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LIFE COURSE TRANSITIONS,
PERSONAL NETWORKS, AND
SOCIAL SUPPORT FOR LGBTQ1
ELDERS: IMPLICATIONS FOR
PHYSICAL AND MENTAL HEALTH
Stacy Torres and Griffin Lacy
ABSTRACT
Purpose: This chapter explores the role of life course transitions, personal
networks, community, and social support in the physical and mental health of
LGBTQ1elders. Specifically, we review the literature on formal and informal
supports and resources available to LGBTQ1elders as they age.
Methodology: We use an intersectional lens that explores dimensions of social
identity and social location among diverse subpopulations within sexual and
gender minority (SGM) elders. We outline the implications of access (or lack
of access) to formal and informal care for SGM elders’physical and mental
health and well-being in late life. We examine the availability of these supports
in the context of broad inequalities and life events that structure the life course
for LGBTQ1elders and have long-term health implications.
Findings: Our findings from this review demonstrate how social factors over
the life course shape SGM mental and physical health later in life for aging
LGBTQ1populations. We reflect on how strained relationships and lack of
acceptance compel some to seek alternative sources of support and relation-
ships. Our analysis uncovers individual and institutional sources of support:
personal social networks and formal spaces, such as healthcare settings, that
connect elders with resources to develop social support and avoid social
isolation.
Sexual and Gender Minority Health
Advances in Medical Sociology, Volume 21, 157–179
Copyright © 2021 by Emerald Publishing Limited
All rights of reproduction in any form reserved
ISSN: 1057-6290/doi:10.1108/S1057-629020210000021012
157
Implications: The implications of our review reveal the unique needs and
barriers to practical and social support that SGM older adults face. We
explore alternative supports that LGBTQ1elders need compared with their
heterosexual cisgender peers, given the disproportionate rejection they face in
a range of public and intimate spaces. We conclude by identifying and cele-
brating sources of support and resilience as LGBTQ1elders have crafted
alternate support networks and advocated for increased recognition, rights,
and care.
Originality and Value: Despite some recent flourishing of research in SGM
health, a road map for scholars, practitioners, and community members out-
lining future research in understudied areas such as LGBTQ1aging and
transgender health would help advance scholarship and policy. Our commen-
tary highlights quantitative and qualitative studies and suggests avenues for
research that put in conversation literatures on rural studies, urban sociology,
and social networks; gerontology; health; and gender/sexuality studies.
Keywords: LGBTQ1older adults; life course; resilience; social support;
community; discrimination; isolation; social networks; physical and mental
health
INTRODUCTION
The United States is undergoing dramatic demographic change with population
aging, due to the graying of the Baby Boom cohort and increases in longevity for
older adults over the age of 65. Between 2007 and 2017, the total percentage of
elders over age 65 increased 34%, from 37.8 million to 50.9 million (Administration
on Aging [AoA], 2018). Increasing diversity in the elder population along lines of
race, ethnicity, immigration status, and sexuality pose additional considerations for
scholars, care providers, policymakers, and ordinary people to support the physical
and mental well-being of all older adults in the United States.
This mosaic of aging includes a growing number of elders in the United States
that self-identify as openly lesbian, gay, bisexual, and transgender (LGBT)
(American Psychological Association, 2019;Shiu, Muraco, & Fredriksen-Goldsen,
2016). At present, some 2.7 million adults aged 50 and older self-identify as LGBT,
a number expected to grow to more than five million by 2060 (Fredriksen-Goldsen,
Kim, Bryan, Shiu, & Emlet, 2017a). This number increases to more than 20 million
older adults if including those who do not publicly self-identify as LGBT but have
participated in same-sex sexual behavior, intimate relationships, or experience
same-sex attraction (Fredriksen-Goldsen, 2018).
Despite the extraordinary and ongoing shift in public attitudes regarding
LGBT citizens, including increasing visibility, societal acceptance, and the
legalization of same-sex marriage, violence and discrimination persist. Even with
growing numbers and rapid social change, gaps remain in scholarly and practi-
tioner knowledge about the experience of LGBT older adults, leaving them
underserved and understudied (Fredriksen-Goldsen, 2018).
158 STACY TORRES AND GRIFFIN LACY
This growing diversity in the older population highlights life trajectories of
marginalization and resilience that help shape later health and well-being for
sexual and gender minority (SGM) elders. These elders grew up at a time of
stigma and even criminalization of same-sex relations and gender nonconfor-
mity (Fredriksen-Goldsen et al., 2017a). As this first generation of SGM elders
continues their journey into late adulthood, we must develop a better under-
standing of key differences in the LGBTQ1life course. Older adults born before
1965, making them over age 50 in 2015, have lived through ground shifting
social movements for civil rights, women’s rights, LGBT rights, and antiwar
protests. They have experienced these historical events differently according to
their social identities, ages, and exposures to certain contexts (Muraco &
Fredriksen-Goldsen, 2016). In this vein, it is important to use an intersectional
framework and consider cohort experiences and life course markers unique to
SGM elders, little explored in most gerontology research to date, such as coming
out.
Life course analysis has proven fruitful for aging scholars from different dis-
ciplines by providing a framework that allows a deeper understanding of
cumulative influences that shape later life, beginning at birth, and inequality in
old age (Abramson, 2015). Ferraro (2018) eloquently explains the value of this
perspective for understanding outcomes and experiences in old age:
A life course can be viewed as a book. The fate of the characters can be gleaned by reading the
last chapters, but it is a shallow reading. To understand the life journey of the characters and
how they reached their fates, we read the whole book. (pp. 34–35)
As Carr (2019) discusses, sociological theories of cumulative inequality view
old age as the sum of these experiences across the life course, and even then, the
accumulation of fortune and misfortune can continue and in some cases intensify
in one’s later years as elders confront growing health challenges, social isolation,
and ageism.
SGM elders have had to grapple with varying levels of cumulative disad-
vantage over the life course, stemming from political, economic, and familial
exclusion, discrimination, and victimization, which leave them more likely to
battle cascading symptoms from poorer physical and mental health later in life
(American Psychological Association, 2019;Shiu et al., 2016). We will outline the
implications of access (or lack of access) to formal and informal care for SGM
elders’physical and mental health and well-being in late life. LGBT older adults
have fewer traditional supports available to them outside of partner help, such as
assistance from children. They demonstrate greater reliance on friends and peers
for informal care. The role of friend caregivers remains underresearched, and
most studies thus far have focused on caregiving provided by partners and other
biological family members (Shiu et al., 2016).
Challenges remain to meet the care and community needs of all older adults.
What do our current responses foretell for future generations of diverse elders?
