The findings, published in The Gerontologist, suggest “that health disparities among LGB populations not only appear in early/prime life but extend to late life,” says Ning Hsieh, lead author of the study and assistant professor of sociology at Michigan State University. “It’s important for social and elder care programs to be aware of the higher risk of cognitive impairment (and likely earlier cognitive decline) among aging LGB people and offer them timely screening and treatment,” Hsieh says.
The Findings
Michigan State researchers were interested in studying the risk of cognitive decline among older LGB people because dementia and cognitive impairment are growing public health concerns in the United States. An estimated 5.8 million Americans over 65 were living with Alzheimer’s disease in 2020, and that number is expected to jump to 13.8 million by 2050, according to the Alzheimer’s Association. In 2020, Alzheimer’s disease and other dementias will cost the U.S. $305 billion. Minority sexual orientations are also linked to multiple known risk factors for dementia, “including elevated stress, social isolation, and poorer mental and physical health outcomes due to prejudice and discrimination,” researchers wrote in the study. But there is little research focused on LGB older adults’ risk of cognitive decline compared to heterosexual older adults. “While the public perception of lesbian, gay, and bisexual people is largely related to young communities, LGB older adults represent an understudied disadvantaged group,” says Hui Liu, co-author of the study and professor of sociology at Michigan State University. After analyzing survey data from 3,567 adults, researchers found that LGB older adults are about twice as likely to have mild cognitive impairment or early dementia than their heterosexual counterparts when sociodemographic factors are adjusted for, Liu explains. “This difference is partially explained by depression: LGB older people suffer higher levels of depression, likely due to minority stress, than heterosexual older people; and depression is a risk factor for cognitive impairment and dementia,” Liu says.
How Stress Affects Older LGB Adults Mental Health
The study did not evaluate why LGB older adults experience more depressive symptoms, but Liu says it’s likely due to minority stress, which refers to the additional stress that marginalized groups experience due to discrimination and prejudice they face. Though LGBTQ+ people now have access to legal marriage and protections against some forms of discrimination, older LGBTQ+ adults didn’t have that for most of their lives, says Benjamin Shepherd, a PhD student in clinical psychology at Nova Southeastern University. “They carry with them a lot of financial, social, and emotional disadvantages,” he says. “For example, they had to be in hiding, because same-sex sexual activity was illegal until 2003… and a lot of them couldn’t even get married.” The historic discrimination they’ve faced, from society and their families, means they often feel like they have to hide who they are, even into adulthood, which affects their mental health. “Being a sexual and gender minority, it’s a concealable stigmatized identity, so people have the choice of disclosing or not,” Shepherd says. “That process of having to decide which situations are safe enough to disclose—that’s a cognitively taxing process and contributes to an added burden.” It can also lead to depression and anxiety, which are risk factors for cognitive decline.
Potential Solutions Across Society And Senior Care Facilities
AARP’s 2018 survey of LGBTQ adults age 45 or older found that 34% of LGBTQ older adults were very or somewhat worried that they would have to hide their identity to access suitable housing. Many also worried about how being LGBTQ+ would impact the care they received through in-home assistance, assisted living, or nursing home care: At least 60% were concerned about neglect, abuse, or verbal or physical harassment and 61% worried about being refused or having limited access to services. Feeling as though you have to conceal your identity is a risk factor for isolation, which increases risk of dementia, Shepherd says. This means that agencies servicing older adults need to foster safer and more openly welcoming environments. “Senior centers, nursing homes, and other care facilities are important places to start implementing sexual and gender minority affirmative, evidence-based trainings and programming,” he says. In the future, Ning says the accumulation of minority stressors and mental distress over the lifetime is an important factor worth studying. “It’s also important for the public to acknowledge that prejudice and discrimination have lasting health impacts on LGB individuals and create burdens on our healthcare system,” Ning says. “The only fundamental solution is to eliminate stigma related to minority sexual orientation.”
