Diversity in Loneliness Among LGBTQ+ Older Adults: Psychosocial Conditions, Social Support, and Implications for Services

Background and Purpose:

Loneliness/social isolation has negative consequences for health and well-being, especially for aging adults. Current research suggests that immigrants, lesbian, gay, bisexual populations experience loneliness more than other groups (National Academies of Sciences, Engineering, and Medicine. 2020), and shows that 1/3 of aging adults experience loneliness. However, knowledge about LGBTQ+ older adults (a difficult-to-reach population) is limited. To understand patterns of loneliness among LGBTQ+ older adults, a coalition of community organizers initiated a survey of LGBTQ+ older adults (45+) in SE Michigan. This paper focuses on two questions:

1. What are the major psychosocial and social support risk/protective factors associated with loneliness?
2. How do unique combinations of risk and protective factors contribute to different intensities of loneliness?

Methods:

Using frameworks drawn from critical intersectionality (Reed et al, 2022) and community-based participatory action research (CBPAR), we designed, recruited, and analyzed a community-based survey (N=264) with aging adults.

Sample: 29% non-white. 43%, cis-female, 46% cis-male, 11% trans/outside binary, with complex sexuality, relationship, dis/ability, and religion categories.

We use fuzzy-set Qualitative Comparative Analysis (fs/QCA) to determine whether particular conditions are important for different types/levels of loneliness. fs/QCA is a methodology that enables the analysis of multiple cases with many variables in complex situations, designed for use with 10-50 cases, but applied recently to larger data-sets to explore different pathways related to positionalities and social justice outcomes. (Reagin & Fiss, 2016). The outcome variable, loneliness intensity, is a composite index derived from the UCLA 3-item Loneliness Scale.

We consider eight conditions based on exploratory factor analysis: 1) level of basic needs, 2) positionalities, 3) mental health status, 4) degree of disability, 5) discrimination history, 6) sense of safety, 7) formal community engagement (LGBTQ+ focused activities engagement & general community participation), 8) informal social connections (living arrangements, received support and provided support).

Results:

The 71% experienced loneliness, which is higher than the general population. 4 loneliness levels were identified with different contributors to those outcomes.

1. Not lonely: low community engagement, social support received more than provided, being partnered, no struggles with survival needs, little discrimination history.
2. Somewhat lonely: low community engagement, social support received almost equal to the provided, with mental health issues.
3. Lonely: high community engagement in transgender-focused programs, social support received somewhat less than the provided (particularly to children), with moderate physical health and economic challenges.
4. Very lonely: high community engagement, social support received less than provided, unstable relationships, unsafe neighborhoods, challenges in survival needs, high frequency of discrimination, no disability, and good mental health.

Conclusions and Implications:

The findings demonstrate complex patterns of practical and psychosocial conditions that are related to different levels of loneliness that have implications for activities, support, and services. No single type of service intervention approach will fulfill the psychosocial needs of diverse LGBTQ+ aging adults, as their pathways to loneliness vary with complex service preferences/positionality characteristics. Effective interventions should consider the above dimensions systematically for tailored services.