We review the literature on formal and informal supports and resources available
to LGBTQ1elders as they age. How do social factors over the life course shape
SGM mental and physical health later in life? What health disparities exist? This
Life Course Transitions, Personal Networks, Social Support 159
commentary examines individual and institutional sources of social support,
including personal networks comprised of kin and nonkin members and inter-
actions in healthcare settings with providers that connect elders with resources
and opportunities to avoid isolation. We examine the availability of supportive
relationships across the life course and discuss the unique LGBTQ1life course
transitions that traditional gerontology has only begun to consider.
In light of the recent, increased attention to LGBT health and aging, we offer
a road map for scholars, practitioners, and community members outlining future
research needs in these understudied areas to advance scholarship and policy. We
chart findings of selected prior studies that have investigated these questions and
outline some directions to help improve scholarly understanding and assist pro-
viders delivering healthcare and social services to SGM populations. Addition-
ally, we emphasize that the LGBT population is not monolithic, with significant
variations in experiences and health outcomes between SGM men and women.
But limited study sample sizes have often prevented fuller exploration. In this
review, we aim to use an intersectional lens that explores dimensions of social
identity and social location among diverse subpopulations within SGM elders,
including intersecting SGM identities with age, race/ethnicity, class, immigration
status, gender or sexual fluidity over time, transgender status, and specific
discrimination for subminorities within the LGBTQIA1community. To the
extent possible, given the limitations of current research, we consider these dif-
ferences within subgroups and highlight the potential to interrogate such
important variations in future work.
DISPARITIES IN HEALTH AND RELATED BEHAVIORS
Significant health disparities exist for LGBTQ1elders as they age, with a greater
likelihood of chronic health conditions, higher rates of disability and mental
distress, and increased risk of substance abuse and suicide, than their heterosexual
peers (Fredriksen-Goldsen, Kim, Shiu, & Bryan, 2017;Lesbian, Gay, Bisexual,
and Transgender Health, n.d.; Shiu et al., 2016). Increasingly, more adults
diagnosed with HIV have reached late adulthood, but while they have gained
longer life expectancy, they also face higher rates of victimization, smoking, drug
use, poverty, challenges accessing healthcare, disability, cardiovascular disease,
cancer, hepatitis, and are more likely to report poorer overall physical and mental
health (Fredriksen-Goldsen & Emlet, n.d.). We consider these wide-ranging
disparities as outcomes of cumulative health disadvantages for SGM older
adults that have come of age in a hetero- and Christo-normative society that has
refused societal recognition, or worse, inflicted systematic oppression and active/
violent discrimination.
Self-reported data from the National Health Interview Survey provide some
insights, though this study (Fredriksen-Goldsen, Kim, Shiu, & Bryan, 2017) did
not have a large enough sample to fully explore differences between LGBT
subgroups. The study’s authors found greater reporting of poor general health,
mental distress, disability, stroke, heart attack, asthma, arthritis, low back or
160 STACY TORRES AND GRIFFIN LACY
neck pain, and a weakened immune system among sexual minority older women
than heterosexual older women. In comparison, they found SGM older men
more likely than heterosexual older men to report angina pectoris, low back or
neck pain, cancer, a weakened immune system, disability, activities of daily living
(ADL) limitations, and mental distress. The study also found differences in
behaviors that have consequences for health, such as higher rates of heavy
drinking and smoking, especially among SGM women. Such disparities in
chronic conditions, disability, and mental distress in younger lesbian, gay, and
bisexual (LGB) adults continue as they age, and others, such as cardiovascular
disease risks, appear later in life (Fredriksen-Goldsen, Kim, Shiu, & Bryan,
2017b).
Disparities in higher rates of cognitive impairments among LGB older adults
have also emerged in the scholarly literature and have not received adequate
attention and treatment in current healthcare systems. (Fredriksen-Goldsen, 2018).
A recent study found that LGBT adults aged 45 and older were 29% more likely to
report symptoms associated with cognitive decline, specifically memory loss and
confusion. The authors of the study offer some possible explanations for these
differences, including higher depression and PTSD rates, lack of access to
healthcare, and the inability to work (Matias, 2019).
Some LGBT subgroups face even greater risk and elevated health disparities,
such as transgender women of color (Sevelius, 2013). Researchers have detected
health disparities in the transgender population compared with LGB older adults,
and find an increased risk for poverty, financial barriers to healthcare, disability,
lower social support, and greater internalized stigma (Emlet, 2016). Data from
the U.S. Transgender Survey reveal the higher prevalence of mental health dis-
abilities among the transgender population, with transgender people six times
more likely than the general population to report “serious difficulty concen-
trating, remembering, or making decisions”and nearly four times more likely to
report “difficulty doing errands alone, such as visiting a doctor’soffice or
shopping,”due to a physical, mental, or emotional condition (Disability Rights
Education & Defense Fund, 2018). But public health surveys often overlook
transgender elders, since they lack gender identity and expression measures
(Lesbian, Gay, Bisexual, and Transgender Health, n.d.). Some research has
found military service associated with good health for transgender older adults
(Fredriksen-Goldsen, 2018). Other findings show heightened risks for bisexual
elders, and the study’s authors posit that these double disadvantages may have
contributed to their findings of greater risks to bisexual older men of low back or
neck pain, mental distress, and smoking and poverty for bisexual older women
(Fredriksen-Goldsen et al., 2017b).
Prior studies have demonstrated that discrimination is the strongest predictor
of poor health among LGBT older adults and that more than two-thirds have
experienced victimization and discrimination on more than three occasions,
including discrimination when seeking health, aging, and disability services, and
reported an average of 6.5 instances over their lifetimes (Fredriksen-Goldsen,
2018). Persistent marginalization, which includes everyday microaggressions, has
strong associations with psychological distress and poor mental and physical
Life Course Transitions, Personal Networks, Social Support 161
health outcomes (Fredriksen-Goldsen et al., 2017a;Lesbian, Gay, Bisexual, and
Transgender Health, n.d.). Research suggests that African-American and other
racial and ethnic minority SGM elders face increased risk of discrimination in
multiple arenas, such as housing, employment, and healthcare, further increasing
their vulnerability to harmful treatment (Kim, Jen, & Fredriksen-Goldsen,
2017a). Transwomen of color experience higher rates of poverty, victimization,
discrimination, and health disparities (Sevelius, 2013).
Despite progress in securing rights and the increasing visibility of LGBT pop-
ulations, researchers warn of rising fear among LGBTQ older adults, who have
already struggled against bias and discrimination, as they confront anew bias such
as limited bathroom options and shifting U.S. policies to limit the right of trans-
gender people to serve in the military (Fredriksen-Goldsen, 2018). The rollback of
military participation rights portends significant harm when considering the posi-
tive health outcomes associated with service for older transgender adults
(Fredriksen-Goldsen, 2018). Scholarly work that has conceptualized social stress as
a process highlights ways to understand how social stresses experienced in one life
arena can spill over to others, with consequences for mental health that warrant
further investigation (LeBlanc, Frost, & Wight, 2015).
