There are roughly 1 million lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults who are 65 years or older, and this number is expected to double by 2030.1 They are a vastly diverse group with unique health care needs. However, research on aging LGBTQ populations has been historically neglected. Large-scale surveys have traditionally excluded sexual orientation and gender identity. Before 2000, research was limited to a few small studies.1,2
This began to change after the Institute of Medicine recognized these critical gaps and set federal milestones to change this. Several studies emerged. One of them is Caring and Aging with Pride, a 2010 national study of 2560 LGBTQ adults aged 50 to 95.3 To address research gaps for transgender older adults, the 2015 US Transgender Survey collected data on over 27,000 transgender and gender-nonconforming individuals, more than 500 of whom are older than 65.4
There are many terms that capture the diversity of the LGBTQ community. Sexual orientation is a broad term used to describe a person to whom someone is physically, emotionally, or romantically attracted. Some may identify as straight, lesbian, gay, bisexual, pansexual, queer, or a number of other sexual orientations. Clinically, it is important to not immediately assume that because one identifies as heterosexual, he or she has not had sexual contact with someone of the same sex—particularly when assessing risk of sexually transmitted infections.
A 2003 New York City survey found that 9.4% of men who identified as heterosexual reported having sexual intercourse with at least one man in the past 12 months.5 The term queer was a slur that has been recently reclaimed by many in the LGBTQ community and can describe those who don’t neatly fit into any sexual or gender categories. It is a controversial term, and it is often avoided by those for whom this still evokes negative connotations. In lieu of the LGBTQ acronym, the US federal government and the National Institutes of Health often use the term sexual and gender minority to be more inclusive.6
Dr. Johnson is a Resident, Department of Psychiatry, Yale University School of Medicine, New Haven, CT.
Dr. Johnson is an unpaid board member of Trans Bodies Trans Selves, a 501c3 nonprofit that is dedicated to empowering trans communities and publishes Trans Bodies, Trans Selves: A Resource for the Transgender Community.
1. Yarns BC, Abrams JM, Meeks TW, et al. The mental health of older LGBT adults. Curr Psychiatry Rep. 2016;18:60.
2. Fredriksen-Goldsen KI, Muraco A. Aging and sexual orientation: a 25-year review of the literature. Res Aging.2010;32:372-413.
3. Fredriksen-Goldsen KI, Kim HJ, Emlet CA, et al. The aging and health report: disparities and resilience among lesbian, gay, bisexual, and transgender older adults. 2011. http://depts.washington.edu/agepride/wordpress/wp-content/uploads/2012/10/Full-report10-25-12.pdf. Accessed December 7, 2017.
4. James SE, Herman JL, Rankin S, et al. The report of the 2015 US transgender survey. Washington, DC: National Center for Transgender Equality; 2016.
5. Pathela P, Hajat A, Schillinger J, et al. Discordance between sexual behavior and self-reported sexual identity: a population-based survey of New York City men. Ann Intern Med. 2006;145:416-425.
6. Choi SK, Ilan M. LGBT Aging: A Review of Research Findings, Needs, and Policy Implications. The Williams Institute. 2016. https://williamsinstitute.law.ucla.edu/wp-content/uploads/LGBT-Aging-A-Review.pdf. Accessed December 7, 2017.
7. Erickson-Schroth L. Trans Bodies, Trans Selves: A Resource for the Transgender Community. Oxford, UK: Oxford University Press; 2014.
8. Fredriksen-Goldsen KI. Despite disparities, most LGBT elders are aging well. Aging Today. 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243168/. Accessed December 7, 2017.
9. Elder A. Experiences of older transgender and gender nonconforming adults in psychotherapy: a qualitative study. Psychol Sex Orient Gender Diver. 2016;3:180-186.
10. National Center on LGBT Aging, Whitman-Walker Health: Creating End-of-Life Documents for Trans Individuals: An Advocate’s Guide. 2014. https://www.whitman-walker.org/wp-content/uploads/2015/02/End-of-Life-PlanningArticle.pdf. Accessed December 7, 2017.
11.Cahill S, Singal R, Grasso C, et al. Do ask, do tell: high levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One. 2014;9:e107104.