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There are more than 1.4 million transgender and gender diverse (TGD) people living in the United States. TGD adults experience higher rates of disability, physical health concerns, and mental health challenges. They also experience legal, structural, and social barriers accessing necessary medical care. These barriers may be particularly pronounced for older TGD adults who also face challenges related to ageism. As such there is a critical need to address these disparities and improve health outcomes, particularly the TGD older adult population. This scoping review aims to summarize the breadth and scope of recent, U.S.-centered research on the physical, mental health, and healthcare experiences of TGD older adults.
Methods:
We compiled a list of search terms that were entered into multiple databases (e.g., PubMed, PsychInfo, Cochrane Library). Articles were included if they met the following criteria: 1) focused on empirical data, 2) published in 2012 or later, 3) written in English, 4) a minimum of 6 participants, 5) at least 20% of the sample was TGD, 6) at least 20% of the sample was aged 50 or older, 7) age and gender were disaggregated such that we could identify the inclusion of TGD older adults, 8) focused on experiences of TGD older adults and health (physical, mental, sexual, accessing care). Articles underwent an initial screening based on title and abstract, and those meeting criteria underwent a full-text review. Using DistillerSR, articles were coded to indicate study design, data source, specific research area, participant demographics, and main findings.
Results:
The initial search yielded 6,382 unduplicated articles which underwent a title and abstract screening process. Of these, 2,255 met criteria based on abstract screening and received a full-text screening, of which 151 continued to meet inclusion criteria. Frequent exclusion reasons at the abstract level included lack of TGD or older adult participants; at the full-text level, articles were commonly excluded because they were not based in the U.S., were not empirical, failed to disaggregate age or gender, or included insufficient numbers of TGD or older adult participants.
The majority of articles used quantitative approaches, and many utilized survey data (e.g., the Behavioral Risk Factors Surveillance System). Research focus varied widely, though the most frequently discussed topics included HIV risk/prevalence, veteran’s health, healthcare service experiences, and mental health. Research tended to focus on older adults from younger age categories (e.g., between ages 50 and 65). Findings generally indicated significant barriers and disparities related to health, mental health, and treatment access among TGD older adults.
Conclusions and Implications:
The studies identified through this scoping review highlight significant disparities related to health and treatment access of TGD older adults in the United States. The review identified a range of research areas that have received attention, but many large gaps in the literature remain. Notably, researchers should consider the degree of specificity with which they describe their samples, particularly related to gender and age, to increase generalizability between studies of this vulnerable population.