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How Fighting Discrimination Can Enhance Well-Being for Aging Gay, Lesbian, Bisexual, and Transgender Americans

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Vanderbilt University School of Medicine
University of Minnesota-Twin Cities

Edith Windsor and Thea Spyer shared a committed relationship for over four decades, but when Thea died at a time when the federal government did not recognize gay marriages, Edith was forced to go to court at age 81 to avoid paying estate taxes on her inheritance from Thea. Heterosexual couples are exempt from such taxes, which helps them pass along resources the surviving partner may need for security and health care in old age. Edith’s case ultimately reached the U.S. Supreme Court, and in 2013, Section 3 of the Defense of Marriage Act – which defined marriage between one man and one woman – was ruled unconstitutional. Like many older lesbian, gay, bisexual and transgender adults, Edith has witnessed dramatic changes in U.S. public policies and social attitudes toward same-sex marriage and homosexuality – changes that promise a smoother path through life for gay, lesbian, bisexual and transgender people in the future. In the meantime, however, aging baby boomers from this community face heightened needs for health care and social support.

A Lifetime of Discrimination Has Led to Deficits in Health and Well-Being

Public health research consistently finds that older gay and transgender adults are at unusually high risk of suffering health problems, for several reasons. Many of these older adults have experienced immense levels of stigma and discrimination across their lives – even coping with the classification of homosexuality as a form of mental illness. More recently, gay and transgender people have navigated sharp shifts in societal and medical attitudes plus the changes in legal status brought by recent repeals of discriminatory federal policies such as the Defense of Marriage Act and the military’s “Don’t Ask, Don’t Tell” rules. Additionally, older men in this community are survivors of the AIDS epidemic that has so far claimed the lives of over 300,000 gay and bisexual men in the United States. Many witnessed the suffering and demise of friends, neighbors, and partners.

Researchers who study the impact of various kinds of social stigma and discrimination have documented that decades of such experiences take a negative toll on the human body. Chronic stress associated with being a member of a marginalized minority group weakens the body’s ability to fight disease, leaving many to struggle with poor health or chronic impairments.

  • In a first-ever “Caring and Aging with Pride” study, high percentages of older gay, lesbian, bisexual and transgender adults reported health problems (22%), disabilities (45%) and depression (29%).
  • California gay, lesbian, bisexual and transgender adults 50 years of age and older were more likely than their heterosexual counterparts to report making more doctor visits and suffering from hypertension, diabetes, symptoms of poor mental health, and physical disabilities.
  • A recent study in the Journal of Aging and Health revealed that gay, lesbian, bisexual and transgender adults 50 years of age and older living with a same-sex partner were more likely than similar heterosexuals to report impaired physical health and psychological distress.

Why Health Problems May Grow in the Near Future

Compared to heterosexuals, today’s aging gay, lesbian, bisexual and transgender people are less likely to have spouses, children, and grandchildren to provide care and assistance.

  • According to some estimates, only five percent of older gay and bisexual men over 50 years of age live with their children, compared to one-fifth of older heterosexual men. Older gay and bisexual men are also more likely to live alone, which can make it less likely for them to get routine health screenings, wellness checkups, or needed medical treatments.
  • Older gay, lesbian, and transgender adults may not receive the non-medical social services and supports they need. In the Aging with Pride study, over half of such respondents identified pressing needs for senior housing, transportation and legal services.
  • Even well-intentioned service providers may not realize that older gay and transgender adults require special assistance with planning for long-term care, estates, and health directives. Fears about discrimination may keep many vulnerable gay, lesbian, bisexual and transgender seniors from entering nursing homes, and those who remain in their homes can feel isolated without social support.

What Health Care Providers and Communities Can Do

Communities and health providers must learn about the challenges facing aging gay, lesbian, bisexual and transgender people and adopt best practices to ensure their health and safety.

  • Health care providers will need to be non-judgmental and knowledgeable about the specific health risks faced by gay and transgender seniors. To bring this about, medical schools and health professional training programs will need to broaden their offerings. 
  • Clinics, nursing homes, and senior living communities should not employ practitioners who discriminate and should allow same-sex couples the same access to shared rooms as heterosexual couples. Symbolic steps can also help, such as annual “pride” celebrations. 
  • Local pride organizations can monitor discrimination, offer provider training, and help institutions to plan activities that are welcoming for gay and transgender seniors.

Finally, health care and service providers should support same-sex marriage, because it secures protections that really matter in later life, including rights to visit partners in the hospital and legally binding health directives and retirement plans. Legal marriage helps aging gay, lesbian, bisexual and transgender Americans become less dependent on public services of last resort by ensuring access to Social Security survivor benefits and Medicaid provisions for long-term care. For fiscal as well as moral reasons, it makes good sense for policymakers and service professionals to support laws that allow their gay, lesbian, bisexual and transgender neighbors to grow old with the partners they love.

Read more in Gilbert Gonzales and Carrie Henning-Smith, “Disparities in Health and Disability among Older Adults in Same-Sex Cohabiting Relationships.” Journal of Aging and Health (online-first article, 2014).