Meeting the Behavioral Health Needs of LGBT Older Adults

Hilary Goldhammer, SM; Lisa Krinsky, MSW; Alex S. Keuroghlian, MD, MPH

Disclosures

J Am Geriatr Soc. 2019;67(8):1565-1570. 

In This Article

Abstract and Introduction

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) older adults face an increased risk of adverse behavioral health outcomes compared with the general population of older adults, yet little attention has been given to factors contributing to these disparities or to the ways in which clinicians can address these challenges. We present the case of a 75-year-old widowed lesbian woman with depression to illustrate how a lifetime of exposure to discrimination and stigma can produce high levels of stress and isolation while also fostering resilience. We then offer recommendations and resources for promoting psychological health among LGBT older adults by attending to the historical and cultural forces that affect LGBT health, and by implementing inclusive policies and programming. The article concludes with suggestions for advancing research and policy to help achieve greater health equity for LGBT older adults.

Introduction

Lesbian, gay, bisexual, and transgender (LGBT) older adults have a disproportionate prevalence of adverse physical and behavioral health outcomes compared with their non-LGBT peers.[1–5] In 2015, the American Geriatrics Society Ethics Committee released a position statement with evidence-based recommendations for improving the quality of care for LGBT older people through research, training, and changes in policies and practice.[6] Since then, additional research has emerged, as have tailored training opportunities and advances in LGBT rights. And yet, gaps persist in the realm of understanding and addressing the behavioral health needs of LGBT older adults.[1] We present the case of a 75-year-old lesbian woman who finds herself in need of culturally appropriate behavioral health care. Through this case we illustrate how anti-LGBT societal discrimination and stigma can lead to health disparities for LGBT older adults, and we demonstrate strategies for improving behavioral health through implementation of affirming and inclusive best practices. In the final section, we discuss the need for more in-depth and translational research, and offer resources for patients and clinicians.

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