Jun 012011

For “older” adults, the IOM uses retirement age (around 60) as their starting age. For this group, there are no well-studied areas of health (beyond HIV/AIDS, which I don’t cover here). I’ve decided to leave the conclusion portion for another post – the last in this series.

  • Depression: Definitely more frequent in LGB elders than heterosexual elders. A very significant mental stress for this group is surviving the start of the HIV/AIDS epidemic. One study of elder gay/bisexual men found that 93% of them had known others who were HIV+ or had died of AIDS. There is no empirical data on rates of depression in elder transgender people, but it’s thought to be high.
  • Suicide/suicidal ideation: Empirical data suggest the rates of suicide are higher in LGB elders. No data on transgender elders.
  • Sexual/reproductive health: This is a rarely studied area. PCOS and its related risks may be an issue in some transgender elders. There is some indication that gay/bisexual men may be at the same risk as heterosexual men for prostate cancer. Early research implies that “lesbian bed death” may be a real phenomenon, but it’s a controversial topic. All cis-gendered women (bisexual, heterosexual, or lesbian) appear to have the same rate of hysterectomies. Sexual violence was reported on for transgender elders and it appears to be high. One study found about half of transgender elders had experienced “unwanted touch” in the past fifteen years.
  • Cancers: There are no data on cancers and transgender elders. Elder gay/bisexual men are at a higher risk of developing anal cancer (which is linked to receiving anal sex and HPV). Non-heterosexual women also appear to be at a higher risk for reproductive cancers (due to risk factors like smoking and obesity).
  • Cardiovascular health: Data appear to be conflicted. Transwomen using estrogen may be at a higher risk for venous thromboembolism (this may be because of the specific forms of estrogen used). There’s an association between transgender people getting their hormones from someone other than a doctor and poor health outcomes (e.g., osteoporosis, cardiovascular disease). The relevant transition hormones may cause long-term health problems at high doses, but no studies have really looked at this.

Risk factors include those for the younger age groups. Ageism within the LGBT communities may be an additional challenge for LGBT elders. Elders may also feel they need to hide their orientation if they move into a retirement home. Some retirement homes may also be discriminatory.  Transgender elders especially face very high threats of violence.

Some studies have found that elders felt more prepared for the aging process by being LGBT. Why? They’d already overcome huge difficulties. They’d already done a lot of personal growth. LGBT people are also more likely to have education beyond high school, and education is a well-known protective factor for the negative effects of aging. Conversely, some LGBT elders reported fewer relationship and social opportunities, being afraid of double discrimination, and problems with health care providers.

As for elder interactions with the health care system, again there’s a lot in common with younger age groups. One out of four transgender elders report being denied health care solely because they were transgender. Elders in general face problems if they need to enter assisted living homes, as some homes are discriminatory. It’s also worth noting that LGBT elder social structure is different from heterosexual social structure. LGBT elders rely much more on close friends than relatives (and/or adult children). Their chosen families are less likely to be recognized by the medical community, especially without legal paperwork.

So that’s it for what I’ll summarize from the report. Thanks for sticking around for it… this is hefty stuff.

  3 Responses to “Institute of Medicine report part 3: LGBT elder adults (60+)”

  1. On higher rates of reproductive cancers in non-heterosexual women, I wonder about lumping all reproductive cancers together. There’s some evidence that early childbirth as well as breastfeeding lowers the risk of some types of breast cancer. Of course, non-heterosexual women do have babies and do breastfeed them, but at lower rates than their straight sisters. So if you controlled for pregnancy and breastfeeding, what does that do to the overall statistic?

    • Good thought! I lumped them all together, not the report.

      Pregnancy/breastfeeding does have an effect on certain cancers, but bisexual and lesbian women tend to be heavier and smoke, which also increases their cancer risks. Bisexual and lesbian women also are less likely to have their screenings (pap smears and/or mammograms) performed regularly.

      If you want to read the actual page of the report that covers it, it’s page 218. Here’s a summary, though:
      In one study: For breast cancer, bisexuals had the highest risk, then lesbians, then straight women. Same for cervical cancer.
      In a different study (comparing non-heterosexual sister to heterosexual sister), lesbians had the most risk factors for ovarian, breast, and endometrial cancer. These included obesity and nulliparity. However, lesbians in this study had fewer risk factors for cervical cancer. The only risk factor the lesbians had was obesity, whereas the heterosexual women had more pregnancies and used more hormonal birth control.

  2. Let’s not leave out the fact that transgender people may have difficulty finding residence in a retirement home due to gender segrigation. Also, as you mentioned, LGBT elders rely less on biological families and more on chosen families which are less likely to be intergenerational. Hence, more reliance on retirement homes and other institutional care in the first place.

    Institutional care scares me as a transgender, queer person. I’m worried that if I’m ever placed into such an environment I’ll loose autonomy and, because my gender identity is not one which is respected, I will be forcibly detransitioned. It’s especially a concern given that I’m developmentally and mentally disabled.

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