Lesbian, Gay, Bisexual, and Transgender Older Adults' Experiences With Elder Abuse and Neglect

Elizabeth M. Bloemen, MD, MPH; Tony Rosen, MD, MPH; Veronica M. LoFaso, MD; Allison Lasky, BA; Skotti Church, MD; Porsha Hall, MPH, MA; Tom Weber, BA; Sunday Clark, ScD, MPH

Disclosures

J Am Geriatr Soc. 2019;67(8):2338-2345. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Little is known about elder abuse and neglect in the lesbian, gay, bisexual, and transgender (LGBT) community; however, this population faces a greater risk of abuse and likely experiences abuse differently and needs different resources. We conducted focus groups to investigate LGBT older adults' perspectives on and experience with elder mistreatment.

Methods: We conducted three focus groups with 26 participants recruited from senior centers dedicated to LGBT older adults. A semistructured questionnaire was developed, and focus groups were audio recorded, professionally transcribed, and analyzed using grounded theory.

Results: Key themes that emerged included: definitions and etiologies of abuse, intersectionality of discrimination from multiple minority identities, reluctance to report, and suggestions for improving outreach. Participants defined elder abuse in multiple ways, including abuse from systems and by law enforcement and medical providers. Commonly reported etiologies included: social isolation due to discrimination, internalization of stigma, intersection of discrimination from multiple minority identities, and an abuser's desire for power and control. Participants were somewhat hesitant to report to police; however, most felt strongly that they would not report abuse to their medical provider. Most reported that they would feel compelled to report if they knew someone was being abused; however, they did not know who to report to. Strategies participants suggested to improve outreach included: increasing awareness about available resources and researchers engaging with the LGBT community directly.

Conclusion: LGBT older adults conceptualize elder abuse differently and have different experiences with police and medical providers. Improved outreach to this potentially vulnerable population is critical to ensuring their safety.

Introduction

Elder abuse, neglect, and exploitation are common and have serious health, social, and financial consequences. In surveys of older adults, it is estimated that 5% to 10% experience mistreatment each year, including physical, sexual, emotional/psychological, and financial abuse, or neglect.[1,2] Victimization increases the risk of mortality,[3] disability,[4] hospitalization,[5] and institutionalization,[6] and likely costs billions of dollars each year.

While research in elder mistreatment has expanded in recent years, there is a great need for a better understanding of how minority populations experience abuse and access services. Little is known about lesbian, gay, bisexual, and transgender (LGBT) older adults' unique experiences.

LGBT older adults have faced a lifetime of discrimination;[7] are more likely to have experienced sexual and intimate partner violence;[8] more often have developed families of choice, resulting in reliance on aging friends and nonbiologically related caregivers;[9] and are more likely to be human immunodeficiency virus (HIV) positive. Each of these may place them at a higher risk for mistreatment in later life as their health declines, partners and loved ones pass away, and the complications of HIV status, including HIV-related dementia, increase.[10] In the limited literature available, 22.1% of LGBT adults older than 60 years reported that they had been harmed, hurt, or neglected by a caregiver, 25.7% reported knowing someone who had been mistreated,[11] and over 60% had experienced psychological abuse.[12] In addition to being at increased risk, LGBT older adults may also have had different relationships with service providers and likely have developed different help-seeking behaviors.[13] To address some of these issues, academic medical groups have provided guidance to improve care for LGBT patients and have cited the need for research and improved understanding of issues pertinent to this population.[14]

Our goal was to improve our understanding of LGBT older adults' experiences with elder mistreatment, access to resources, and interactions with medical and service providers.

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