Research has pointed toward developing a strong and positive affirmation of
sexual and gender identity as one important measure to bolster good mental
health (Fredriksen-Goldsen, Kim, Shiu, Goldsen, & Emlet, 2015). Cultivating a
positive appraisal of one’s sexual identity has a strong association with greater
well-being, life satisfaction, and access to social ties. A negative view, or identity
stigma, may take hold when people internalize societal prejudice against SGM
communities and is associated with poor mental and physical health. Further
research may help us understand with more clarity how identity affirmation helps
SGM elders access social resources, and thus, promote health equity and better
physical and mental health (Fredriksen-Goldsen et al., 2017a).
While many LGBT older adults have weathered multiple adversities that have
made it more difficult to attain good health, they have also demonstrated resil-
ience in the face of stigma and discrimination, which also has an association with
psychological and social resources that support better health (Fredriksen-
Goldsen et al., 2017a). From the research on chronic illness among SGM
elders, some bright spots suggest pathways of resilience. Despite some higher
risks of disability, chronic disease, and poor general health, SGM older men had
lower rates of obesity, and SGM women had a lower likelihood of having dia-
betes and reporting ADL limitations. SGM elder women in this study stand as
models of resilience and had also achieved higher incomes, educational attain-
ment, and rates of employment than their heterosexual age peers (Fredriksen-
Goldsen et al., 2017b). And more LGB adults than heterosexual older adults take
preventive health measures, including blood pressure and HIV screenings
(Fredriksen-Goldsen, 2018). In the face of these disparities, most LGBT older
adults report good health and life satisfaction, good social relationships, com-
munity connections, and take action to support their health, attesting to their
resilience in the face of historical marginalization (Fredriksen-Goldsen et al.,
2017a).
162 STACY TORRES AND GRIFFIN LACY
REENVISIONING THE LIFE COURSE
Considering typical life course markers, such as moving out of the family home,
marriage, having children, and menopause, prompts us to ask in what ways do
SGM elders experience a lack of these benchmarks or a dramatic time sequencing
of life events due to gender transitions, coming out experiences, a lack of financial
support for in vitro fertilization in some states, early homelessness due to family
rejection, and a historical lack of legal right to marry. We examine the avail-
ability of supports to address documented health disparities in the context of
cumulative inequalities and distinct life events that structure the life course for
LGBTQ1elders and have long-term health implications, such as coming out
earlier and later in life, varying levels of managing disclosure, and forging sexual
and gender identity.
Most prior life course research has taken a heteronormative view of key
events that structure lives and has prioritized family transitions, such as mar-
riage, childbearing, divorce, and adjustment to death and widowhood, and
work patterns including unemployment, reentry to employment, and retirement,
while neglecting sexual and gender identity events prominent in SGM elders’
lives such as coming out. Life course theory provides a useful framework for the
study of LGBTQ1aging but remains limited in its examination of inter-
sectionality. Few studies have thus far investigated the experiences of the oldest-
old (age 80 and over), bisexual, gender nonconforming, intersex, poor, and
elders of color in SGM communities (Fredriksen-Goldsen, Jen, & Muraco,
2019). LGBT elders often report significant events that have not received much
attention in gerontology research, related to the development of sexual and
gender identity, a history of marginalization, workplace and other discrimina-
tion, and different experiences of family relationships (Fredriksen-Goldsen
et al., 2017c). Throughout their lives, middle-aged and older lesbian and gay
adults have fought political exclusion that until only recently deprived them of
employment protections against discrimination and the right to same-sex
marriage and have faced other stigma and discrimination. Older lesbians also
encountered legal discrimination against women in workplace and educational
contexts (Muraco & Fredriksen-Goldsen, 2016). Transwomen, especially
women of color, face a heightened risk of intimate partner violence due to
“gender norm transgression[s]”(Schilt & Westbrook, 2009,p.459)and“penis
panics,”an imagined sexual threat based on perceived gender (Westbrook &
Schilt, 2014, p. 48).
Coming out and the pressures of managing disclosure consistently appear in
the research thus far as a distinct life event that distinguishes the life trajectories
of SGM elders from their peers of other identities. The process of coming out
can be emotional, long anticipated, and life-changing for many LGBTQAI
individuals; however, the experience may be positive or negative, depending on
the age of disclosure and the class, race, and gender-based reactions of each
individual’s respective communities. A study by Ryan, Legate, and Weinstein
(2015) explores whether sexual identity disclosure supports health and well-being
and finds that negative responses to coming out have a greater impact on well-
Life Course Transitions, Personal Networks, Social Support 163
being than positive reactions. These findings suggest that avoidance of negative
reactions outweighs the creation of positive supportive communities during the
coming out process (Ryan et al., 2015), thus potentially easier to achieve in
practice and resulting in better health and well-being outcomes for aging SGM
adults.
On average, older adults reported coming out in their late 20s, though
experienced their first awareness at age 21 (Fredriksen-Goldsen et al., 2017c).
But variation exists in coming out by gender sexual identity and cohort, with
women demonstrating greater sexual fluidity over their lifetimes and later
disclosure along with bisexual and transgender individuals and older LGBT
cohorts (Fredriksen-Goldsen et al., 2017c). Qualitative research has provided
rich accounts of the pressures to manage disclosure and the long period some
eldershavehadtowaittorevealandreceiverecognitionoftheirsexualiden-
tities. For example, when researchers in one study asked one of the eldest
participants, aged 95, how old he was when he first knew he was gay, he
answered 15. They asked his age when he first told someone he was gay, and he
replied 90 (Fredriksen-Goldsen, 2018). Such late life disclosure raises the
possibility that many others, uncounted and invisible to researchers studying
LGBTQ health, may have passed away before having the opportunity to come
out and disclose their identity. While this example highlights the great length
that some wait to disclose their identities, identity disclosure matters a great
deal for SGM elders and young people alike. Coming out is a unique experience
and a district life event for SGM groups, regardless of the age of disclosure.
Many people remain fearful of disclosure, often choosing not to share their
identities at all, due to the potential for family and social rejection, which leads
to negative feelings, isolation, and reduced self-esteem (Mckenna & Bargh,
1998).
Important variations arise in the life experiences of LGBT subgroups. More
LGBT older adults have participated in opposite-sex marriages than in same-
sex marriages (Fredriksen-Goldsen et al., 2017). For example, many older
lesbians self-identify as a sexual minority at later ages, after having an
opposite-sex marriage earlier on, which often increases the chance of bearing
children. Such timing may have positive consequences for these women, as
coming out later in life correlates with involvement in LGBT community
activism, serving as an anchor that may help cultivate a sense of belonging
(Fredriksen-Goldsen el al., 2017c). However, this theoretical concept and its
importance require further interrogation. Due to a current trend, especially
among queer, nonbinary and genderfluid youth, to resist adopting traditional
SGM self-identity labels, future research will benefit from an inclusion of multiple
identities, including but not limited to queer, pansexual, genderfluid, nonbinary,
asexual, and those who choose not to adopt any label (Scherrer, Kazyak, &
Schmitz, 2015).
