Lessons on social and health disparities from older lesbians with alcoholism and the role of interventions to promote culturally competent services

ABSTRACT

Older adults who are lesbian, gay, bisexual, or transgender (LGBT) face greater health risks and possibly more costly care because of their reluctance to seek out health and long-term care services because of limited cultural sensitivity of service providers. This is particularly evident in older lesbians who face substantial risk of health problems associated with alcoholism and are less likely to be open with health care providers because of stigma combined with feelings of alienation, stress, and depression. An estimated 4.4 million older adults are predicted to have problems with alcohol by 2020, and the rates of alcohol-related hospitalizations are similar to those for heart attacks, creating exorbitant medical costs. More culturally competent health and long-term care may reduce health care costs by effectively addressing the dynamics of alcoholism, aging, and lesbian culture. Training initiatives such as those developed by the National Resource Center on LGBT Aging have begun to address the need of a more culturally competent aging services network. This article provides exemplars from empirical data on older lesbians with alcoholism to highlight some of the health, economic, and social disparities experienced in the aging LGBT community. Current interventions in the form of cultural competence training for service providers are presented as a potential step toward addressing health disparities among LGBT older adults.     

Belonging and Acceptance: Examining the Correlates of Sociopolitical Involvement Among Bisexual and Lesbian Latinas

This article employs a national sample of almost 400 bisexual and lesbian Latinas to examine the impact of community-level support/comfort, as well as the importance of sexual orientation and racial identity, on sociopolitical involvement. Results indicate that feelings of connectedness to the lesbian, gay, bisexual, and transgender (LGBT) community are the most important predictor of sociopolitical involvement within both LGBT and people of color (POC) communities. While comfort within the LGBT community had no impact on LGBT sociopolitical involvement, it had a negative impact on POC sociopolitical involvement.     

Rural/Non-Rural differences in psychosocial risk factors among sexual minorities

The purpose of this study was to examine rural versus non-rural differences in the following risk factors among sexual minority adults: victimization/discrimination, fundamental religiosity, identification and involvement in the lesbian, gay, bisexual, and transgender (LGBT) community, social support, and level of comfort disclosing sexual identity to others. The study recruited sexual minority individuals via online communications to LGBT organizations. Of the total sample (N = 699), 23.3% resided in rural areas and 76.7% resided in non-rural areas. A MANCOVA was conducted to determine if there was a significant overall relation of rural versus non-rural location to the five risk factors of interests, while controlling for age, sex, race, relationship status, and sexual identity. Post hoc ANCOVAs were then conducted to explore the specific directionality of the significant differences. Results revealed rural sexual minorities reported greater identification with fundamental religious beliefs, less comfort in disclosing their sexual identity to others, more experiences of victimization and discrimination, less identification with and involvement in the LGBT community, and less perceived social support when compared to their non-rural counterparts. These findings suggest sexual minorities residing in rural areas may experience increased exposure to negative risk factors. Implications for mental health providers working with rural sexual minorities are discussed.     

“I'm still raring to go”: Successful aging among lesbian,gay, bisexual,and transgender older adults

While we know that minority status differentiates the experience of aging, little research has been done to examine the ways in which patterns of successful aging may differ in diverse subgroups of older adults. In this exploratory study, we investigated and described experiences of successful aging in a sample of lesbian, gay, bisexual and transgender (LGBT) older adults. Directed by a community-based participatory research process, we conducted semi-structured in-depth interviews with 22 LGBT adults, age 60 and older. We took an inductive, grounded theory approach to analyze the taped and transcribed interviews. We coded respondent experiences in four domains: physical health, mental health, emotional state and social engagement. Four gradations of successful aging emerged. Very few in our sample met the bar for “traditional success” characterized by the absence of problems in all four domains of health. Most of the sample was coping to a degree with problems and was categorized in one of two gradations on a continuum of successful aging: “surviving and thriving” and “working at it.” A small number was “ailing”: not coping well with problems. Some of the experiences that respondents described were related to LGBT status; others were related to more general processes of aging. The research suggests that a successful aging framework that is modified to include coping can better describe the experiences of LGBT older adults. The modified conceptual model outlined here may be useful in future research on this population, as well as more broadly for diverse populations of adults, and may be adapted for use in practice to assess and improve health and well-being.     

