Health-Related Issues Facing LGBT Older Adults

LGBT Seniors Are a Growing Population

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According to the U.S. Administration on Aging, it’s estimated that our senior population —those who are 65 years old and beyond, will more than double to 98 million by 2060. Even sooner, by 2040, they estimate that older adults will represent 21.7% of our population, versus the 14.1% in 2013.

Unfortunately, lesbian, gay, bisexual, and/or transgender (LGBT) elders are an important demographic that doesn’t always get discussed in these numbers. Though it is difficult to precisely capture numbers for this population, it is currently estimated that there are between 1.75 and 4 million LGBT individuals aged 60+. Research shows that this number may surpass the 6 million mark by 2030meaning it’s key that younger generations of LGBT people—as well as their communities and caregivers—learn about the pressing issues facing them.

What challenges face LGBT older adults, especially in relation to sexual health?

Cahill, S., South, K., & Spade, J. (2000). Outing age: Public policy issues affecting gay, lesbian, bisexual and transgender elders. Policy Institute of the National Gay and Lesbian Taskforce.

Ritter, M. J. (2010). Quality Care for Queer Nursing Home Residents: The Prospect of Reforming the Nursing Home Reform Act. Tex. L. Rev., 89, 999.

Key Issues Around Sexual Health

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Overall, there are many intersecting issues, including financial insecurity, social isolation, and difficulties with care. Here, we will focus specifically on how some key issues relate to sexual health—defined by the World Health Organization as “a state of physical, emotional, mental and social well-being in relation to sexuality.” WHO also highlights “the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence” as part of health. Therefore we also must consider issues of abuse, intersecting marginalized identities, and sexual expression.

Contrary to prevalent ideas of older adults as uninterested in sex and romance, research supports that sexuality is an integral part of life and that desire does not simply disappear as people age, though behaviors and abilities may change. 

What are those things that impact people’s behaviors, abilities, and access to resources?

Bortz, W. M., Wallace, D. H., & Wiley, D. (1999). Sexual function in 1,202 aging males: differentiating aspects. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 54(5), M237-M241.

Kontula, O., & Haavio-Mannila, E. (2009). The impact of aging on human sexual activity and sexual desire. Journal of Sex Research, 46(1), 46-56.

Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O'Muircheartaigh, C. A., & Waite, L. J. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357(8), 762-774.

Economic Insecurity

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Overall, the LGBT older adult community faces disproportionately high rates of poverty, partly due to long-term marriage and employment discrimination. This instability reduces people’s access to all kinds of health-related resources, hurts elders’ ability to live safely in their communities, and adds a stressor to people’s interpersonal relationships. Particularly when looking at intergenerational poverty in communities of color, and how poverty is a risk factor for many health issues, it’s clear that financial instability has a negative impact on overall wellness of LGBT older adults.

Within the LGBT community, transgender individuals are the most vulnerable. However, people’s social positions greatly affect where they can draw strength from and what kinds of capital they have access to. Thus, not all transgender people face the same barriers, especially when privileged along axes like race and citizenship status. For the great many who do experience financial struggles, these are further exacerbated when individuals don’t have community supports.

So what is the role of social connections in all this?

Social Isolation and Stigma

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Older generations of LGBT people grew up being considered “sick by doctors, immoral by clergy, unfit by the military, and a menace by the police." There’s an understandable distrust or even fear of institutions combined with the reality of needing care, particularly for those estranged from biological families or who immigrated to the U.S. seeking asylum. In fact, LGBT older adults are “twice as likely to live alone, twice as likely to be single, and 3 to 4 times less likely to have children,” which are all markers related to social isolation. Especially for those in small or rural communities, access to other LGBT people may be almost nonexistent.

Both isolation and stigma impact mental health greatly in a community where there are already high rates of suicidality and depression. This can be especially difficult for those who have lost long-term partners to illnesses like AIDS and find themselves single in later life, dealing with grief, and then wondering where and how to connect to new partners. For those that enter the dating pool, what happens when trying to express sexual desires?

Cohen, H. L., Curry, L. C., Jenkins, D., Walker, C. A., & Hogstel, M. O. (2008). Older lesbians and gay men: Long-term care issues. Annals of Long-Term Care, 16(2), 33.

Sexual Expression and Its Challenges

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On a core level, seniors already have an uphill battle when it comes to being seen as sexual. Add hormone level changes and older adults may notice things like decreased lubrication and longer time required to attain an erection. Not to mention the weight of illness, disability, and treatments/drugs [including transition-related hormones] on sexual desire and functioning! LGBT elders in particular face health disparities in the realms of diabetes, HIV/AIDS, heart disease, etc. and these can cause complications such as nerve damage that dull sensation so individuals require more, or different, stimulation levels to achieve pleasure. Furthermore, as people’s ability levels change, concerns about mobility, grip, and falling enter the picture if they weren’t already there from birth.

Though pregnancy is no longer a concern, if it ever even was for some, LGBT older adults still face the risk of contracting sexually transmitted infections (STIs). In fact, the CDC notes the number of elders with STIs and HIV/AIDS is rising.

Another challenge is dealing with the intersection of dementia and sexuality (which complicates navigating consent, safer sex, and even one’s sense of self), as well as cases of elder sexual abuse—including those perpetrated by cognitively-impaired residents. Though there’s some research on these intersections, the scholarship isn’t large or widely-known. Additionally, there’s a higher dependence on caregivers and more restrictions placed on behavior and expression when people have dementia.

LGBT elders are already at increased rates of victimization and having fewer advocates helping them navigate these institutions only makes it harder. While some care facilities have very progressive sexuality policies, most don’t. So what is the impact on sexual health when LGBT elders go into care?

Restricted Freedom and Discrimination in Care Facilities

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Lack of social supports and financial insecurity due to long-term same-sex marriage bans make LGBT older adults “more likely to move into nursing homes." Apart from a change in residence, this can also mean a return to the closet. This is explored in the film GenSilent, whose tagline is “the generation that fought hardest to come out of the closet is going back in to survive.”

Once LGBT adults go into care, many experience discrimination, including harassment from both staff and fellow residents, staff refusal to use a person’s preferred pronouns, and outright denial of care. There is also documented bias against same-sex relationships and displays of affection in many facilities. Additionally, places like nursing homes aren’t well-equipped to promote sexual health in the first place, so adding these biases makes it harder to achieve a state of overall health.

Though we are currently seeing many advances in LGBT rights, there is still much to be done. If you or a loved one is considering long-term care, here’s more information about what issues may crop up and what questions to preemptively ask. You can also learn more about organizations dealing with these issues by visiting The LGBT Aging Project, SAGE USA, FORGE Forward, and the National Resource on LGBT Aging. Two of the greatest tools to combat stigma and negative health outcomes are knowledge and support systems. How will you make a difference?

Ritter, M. J. (2010). Quality Care for Queer Nursing Home Residents: The Prospect of Reforming the Nursing Home Reform Act. Tex. L. Rev., 89, 999.

McFadden, S. H., Frankowski, S., Flick, H., & Witten, T. M. (2013). Resilience and Multiple Stigmatized Identities: Lessons from Transgender Persons’


Aida Manduley is an award-winning activist and presenter trained as a social worker, sexuality educator, and nonprofit management professional. She's currently finishing her Master's of Social Work at Boston University—with a focus on aging populations—& holds a B.A. in Gender & Sexuality Studies from Brown University.

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