What influences physical and mental health-related quality of life for LGBT older people?

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As the ‘Baby Boomer’ generation of lesbian, gay, bisexual and transgender (LGBT) people enter into older age, there is increasing discussion on how to provide appropriate services and support for those who were arguably the first generation to ‘come out’, enabled by civil rights activism and decriminalisation in the late 1960’s and early 1970’s.

It is well established in UK research that non-heterosexual people are at greater risk of experiencing mental health problems, with discrimination being identified as a particular risk factor (King et al, 2008; Chakraborty et al 2011). However, less is known about the mental and physical health of older LGBT people, and even less about the different generations within the over-50 group.

Using survey data analysis, the US study explored the physical and mental-health related quality of life for older LGBT adults by age group, with particular regard to the affects of lifetime social adversity as well as other factors. The authors used a ‘Resilience Framework’ to ‘incorporate a multidimensional and lifecourse perspective including the larger social context as well as personal and social resources.’

The researchers use a lifecourse perspective.

The researchers used a multidimensional, lifecourse perspective to analyse the survey data.

Method

The study used data from a national survey entitled ‘Caring and Aging with Pride: The National Health, Aging and Sexuality Study’. This survey was designed to assess the health and wellbeing of older LGBT adults. Survey participants were recruited over a five month period from eleven participating sites across US. A total number of 2,560 participants who were over 50 years of age and self-identified as lesbian, gay, bisexual and/or transgender were included.

The analysis reported in this paper drew on data from 2,463 participants, who were grouped into 44% ‘young-old’ (50-64); 46% ‘middle-old’ (65-79) and 10% ‘old-old’ (80 and above). The proportions of women, transgender people and ethnic minorities were highest for the ‘young-old’ group.

The researchers used a Resilience Framework to examine the association of the following ‘explanatory factors’ to physical and mental health-related quality of life:

  • social risks (lifetime victimisation and discrimination)
  • identity management resources (positive sense of sexual identity, identity disclosure, time length of disclosure)
  • social resources (partner, social network size, religious or spiritual activity, community connectedness)
  • health-promoting behaviours (physical and leisure activity, routine check-up, substance non-use)
  • socioeconomic resources (income, employment, education).

Several statisical analyses, including linear regression, were performed to test the relationships and modifying effects of the different variables within and between the three age groups.

Findings

The findings of the research were very detailed, so the main highlights are summarised here.

Physical health-related quality of life

The physical health-related quality of life differed by age group, with the lowest being for the ‘old-old’ group.  However, social risks, identity management and social resources, health-promoting behaviours and socioeconomic resources were signficantly associated with mental and physical health quality of life, regardless of age group.

Physical health-related was found to be negatively associated with lifetime victimisation and discrimination, particularly for the ‘old-old’ group. It was positively associated with social network size, social support, physical and leisure activity, income, employment and being male. Education was positively associated for the ‘old-old’ group and employment had a stronger association for the ‘younger-old’ group.

Mental health-related quality of life

In terms of identity management, a positive sexual identity was associated with better mental health-related quality of life. Mental health-related quality of life was also positively associated with social network size, social support, physical and leisure activity, substance non-use, routine health check-up, income, employment and being male.

The negative influence of lifetime victimisation and discrimination were stronger for the ‘young-old’ and the ‘old-old’ than they were for the ‘middle-old’.

Positive sexual identity

Positive sexual identity was associated with better mental health-related quality of life.

Conclusion

The authors conclude that their findings

support existing literature on interconnections between successful aging, physical and mental health and functioning, social connectedness, while also contextualising unique experiences of LGBT older adults including a positive sense of sexual identity and experiences of lifetime victimisation and discrimination.

Strengths and limitations

The authors are quite transparent about the limitations of their research for the US context. They note that the study does not account for the subjective assessment of successful aging for LGBT people, which may include the role of ‘life successes’ on physical and mental health-related quality of life. The group of ‘old-old’ people is only 10% of the sample, which could lead to problems with estimating the outcomes and explanatory factors for this group.

More importantly, the study used a community-based recruitment method to obtain a demographically diverse sample, but this approach means that the data is not generalisable, even in the US context.

Given that demographic data on transgender identity and ethnicity were available in the dataset, it would have been helpful to see more analysis on how those variables come into play for physical and mental-health related quality of life.

It is notable that ‘being male’ was found to have positive associations, but the authors do not explore the implications of this finding further.

Despite these limitations, this study provides a very useful indicator of what needs to be considered for the successful aging of the full age-range of older LGBT people living in the UK. Broadly, the UK and US have a similar socio-political environment, with related development of LGBT civil and human rights. However, the UK arguably has a less well-developed infrastructure for older LGB and T activism, research, development and service provision (Carr & Ross, 2013).

Summing up

In the absence of a similar dataset in UK, this study provides a vital picture of the general and particular factors that influence physical and mental health-related quality of life for LGBT older people in three over-50 age groups.

It is important to have this type of analysis as different generations of LGBT people who are now all older, will have experienced different social, psychological and emotional stressors relating to the differing legal, political and social acceptance and developed different forms of resilence accordingly.

The physical and mental health-related quality of life of older LGBT people is influenced by a lifetime of experiences in particular personal and socio-political contexts. Therefore the picture is complex and continually changing, and as the authors note

It is critical to fully investigate factors leading to good health in this population if we are to develop balanced and tailored interventions that support the strengths as well as the challenges facing older LGBT adults.

It is important to investigate the complex factors influencing LGBT health to provide proper care and support.

It is important to investigate the complex factors influencing LGBT health and resilience to provide proper care and support.

Link

Fredriksen-Goldsen, K. I., Kim, H.-J., Shiu, C., Goldsen, J., & Emlet, C. A. (2014). Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group. The Gerontologist, 55(1), 154–168. doi:10.1093/geront/gnu081 [Abstract]

References

Chakraborty, A. et al (2011) Mental health of the non-heterosexual population of England. British Journal of Psychiatry, 198, pp. 143-48. [Full text]

King, M. et al. (2008) A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay and bisexual people. BMC Psychiatry, 18, 8:70. [Full text]

Carr, S. & Ross, P. (2013) Assessing current and future housing and support options for older LGB people, York: Joseph Rowntree Foundation. [Full text]

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Sarah Carr

Sarah Carr

Sarah is Associate Professor of Mental Health Research at Middlesex University. Sarah also runs an independent mental health and social care knowledge consultancy. She has a background as a senior research and policy analyst in mental health and social care, with a focus on service user participation, personalisation and equality issues, having formerly worked for the Social Care Institute for Excellence (SCIE). She is an Honorary Senior Lecturer at Institute for Applied Social Science at the University of Birmingham, an Honorary Visiting Fellow, Social Policy and Social Work at the University of York and a Fellow of the Royal Society of Arts. Co-chair of the National Survivor and User Network (NSUN) and a member of the editorial boards of the journals Disability and Society and Lancet Psychiatry, Sarah has a particular interest in social care and mental health issues and is a long term user of services.

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