBTQ+ older adults show resilience and strengths that can protect against inequities. The first paper discusses the components of sexual and gender identities, shifts in how participants reported their sexual and gender identity over time, and their associations with physical and psychological health-related quality of life. The second paper is focused on health-related behavior variables and behavior-determining barriers to healthcare. It found four latent classes characterized with distinct behavior and barrier factors and their predictors and outcomes. The third paper is focused on multi-dimensional construct of social connectedness and derived three distinct factor structures, i.e., relational, collective, and perceived social connectedness. The last paper describes the development of a culturally relevant and multidimensional assessment tool used to evaluate health care access among LGBTQ+ older adults. This symposium will provide an opportunity to consider optimal and valid measures for complex and unique processes of health outcomes among LGBTQ+ older adults and to understand their utilities in empirical research toward dismantling health disparities among this population.