“Off time”life course transitions, such as leaving school early to work or
exiting the workforce before retirement due to disability, have long-term conse-
quences for well-being later in life and exact a cost in terms of diminished social,
financial, and health-related resources (Carr, 2019). These transitions go against
164 STACY TORRES AND GRIFFIN LACY
the grain of the “typical”life course and occur more frequently in the lives of the
less advantaged (Carr, 2019). LGBT older adults experience differences in the
timing of life events that diverge from prior findings about the timing of events in
the heterosexual life course, and they report several instances of “off time”
transitions during their lives (Fredriksen-Goldsen et al., 2017;Muraco &
Fredriksen-Goldsen, 2016).
The loss of loved ones in the context of the AIDS epidemic serves as a powerful
example of an “off time”transition often mentioned as a major turning point in life
by gay men that hastened their confrontation with death and health concerns.
Overlaying these losses may be negative experiences for LGBT people whose
contributions as partners or parents have not received adequate recognition
(Fredriksen-Goldsen et al., 2017). In one study (Muraco & Fredriksen-Goldsen,
2016), interviewees mentioned the significance of not only losing parents and
grandparents but also the deaths endured during the AIDS epidemic in 1980s and
1990s. Friends’and partners’diagnoses of HIV and AIDS prompted “off time”
health and caregiving concerns much earlier in life as participants lost entire
friendships circles. Most talked about other’s diagnoses as a major turning point
instead of their own health concerns. Yet, most lesbian study participants did not
connect their own health and aging concerns to HIV and AIDS (Muraco &
Fredriksen-Goldsen, 2016).
Understanding how LGBT elders have experienced these transitions and
turning points in their lives within broader social and historical contexts is
necessary and directs our attention to the significance of differences between
generations and cohorts, which sometimes challenge assumptions about how
social change intersects with increased opportunities and lessened barriers such as
discrimination. For example, some prior research (Fredriksen-Goldsen, 2018) has
clustered LGBT older adults into three generations: the oldest elders belonging to
the Invisible Generation which came of age in a context with little public
discourse on SGM populations; the Silenced Generation which endured public
antigay messages, including the required removal of gay and lesbian federal
employees and homosexuality categorized as a mental disorder; and the youngest
elders in the Pride Generation that reached maturity at the height of the civil
rights and women’s movements, followed by the Stonewall Riots and gay liber-
ation movement, and saw policy shifts such as decriminalizing sodomy and
ending treatment of homosexuality as a mental illness along with increased
activism during the AIDS crisis. Yet, despite the social strides experienced by the
youngest elder LGBT cohorts, they reported higher rates of victimization and
discrimination, possibly tied to greater openness around sexual and gender
identity that left them vulnerable to attacks. The oldest LGBT adults in this study
not only reported the lowest rates of victimization and discrimination but also
had less positive views of their own sexual identity and disclosure and fewer social
resources. Such generational differences and variation in reported discrimination
highlight the heterogeneity in this population and necessity of understanding the
convergence of timing, age, and life events within larger social and historical
contexts (Fredriksen-Goldsen, 2018).
Life Course Transitions, Personal Networks, Social Support 165
Such consideration sheds light on the interesting role the military served for
many older gay men and lesbians who joined to escape repressive family envi-
ronments. They had to hide their sexual orientation and for gay and gender
nonconforming men who were drafted or joined out of social pressure, they often
encountered strict gender norms and expectations to conform to ideals of hege-
monic masculinity. But the military also allowed women alternatives to build
lives outside the traditional confines of heterosexual marriage and motherhood
(Muraco & Fredriksen-Goldsen, 2016).
A qualitative study (Muraco & Fredriksen-Goldsen, 2016) of lesbian women
and gay men offers important insights into how these groups perceive turning
points they consider significant in their life trajectories. Most often participants
pointed to relationship formation and dissolution, educational milestones, and
job-related turning points. Beginning and ending relationships emerged differ-
ently as key transitions for gay men and women, with gay men pointing to
breakups of previous heterosexual relationships as liberating in many cases.
Lesbians more often cited relationship breakups and occupational and educa-
tional experiences as major turning points. The beginning of a relationship,
coming out, and HIV/AIDS-related experiences came up as key turning points
for gay men. Participants identified long-term, same-sex relationships as crucial
cushions of stability, which correlate with findings about meaningful relationships
in the general population of older adults, though only recently could LGBT
adults legally marry a same-sex partner.
In the LGBT life course, work figures prominently as a source of stress and
discrimination. Prior research has found that one in five LGBT older adults has
been passed over for a job and almost one in six has been fired due to sexual or
gender identity, leading to disparities in financial and social resources that have
consequences for health and well-being in old age (Fredriksen-Goldsen et al.,
2017c). Additionally, gender inequalities in the workplace privilege men,
especially those who conform to cultural expectations of masculinity, with tall,
white men receiving the greatest advantages (Schilt, 2006).Atthesametime,
work and education can serve as powerful milestones over the life course. For
example, lesbian interviewees in one study described occupational and educa-
tional experiences in greater detail than men, taking care to mention specific
achievements such as graduating with honors, receiving scholarships, and praise
from teachers about their academic ability (Muraco & Fredriksen-Goldsen,
2016).
But the continuation of work into old age emerges as a recurrent theme,
despite histories of negative workplace experiences and more limited professional
paths. A quarter of those aged 65 and older work, a higher rate than the 18% of
general population of employed adults 65 and older, suggesting that some LGBT
older adults may need to work later in life due to compounding inequalities that
diminish the ability to accumulate financial resources over the life course
(Fredriksen-Goldsen et al., 2017c). In a study of turning points, no participants
identified retirement as personally significant turning point, despite many having
retired and naming employment-related events as most important in their lives
(Muraco & Fredriksen-Goldsen, 2016).
