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Recent research has shown that lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults and racial/ethnic minority older adults are at a higher risk for cognitive impairment than their cisgender and heterosexual white peers. As the Health Equity Promotion Model suggests, LGBTQ older adults of color may experience differing patterns in disparities in cognitive health due to their intersecting identities. According to our previous study, African American and Hispanic LGBTQ older adults, when compared to non-Hispanic whites, are more likely to experience decline in psychological and physical health related quality of life possibly due to heightened risks of discrimination and lack of social connectedness. However, little is known about the cognitive health of LGBTQ older adults with intersecting racial/ethnic identities.
Methods:
To address this research gap, we analyzed data from four-time points of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study, a longitudinal study of a diverse sample of LGBTQ adults born in 1964 or earlier (N = 2,450). Multilevel mixed models were tested to examine the predictors of cognitive impairment, including day-to-day discrimination due to sexual/gender and racial/ethnic identities; the structure, function, and quality of social relations; and LGBTQ community engagement, while considering the moderating effects of race/ethnicity (African American, Hispanic, and non-Hispanic white). To reduce sampling bias and increase the generalizability of the findings, we applied survey weights to statistical analyses.
Results:
Non-Hispanic white participants were older and more likely to identify themselves as lesbian or gay (vs. bisexual or sexually diverse) than African American and Hispanic participants. No racial/ethnic differences were found in gender proportions. African American and Hispanic participants reported lower socioeconomic status than non-Hispanic white participants. When controlling for sociodemographic characteristics, cognitive impairment did not significantly change over time among the sample. However, African American and Hispanic LGBTQ older adults (b = 5.20, p <. 01; b = 4.05, p < .01) experienced higher levels of cognitive impairment over time than their white LGBTQ peers. Day-to-day discrimination targeting intersecting identities was positively associated with higher cognitive impairment (b = 2.78, p < .05). LGBTQ community engagement was negatively associated with cognitive impairment regardless of race/ethnicity (b = -.46, p < .05). Higher social network size was significantly associated with a lower level of cognitive impairment for African American LGBTQ older adults.
Conclusions and Implications:
This study highlights the importance of recognizing and addressing intersectionality in research and interventions aimed at promoting cognitive health in diverse populations. The findings underscore the need for culturally tailored interventions that account for intersectionality, discrimination, and social connectivity to promote cognitive health among specific subgroups of LGBTQ older adults. The importance of community engagement and social networks in promoting cognitive health among all older adults, regardless of their identity, is also emphasized. Future research should investigate potential mechanisms through which discrimination affects cognitive health and develop and test interventions to promote cognitive health in LGBTQ older adults with intersecting identities.