1. The Aging and Health Report Disparities and Resilience among LGBT Older Adults National Health, Aging, and Sexuality Project Karen I. Fredriksen-Goldsen, PhD Grantmakers In Health Webinar  October 30, 2013 Funded in part by the National Institutes of Health and the National Institute on Aging R01 AG026526 (Fredriksen-Goldsen, PI) © Institute for Multigenerational Health

2. Making it Possible Project support and development National Institutes of Health/National Institute on Aging Pilot funding Hartford Foundation and Gerontological Society of America 11 community-based agencies across the country Center on Halsted, FORGE, GLBT Generations, LA Gay and Lesbian Center, LGBT Aging Project, Milwaukee/SAGE, New Leaf, Openhouse, SAGE, SAGE Metro St. Louis, and Senior Services Report sponsors AARP, Gerontological Society of America, National Gay and Lesbian Task Force, National Gero-Ed Center, and Pride Foundation © Institute for Multigenerational Health

3. Changing Social Context From Peter Wichern one of the first out businessmen to Fortune Magazine: Queer Inc. How Corporate America fell in love with gays and lesbians. It's a movement. © Institute for Multigenerational Health

4. Who is still invisible: elders, people of color, diverse cultures, different abilities, incomes, and education levels An alarming and tragic number of LGBT teen suicides Among LGBT elders 33% considered taking their lives over lifetime Across the Generations “LGBT's read of youth suicide. How many LGBT elders kill themselves because of isolation, grieving, and lack of reliable resources?” 63-year-old gay CAP participant © Institute for Multigenerational Health

5. Closing the Gap Behavioral Risk Factor Surveillance System (BRFSS-WA) Random-digit-dial telephone survey of adults 2% adults, 50 and older self-identity as lesbian, gay, or bisexual Caring and Aging with Pride (CAP): Community-based Surveys distributed through 11 aging agencies across the country 2,560 LGBT older adults participated, age 50 to 95 “Isolation, finding friend support, caregiving and health issues are the biggest issues old gay people face. Who will be there for us, who will help us without judgment?” 66-year-old lesbian CAP participant © Institute for Multigenerational Health

6. Health Disparities – BRFSS WA LGB older adults compared to heterosexuals of similar age Higher rates of disability More mental distress Higher risks of smoking and excessive drinking Less likely to be married or partnered ► Those living alone are at serious risk of social isolation, which is linked to poor health and premature death Fredriksen-Goldsen K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health Disparities Among Lesbian, Gay, and Bisexual Older Adults – Results from a Population-Based Study. American Journal of Public Health, 103(10), 1802–1809. doi:10.2105/AJPH.2012.301110 © Institute for Multigenerational Health

7. Distinct Risks – BRFSS WA Lesbians and bisexual women compared to heterosexual women CVD risk Obesity Gay and bisexual men compared to heterosexual men More likely to live alone Poor physical health ► “LGBT” is often used in research and services yet they are distinct groups with specific needs © Institute for Multigenerational Health

8. Survey Sample Characteristics © Institute for Multigenerational Health Total (N=2,560) Age, y, M(SD)66.5 (9.1) Gender, Male63% Gay men58% Lesbians32% Bisexuals7% Transgender7% Income, ≤ 200% FPL31% Education, ≤ high school8% People of color13% Chronic conditions, M(SD)2.0 (1.4) Living with HIV9%

9. CAP Survey: Risks 82% victimized at least once 64% victimized 3 or more times LGBT racial and ethnic minorities, those with lower incomes, and those with less education experience heightened, cumulative risks ► Victimization and discrimination are linked with poor health outcomes Fredriksen-Goldsen, K. I., Emlet, C. A., Kim, H.-J., Muraco, A., Erosheva, E. A., Goldsen, J., & Hoy- Ellis, C. P. (2012). The physical and mental health of lesbian, gay male and bisexual (LGB) older adults: The role of key health indicators and risk and protective factors. The Gerontologist. Editors’ Choice. Advance online publication. doi: 10.1093/geront/gns123 © Institute for Multigenerational Health

10. CAP Survey: Resilience 91% wellness activities 82% moderate physical activities 38% spiritual or religious activities ► Recognize societal contributions: many have actively served in the US military. “When the AIDS crisis began we took a hold of our own community to help ourselves survive and showed the rest of the world how to do it. We need to keep doing it.” 58-year-old gay CAP participant © Institute for Multigenerational Health

11. Lack of Access 13% were denied healthcare or received inferior healthcare 21% do not disclose sexual or gender identity to physician Bisexual older adults less likely to disclose ► The American Medical Association warns physicians’ failure to recognize, and patients’ reluctance to disclose, can lead to failure to diagnosis serious medical problems “I have had an overwhelmingly positive experience with my gender transition so far, but my primary concern about the future is with access to healthcare and potential discrimination as a senior, especially when the need arises for emergency or long-term care.” 56-year-old transgender woman CAP participant © Institute for Multigenerational Health

12. Unique Support Rely heavily on friends and partners Most of similar age ► There may be limits in friends’ ability to provide care over the long- term, especially if decision-making is required “I need to know if there are resources for someone to bury me with my Mom and Dad. How do I make arrangements, what type of arrangements, where do I turn for help? I have no siblings, no family.” 63-year-old bisexual CAP participant Muraco, A., & Fredriksen-Goldsen, K. I. (2011). That’s what friends do: Informal caregiving for chronically ill lesbian, gay and bisexual elders. Journal of Social and Personal Relationships, 28(8), 1073-1092. doi: 10.1177/0265407511402419 © Institute for Multigenerational Health

13. Services Needed Senior housing, transportation, legal services, social events, and support groups most important services needed Caregivers: Supportive long-term care facilities 30% no will; 36% no durable power of attorney for healthcare ► Most services fail to take into account the unique needs facing LGBT older adults and their caregivers “My partner died and I’m alone. But I make myself go out and attend events at the local center. On a lighter note, I just recently realized I’m in the love with the piano player. She hasn’t noticed me yet, but she will.” 81-year-old lesbian CAP participant © Institute for Multigenerational Health

14. Limitations Potential underreporting in a state level population-based telephone survey (BRFSS) Older adults connected with service agencies may have more health and aging needs than non-service users (CAP) Community survey is not generalizable ► Convergence of findings across different data sources © Institute for Multigenerational Health

15. Moving Forward Development of services tailored to unique needs Prevention and intervention development Responsive policies Appropriate measures for public health surveys Investigate health and aging of LGBT older adults over time “The LGBT community has stepped up in the past to address coming out, AIDS, and civil rights. The next wave has to be aging.” 63-year-old gay CAP participant © Institute for Multigenerational Health

16. Moving Forward National Health, Aging and Sexuality Study: Caring and Aging with Pride Over Time Longitudinal study to identify health trajectories over time and potentially modifiable factors Demographically diverse sample of LGBT older adults Investigate cohort differences Baby Boom Generation vs. Silent Generation © Institute for Multigenerational Health

17. Resources Website: CaringAndAging.org The LGBT Aging and Health Report: http://depts.washington.edu/agepride/wordpress/wp- content/uploads/2012/10/Full-report10-25-12.pdf Publication list: http://caringandaging.org/wordpress/published- articles/ © Institute for Multigenerational Health Research reported in this presentation was supported by the National Institute On Aging of the National Institutes of Health under Award Number R01AG026526. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.