166 STACY TORRES AND GRIFFIN LACY
PERSONAL NETWORKS, HEALTH OUTCOMES, AND
ALTERNATIVE SUPPORTS
Scholars have long documented the protective benefits of social relationships for
older adults, which help elders avoid social isolation and may provide social
capital that bolsters emotional, financial, and practical support, along with a
sense of belonging and embeddedness in community (Gray, 2009). Prior
research has found that larger and more diverse networks that provide access to
abundant social resources have a stronger association with better physical and
mental health, greater subjective feelings of well-being, and lower levels of
depressive symptoms than more limited, restricted networks (Kim, Fredriksen-
Goldsen, Bryan, & Muraco, 2017b;Litwin & Shiovitz-Ezra, 2011). A sub-
stantial literature has documented the negative effects of loneliness and a lack of
companionship on physical and mental health (Thoits, 2011;Uchino,
Cacioppo, & Kiecolt-Glaser, 1996), and prior research has found participation
in social activities and perceived support associated with better cognitive
function in older adults (Krueger et al., 2009;Zunzunegui, Alvarado, Del Ser, &
Otero, 2003). Other research has found loneliness and social isolation positively
correlated with physical inactivity, smoking, blood pressure, and biological
processes related to the development of cardiovascular disease, such as the
inflammation markers CRP and fibrinogen (Shankar, McMunn, Banks, &
Steptoe, 2011).
Understanding the causal relationships between the size, type, and quality of
social networks and health outcomes remains a challenge for researchers. Causal
directionality is not always clear, as lacking connections may lead to deterio-
rating health. But those in poor health may also have fewer contacts due to
greater difficulty reciprocating support and participating in activities and social
interaction (Gray, 2009). Prior studies suggest multiple potential pathways to
account for the relationship between social networks, social support, health, and
well-being.
Larger, diverse networks comprised of plentiful kin and nonkin ties may
provide greater sources of health-related information and resources, reducing
dependency on a few key network members and thereby supporting a sense of
independence and autonomy (Cornwell, 2009). In addition to information, larger
networks may indicate the presence of close relationships which may influence
“health behaviors”(Shankar et al., 2011), which Umberson and colleagues define
as “a range of personal actions that influence health, disability, and mortality”
(Umberson, Crosnoe, & Reczek, 2010, p. 140). Significant others may encourage
healthier choices by serving as exemplars of health-promoting behaviors or
pressure network members to change risky behavior (Shankar et al., 2011). The
socially isolated may miss out on these subtle and explicit network influences on
habits and behavior. Empirical studies have found that those with many social
connections reported higher levels of screenings for colorectal cancer, blood
pressure, and cholesterol, and older adults in networks with fewer resources faced
increased risk of alcohol abuse, physical inactivity, and lower use of comple-
mentary and alternative medicine (Litwin & Shiovitz-Ezra, 2011).
Life Course Transitions, Personal Networks, Social Support 167
Besides the size of the network, the perceived quality of available support and
subjective feelings of loneliness also matter for health outcomes (Fiori, Anto-
nucci, & Cortina, 2006, pp. P25–P32). Some research posits that the type of
network, broad “diverse”networks composed many different kinds of ties versus
“restricted”networks limited to friends or family, bears on health outcomes.
Prior studies have found diverse networks associated with better health than
restricted networks and differences in health outcomes between networks
restricted to family versus friends, with those more reliant on family ties expe-
riencing greater depressive symptoms (Fiori et al., 2006). These findings support
other research that demonstrates the significance of friends and other nonkin ties
for the well-being of older adults (Adams & Blieszner, 1995;Torres, 2019).
Challenges persist for all elders to remain connected as their social network
size diminishes, which occurs for older LGBT adults as well as the general
population of older adults. Prior research has also documented smaller networks
among older African-American and Latino older adults, compared to white
elders, and for those with chronic disease, those who remain unmarried, and
those who do not have children (Erosheva, Kim, Emlet, & Fredriksen-Goldsen,
2016). Estimated numbers of LGBT parents vary; however, approximately 37%
of LGBT adults have been parents, leaving a significant percentage of aging
LGBT adults without children to care for them in their old age. Approximately
six million people in the United States have an LGBT parent, with 2–3.7 million
of those children under age 18 (Gates, 2015).
The size of social networks has implications for psychological well-being, with
smaller networks potentially increasing loneliness. Ensuring that LGB elders
have high-quality social support despite fewer network members is a key concern.
Despite a greater lack of family-based networks due to lower birth rates, other
research suggests that LGB older adults may have some advantages from their
efforts to forge alternate social networks containing a wider range of nonkin ties,
including friends and ex-partners, which provide other well-developed streams of
support (Kim & Fredriksen-Goldsen, 2016).
What unique needs and barriers to practical and social support do SGM older
adults face? When and how do family, friends, and neighbors, to name a few
sources of social ties, fit into SGM elders’social networks? We consider the
alternative supports LGBTQ1elders may need compared to their heterosexual
cisgender peers, given the potential rejection they face in a range of public and
intimate spaces.
Few studies have focused on the social networks of SGM elders, and little is
known about their network characteristics or diversity (Erosheva et al., 2016).
The shape and complexity of LGBT older adults’networks challenge existing
conceptual models that prioritize relationships based on biology or marriage
(Kim et al., 2017b). They have faced challenges to maintaining and forming ties
in traditional biological families of origin or destination due to early rejection or
legal limitations to family formation, such as a long history of marriage exclu-
sion. Compared with heterosexual older adults, LGBT elders have lower
participation in marriage or partnered relationships, partly as a result of marriage
exclusion. Familial acceptance also varies within older LGBT populations.
168 STACY TORRES AND GRIFFIN LACY
Among the Baby Boom cohorts, a majority of gay men and lesbians have
received acceptance from their biological families, but bisexual and transgender
people less so (Erosheva et al., 2016). Intersecting forms of oppression may lead
to greater familial rejection and risk; however, further systematic investigation
will help us better understand how race, social class, and (dis)ability status shape
experiences of family acceptance (Ryan et al., 2015).
Social isolation remains a special concern for many LGBTQ older adults,
especially those who rely on support and connection from similar aged peers. As
their counterparts grow older and encounter their own health issues, long-term
survivors in these social circles face a higher risk of social isolation and early
institutionalization and death (Fredriksen-Goldsen, 2018). Other hurdles to
remaining connected for LGB older adults include persistent discrimination,
stigmatization, and the historical lack of legal recognition of same-sex
relationships.
Scholarship has found a higher prevalence of LGB elders living alone.
Compared with less than a fifth of older heterosexual adults, roughly half of older
gay and bisexual men and more than a quarter of lesbians and bisexual women
live alone (Kim & Fredriksen-Goldsen, 2016). One study found that SGM men
were also less likely to have children in their households, which could further
increase the risk of social isolation (Fredriksen-Goldsen et al., 2017b). Partner
losses to HIV/AIDS may partially help explain older gay men’s higher rates of
living alone (Kim & Fredriksen-Goldsen, 2016).While living alone does not
necessitate loneliness, this living arrangement has a strong association with higher
levels loneliness for LGB elders, more so than for those living with a partner or
spouse, but similar to levels of loneliness experienced by those living with others
besides a relationship partner (Kim & Fredriksen-Goldsen, 2016).
Researchers have found some differences in the prevalence of isolation among
different LGBT subgroups that warrant further attention (Fredriksen-Goldsen
et al., 2017b). As in the general population, among LGB elders, women have
larger social networks (Erosheva et al., 2016). But people who identify as bisexual
may experience increased stress and social isolation, partly due to marginaliza-
tion within lesbian and gay communities and the larger social realm. Meanwhile,
variation also emerges in examining the relationship experiences of transgender
older adults, compared with nontransgender LGB older adults, who not only
have a greater likelihood of having a legal marriage, children, and living with
others but also a higher chance of having a divorce and less social support (Kim
et al., 2017b).
Marriage continues to demonstrate evidence of protective benefits. For
example, a recent study (Goldsen et al., 2017) found that legally married LGBT
older adults aged 50 and older reported a higher quality of life and greater
economic and social resources than partnered people who remained unmarried.
The study authors found similar physical health markers between legally married
and unmarried partnered participants, providing further evidence of the protec-
tive value of close relationships, as single research participants reported poorer
health and fewer resources than married and unmarried respondents. Yet, women
in same-sex marriages reported more microaggressions based on LGBT status
Life Course Transitions, Personal Networks, Social Support 169
(Goldsen et al., 2017). The complicated, protective benefits of marriage warrant
further investigation post-legalization to properly assess risks and rewards for
LGBT couples.
These strains and denial of rights have resulted in disadvantages that
researchers are only beginning to understand, and also opportunities of necessity
to forge alternate configurations of supportive ties to circumvent challenges to
forming traditional networks. Furthermore, SGM elders face unique barriers to
obtaining care from family members bonded to them through biological and/or
legal ties. We reflect on how strained relationships and challenges with familial
acceptance compel some to seek alternative sources of support and relationships.
Many create different models of family due to rejection or other constraints in
forming traditional households based on marriage and child rearing. Finally, do
LGBTQ1elders have more community support in some spaces, because they
share an overarching identity characteristic with a growing “out”community?
LGBT older adults have charted a long tradition of “chosen”families, which
include a wide range of ties with friends, ex-partners, neighbors, and other
associations. These friendships may result in greater diversity in the backgrounds
of network members and the prevalence of multiple types of friendship networks
(Kim et al., 2017b). Prior studies have found that LGBT older adults have a
greater likelihood than their heterosexual age peers to solicit advice, emotional
support, and help with personal matters, errands, and emergencies from close
friends (Erosheva et al., 2016). Other research has shown that gay men and les-
bians more often maintain friendship ties and contact with ex-partners and
suggests that network scholars may even underestimate the prevalence of such
ties as respondents may identify ex-partners as “friends”and they become sub-
sumed under the category of friendship ties (Kim et al., 2017b).
Friends figure prominently in the networks of LGBT adults, and their care-
giving is an important contribution within SGM communities. LGBT older
adults provide much more informal care to friends, with one study finding that
21% have taken care of a friend compared with 6% of heterosexual adults
(MetLife Mature Market Institute & American Society on Aging, 2010,inShiu
et al., 2016). Historically, friend care filled a vital gap during the HIV/AIDS
epidemic, when vast proportions of gay and bisexual men and transgender
women became infected and lacked support from biological families and insti-
tutional structures due to discrimination based on infection status and sexuality
(Shiu et al., 2016). But such care remains unrecognized, and informal friend
caregivers lack adequate social support and feel as burdened with stress and
depressive symptoms as those providing care to spouses and partners (Shiu et al.,
2016). Caregiving can not only build self-esteem but also cause higher stress and
depression, especially when caregiving obligations pile on a caregiver’s own
health problems in old age, the demands of continuing paid work, and efforts to
secure one’s own social support (Shiu et al., 2016).
One unique feature of everyday life for LGBT adults of all ages is the issue of
sexual identity revelation, a decision which may carry even more weight for SGM
older adults that have accumulated many more years of social marginalization
due to their advanced ages and the social contexts in which they reached
170 STACY TORRES AND GRIFFIN LACY
maturity. Efforts to conceal their sexuality may protect from some discrimination
but also curtail possibilities for community with others that affirm a positive
identity and provide support, resulting in smaller, less diverse networks (Erosheva
et al., 2016;Fredriksen-Goldsen et al., 2017a). Research has shown that LGB
older adults living alone and living with others, besides a partner or spouse, are
more likely to hide their sexual identity and have higher levels of internalized
stigma about their sexuality, which in turn corresponds with lower rates of close
relationships and more relationship problems (Kim & Fredriksen-Goldsen,
2016).
Research that finds SGM elders of color more likely conceal their sexual
identity among relatives offers insights into circumstances that lead to lower
levels of social support (Kim et al., 2017a). Compared with whites, African-
American and Latino/a/x SGM older adults had lower social support, associated
with poorer physical and psychological health-related quality of life. Racial and
ethnic minority LGBT elders may face multiple disadvantages in securing social
support as they grapple with more heterosexism and homophobia in communities
of color, racism in LGBT communities, and multiple instances of stigma and
discrimination in society at large. Additionally, lower levels of social support may
reflect more limited family and partner support (Kim et al., 2017a). Multiple
challenges to remaining connected and maintaining robust social networks illu-
minate the potential mental health disadvantages for historically marginalized
groups (Kim et al., 2017b).
What challenges persist for aging in place and finding spaces where SGM
elders can socialize? Is there an urban/rural divide and exclusion/inclusion in
religious spaces? Is the need to socialize with peers greater for LGBT elders –not
only for those who lack family support but also for all who feel a need to connect
with a community that allows them to feel understood? What opportunities and
challenges exist, including special sources of resilience and support?
LGBT elders living in rural areas may feel less comfortable disclosing their
sexual orientation and gender identity, due to a more socially, politically, and
religiously conservative environment that may be less accepting of lifestyles that
diverge from the “heteronormativity”of rural communities. In addition to fear of
homophobia and transphobia in their small communities, SGM older adults also
confront broader challenges related to aging in rural environments, including
health services located far from home, lack of adequate public transportation,
and social isolation, increasing the pressure to avoid ostracism from neighbors
and local institutions that may provide assistance (Butler, 2017).
Few studies have explored religious and spiritual participation among LGBT
elders. Exclusion and inclusion in religious spaces for LGBT adults is a
complicated and important consideration, and a third of SGM elders regularly
attended religious or spiritual gatherings (Fredriksen-Goldsen, 2018). African-
American and Latino/a/x elders show higher rates of religious service attendance,
which is associated with increased well-being and connectedness in older adults,
but also potentially exposes SGM elders to homophobia. Many SGM elders have
reported adverse experiences with churches, making them reluctant to seek
out religious guidance and support (Boggs et al., 2017). While white LGB people
Life Course Transitions, Personal Networks, Social Support 171
often seek a more gay-affirmative religious community than they experienced
growing up, Black and Latino/a/x LGB adults less often make these switches
(Choi & Meyer, 2016). Some participants attempt to propose more egalitarian
reforms within cisnormative patriarchal Christian religious traditions, as found in
one study about the experiences of transgender members of the Mormon Church
(Sumerau, Mathers, & Cragun, 2018). Involvement in religious and spiritual
communities has advantages and potential drawbacks. Some LGBT elders attest
to receiving emotional and practical support from other members of their reli-
gious communities, either at the cost of concealing their sexual identities or by
participating in gay-friendly religious institutions (Choi & Meyer, 2016;Kim,
Jen, & Fredriksen-Goldsen, 2017). One study found higher spirituality among
African-American and Latino SGM elders associated with an increase in psy-
chological resources, which may serve as an important counterweight to the
decrease in physical and psychological resources in minority elders who have
endured greater lifetime LGBT discrimination and other forms of bias and
discrimination due to race and ethnicity (Kim, Jen, & Fredriksen-Goldsen, 2017).
HEALTHCARE INTERACTIONS AND DISCRIMINATION
IN MEDICAL SETTINGS
Unequal treatment in healthcare settings can have serious medical consequences
for a wide range of marginalized groups, as research on Black women’s higher
maternal mortality rates has demonstrated that unconscious racial biases lead
some providers to ignore patients’life-threatening symptoms from strokes and
heart attacks (Martin & Montagne, 2017). Other research (Sacks, 2018) has
examined how Black middle-class women attempt to combat racial stereotypes in
healthcare settings by dressing well, trying to make a personal connection with
providers, and by conducting research before visits to communicate their medical
knowledge. This pressure to “perform”to gain recognition and respect takes an
emotional toll that can contribute to poor health. Challenges for SGM elders to
access care in medical settings include distrust of the healthcare system, which
may complicate the kind of support SGM elders can draw from existing medical
infrastructure. Despite efforts and progress in recent years to increase the avail-
ability of LGBT-friendly healthcare, SGM elders continue to fear receiving
apathetic, discriminatory, or even abusive treatment as they access medical care
(Gendron et al., 2013).
One form of systemic oppression that SGM populations face is the historical
stigmatization of their identities. The Diagnostic and Statistical Manual of
Mental Disorders originally designated homosexuality and transgender identity
as mental disorders, and the medical establishment regularly administered
treatments such as electroshock therapy and castration for these perceived
pathologies (Hswen et al., 2018). At best, such treatments were ineffective and
otherwise harmful and traumatic. The stigma of inaccurate labels such as
“mentally ill”has long-term negative effects on LGBTQ1communities and
individuals.
172 STACY TORRES AND GRIFFIN LACY
Many healthcare providers lack the knowledge, skills, and training to provide
culturally relevant care to SGM populations, and previous negative experiences
may also prevent LGBTQ people from feeling comfortable enough to share
information with their physicians and other providers, such as potential health
concerns about breast or prostate cancer and HIV (Fredriksen-Goldsen, 2018).
Twenty-one percent of LGBT elders in one survey concealed their sexual or
gender identities from healthcare staff out of fear of receiving worse treatment or
being denied treatment, which 13% of study participants had reported (Seegert,
2018). Clinicians focused on screening heterosexual ciswomen may neglect to
screen for intimate partner violence and other forms of abuse in queer and same-
sex couples, compounding health disparities for SGM groups (Ard & Harvey,
2011).
Many healthcare hurdles exist for transgender populations who need special
medical treatment. They may also use medical services more as they age and
require bodily care that exposes their transitions to healthcare providers who they
fear may mistreat them emotionally and/or physically. Because transitions are
framed as medical journeys requiring clinical intervention, transgender elders
may have unique interactions with healthcare institutions compared with their
SGM peers. Patients who seek hormone replacement therapy or gender affir-
mation surgery for physical gender transitions, which can be life-saving, and
those who do not conform to typical binaries in their gender expression or
physical appearance, require appropriate medical knowledge and bedside manner
from healthcare providers.
Many LGBTQ1identified elders continue to have concerns about receiving
adequate care from knowledgeable providers and express distrust and anxiety
about encountering homophobic staff in medical offices, assisted living, and long-
term care settings (Stinchcombe, Smallbone, Wilson, & Kortes-Miller, 2017).
Some research indicates that LGBT older adults are far less likely to access
necessary health and social services due to fear of discrimination, which can have
serious ramifications for health and other markers of well-being (in Gendron
et al., 2013). For LGBT elders aging in place, who may need in-home, long-term
care services, allowing healthcare workers into their personal spaces can spark
fear and discomfort. As one self-identified lesbian interviewee expressed,
I think one issue would be if you thought that somebody was coming who was not in the gay
community, you’re going to have to de-gay your house. (Bradford et al., 2016, p. 113)
Those faced with the necessity of moving to a residential community that serves
older adults have revealed pressure to “go back into the closet,”and many
preferred housing options and assisted living facilities exclusively for LGBTQ older
adults (Boggs et al., 2017;SAGE and the Human RightsCampaign Foundation,
2020).
LGBT caregivers have also shown a lower likelihood of using formal support
services, often designed for heterosexual partners and other biological relatives,
and have fewer legal rights in situations where they lack power of attorney and
other next-of-kin rights. Such avoidance of supports embedded in formal care
structures stems in part from past negative experiences with providers lacking
Life Course Transitions, Personal Networks, Social Support 173
sensitivity to LGBT issues and needs, furthering the invisibility of informal SGM
caregivers (Shiu et al., 2016). Meeting the needs of a growing number of SGM
elders and their caregivers requires adequate training and attentiveness to their
specific healthcare and psychosocial needs, but as Veronica Calderon, Chief
Diversity, Inclusion and Equity Officer of Aldersgate Life Planned Services also
urges, “LGBTQ1inclusivity should be part of the organization’s strategic plan,
not a program, stand-alone activity or event”(SAGE and the Human Rights
Campaign Foundation, 2020, p. 4).
DIRECTIONS FOR FUTURE RESEARCH
Despite recent flourishing of research in SGM health, as this population ages, we
have much to understand to support elder members of LGBTQIA1commu-
nities. Scholars, practitioners, and community members have ample opportunity
to advance scholarship and policy in understudied areas such as LGBTQ1aging
and transgender health. This commentary has highlighted a range of quantitative
and qualitative studies that suggest avenues for future research we summarize
here.
The persistence of LGBT health disparities comes with a heavy societal cost.
While scholars have documented some risks for SGM elders in this emerging
research area, more research is needed to better understand how physical activity
and socioeconomic status affect health problems, such as chronic illness and ADL
limitations that may hinder independence (Fredriksen-Goldsen et al., 2017b).
Future studies need to examine complexities in the relationship of resilience and
risk to health (Fredriksen-Goldsen et al., 2017b). Further investment in training for
healthcare providers to deliver culturally appropriate and sensitive care remains an
urgent need as more LGBT elders enter healthcare spaces.
We also lack crucial knowledge about how sexual minority populations
experience the life course (Muraco & Fredriksen-Goldsen, 2016). Theoretical
frameworks that incorporate queer theory and deeper attention to how hetero-
normativity bears on the aging experiences of LGBTQ1older adults have gained
momentum but remain a relatively recent development in gerontology studies
(Fabbre et al., 2019). Increased use of longitudinal data would provide greater
ability to analyze the timing and sequence of key life events in the LGBTQ1life
course, such as the legalization of same-sex marriage, and untangle the effects of
age, cohort, and historical period on outcomes (Fredriksen-Goldsen et al.,
2017c). Prior research has also pointed toward greater understanding required for
scholars and providers of healthcare and social services of the changing needs,
strengths, available resources, and experiences of lifetime discrimination for
different generations of LGBT older adults (Fredriksen-Goldsen et al., 2017).
Does the act of resistance and an antinormative lifetime of SGM status help
elders advocate for themselves and create community as they age? How does
early oppression lead to later advocacy as SGM elders face increased challenges
and marginalization old age? Some research indicates such experiences may
spur future participation in activism, and in one study roughly three-quarters of
174 STACY TORRES AND GRIFFIN LACY
LGBTQ older adults reported involvement in antidiscrimination efforts, with
high rates found among bisexual women and transgender older adults
(Fredriksen-Goldsen, 2018).
We also require further research to understand the unique configurations of
the social networks of LGBTQ1elders, which would help increase under-
standing of the vulnerability to poor mental health via more restricted networks,
and connections between loneliness and living alone. Future research in this
area would also offer insights to support intervention efforts that leverage social
ties to reach hard to find subpopulations and illuminate subpopulation dis-
parities in social resources, such as older transgender adults with documented
lower levels of social support (Erosheva et al., 2016). Integrating life course
theory, discussed earlier, would further knowledge of variations in LGBT late
life networks and available social support shaped in part by past experiences of
childbearing, opposite-sex marriage, and the timing of those marriages. The role
of friends in networks, which previous studies have found instrumental sources
of practical and emotional support, also warrants further investigation (Shiu
et al., 2016), as does understanding how spiritual spaces may help augment
supportive networks for LGBT elders of color (Kim, Jen, & Fredriksen-
Goldsen, 2017). Connecting online may provide LGBT adults with an addi-
tional outlet for social exchange but how virtual online communities fitinto
their social networks requires further study. Using social media as a tool to
analyze the experiences of aging SGM populations may grow in importance as
older generations increase technology usage.
The role of sexual identity concealment also is a unique feature of SGM
elders’life experiences, but we do not have a well-developed understanding of
the conditions under which nondisclosure influences feelings of connection and
depressive symptoms with age. The potential for internalized stigma in this
population is an important area for practitioners to consider to reduce loneliness
and the potential for isolation, poor mental health, and health-risk behaviors
such as smoking and inadequate nutrition (Fredriksen-Goldsen et al., 2017a;
Kim & Fredriksen-Goldsen, 2016).
Recognizing the diversity and heterogeneity of sexuality subgroups and racial
and ethnic minority LGBT older adults is crucial and often overlooked in most
research samples of LGBT older adults that are predominantly non-Hispanic
white and too small to explore other variations between sexual identities (Kim
et al., 2017a;Kim & Fredriksen-Goldsen, 2016). In order to capture a wider
range of experiences for analysis, improvement in sampling and measurement is
key. Including sexual orientation and gender identity and expression questions is
long overdue in gerontology and public health research to ensure adequate data
available to assess the needs of all LGBTQ older adults (Fredriksen-Goldsen,
2018). Similarly, research on race/ethnicity, sexual identity, and age remains
limited and inconclusive due to insufficient sample sizes which often collapse
racial/ethnic minorities such as African-Americans and Latinos into a single
group (Kim, Jen, & Fredriksen-Goldsen, 2017).
Qualitative research using participant observation and in-depth interviewing
would provide additional insight into the lived experiences of LGBTQ1elders,
Life Course Transitions, Personal Networks, Social Support 175
greater leverage for understanding processes of exclusion, and participant nar-
ratives of how they make meaning of life events. Intersectional research that
considers privilege and oppression along multiple, intersecting axes of social
identity, such as sexuality, race, ethnicity, class, and age, would further highlight
the diversity of experiences and needs in this population.
Scholarship thus far speaks to the necessity of safeguarding policies that
promote equality and protections for LGBT adults. Research has demonstrated
positive outcomes for the beneficiaries of same-sex marriage rights, with mar-
ried participants reporting better health, more openness about their sexual
identities, and having greater social and economic resources than unmarried
couples (Goldsen et al., 2017). But more research is needed to understand the
full array of experiences that marriage bestows, both positive and negative.
Despite documented marriage benefits, married women in same-sex unions also
reported higher rates of daily bias incidents compared to unmarried people. The
wide range of public benefits available through marriage, including Social
Security spousal payments, do not extend to the half of LGBTQ older adults in
long-term partnerships outside of legal marriage. Additionally, variable federal
antidiscrimination legal protections on the basis of sexuality in employment,
healthcare, and housing continue to leave LGBT communities vulnerable. SGM
adults’resilience provides important insights for the field of gerontology and
our understanding of how all older adults build communities and meet needs for
care and connection as they weather adversity and change (Fredriksen-Goldsen,
2018:26–27). Finally, greater scholarly and practitioner recognition of the
significance of friends in SGM elder care networks and the higher prevalence of
informal caregiving in LGBT communities is a prime area for additional sup-
port services and research (Shiu et al., 2016).
CONCLUSION
While LGBTQ1elders face many challenges in their later years, due to years of
stigma, discrimination, restricted rights, and accumulated disadvantage in family,
work, income, and health, this review also identifies and celebrates those sources
of support and resilience as they have crafted alternate support networks and
advocated for increased recognition, rights, and care. We have aimed to highlight
the ways that SGM elders have helped us all learn about aging and thriving in
late life. They stand as forerunners of many trends that everyone must consider to
age well. Their experiences help broaden our understanding of people who lead
lives outside the normative transitions that we have come to expect in the life
course and a growing number of people of all identities who do not have children
or strong biological kin ties (Muraco & Fredriksen-Goldsen, 2016). Learning
from the struggles and successes of SGM populations reveals the shortcomings of
current family and community structures in the United States, what young people
can expect for themselves and their own lives, and hopefully spurs us all to
advocate for the type of world that any person, of any gender identity or sexual
orientation, would want to age in.
176 STACY TORRES AND GRIFFIN LACY
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