Unpacking Civic Engagement: The Sociopolitical Involvement of Same-Gender Loving Black Women

Employing a national sample of over 600 same-gender loving (SGL) Black women, we explore the relative impact of community-level support/comfort and the importance of sexual orientation and racial identity on two dependent variables—sociopolitical involvement within lesbian, gay, bisexual, and transgender (LGBT) communities as well as sociopolitical involvement within people of color (POC) communities. Findings indicate that feelings of connectedness to the LGBT community are the most important predictor of sociopolitical involvement within both LGBT and POC communities; while, counterintuitively, being comfortable within the LGBT community had a negative impact. Further, the impact of the importance of identity was negligible.     

Measuring community connectedness among diverse sexual minority populations

Theory and research agree that connectedness to the lesbian, gay, bisexual, and transgender (LGBT) community is an important construct to account for in understanding issues related to health and well-being among gay and bisexual men. However, the measurement of this construct among lesbian and bisexual women or racial and ethnic minority individuals has not yet been adequately investigated. This study examined the reliability and validity of an existing measure of connectedness to the LGBT Community among a diverse group of sexual minority individuals in New York City, and whether differences in connectedness existed across gender and race or ethnicity. Scores on the measure demonstrated both internal consistency and construct stability across subgroups defined by gender and race or ethnicity. The subgroups did not differ in their mean levels of connectedness, and scores on the measure demonstrated factorial, convergent, and discriminant validity, both generally and within each of the subgroups. Inconsistencies were observed with regard to which scores on the measure demonstrated predictive validity in their associations with indicators of mental health and well-being. The scale is a useful tool for researchers and practitioners interested in understanding the role of community connectedness in the lives of diverse populations of sexual minority individuals.     

Virginity Definitions and Meaning Among the LGBT Community

The literature on lesbian, gay, bisexual, and transgender (LGBT) virginity is almost nonexistent. Thus this exploratory study was completed to understand virginity in the LGBT community. The research questions asked members of two LGBT student groups to define virginity, discuss its meaning, and share experiences. Data were collected from two focus groups and six individual follow-up interviews and were analyzed. Results indicate that there is a range of virginity definitions, there is little discussion of the topic, and that “coming out” is a more important rite of passage than virginity among these LGBT community members. Future research needs are discussed.     

“Family” Support for Family Violence: Exploring Community Support Systems for Lesbian and Bisexual Women Who Have Experienced Abuse

ABSTRACT

“Family” is a euphemistic term that lesbian, gay, bisexual, and transgender (LGBT) people use among ourselves to designate membership in lesbian, gay, bisexual, and transgender communities. Ironically, this “family” may be the most sought, yet least successful, support for dealing with the intimate partner violence that occurs within LGBT families. This study of 11 lesbian and bisexual women's experiences seeking support revealed several tiers of unmet needs within the LGBT community. They rarely used services in the general community, although these services are often the focus of both criticism and efforts to build support systems for LGBT victim/survivors. A model presents the different stages and potential sources of support.     

Dance of the Dedicated Bottom

Abstract

LGBT caregiving for midlife and older adults facing chronic illness or disability as well as the development and evaluation of interventions targeting LGBT caregivers remains fundamentally unexplored. Caregivers regardless of their sexual orientation or gender identity often juggle multiple roles and responsibilities leading to increased stress and distress. However, largely due to discrimination and discriminatory policies, many LGBT caregivers face barriers at multiple levels of service provision that can exacerbate stress and negatively impact caregiver and care recipient quality of life. This article highlights many of these obstacles and provides examples of intervention strategies designed to assist LGBT caregivers ranging from interventions aimed at the individual and interpersonal levels of service provision to changes needed at the social policy level. As an example of an individual or interpersonal level of intervention designed to assist LGBT caregivers, the SURE 2 framework is presented and more thoroughly discussed. Given the diversity of the LGBT community, the article ends with ways to extend or adapt SURE 2 as well as suggesting that the time has come to develop and test a variety of interventions for LGBT caregivers.     

Lesbian and gay men’s perceptions of their local area agency on aging

This article reviews data from a qualitative study of lesbians and gay men about engagement with their local Area Agency on Aging (AAA). Findings include lack of knowledge about the local AAA, feelings of exclusion, and the need for better outreach. It is important that AAAs engage their local lesbian, gay, bisexual, and transgender (LGBT) elders, as data show they are at higher risk for aging alone and can often harbor mistrust of formal services due to lifetimes of discrimination. Suggestions on where AAAs can find training and resources on reaching out to the LGBT older adult community and implications for the profession of social work are provided.     

Happily Religious: The Surprising Sources of Happiness Among Lesbian,Gay, Bisexual,and Transgender Adults

This article analyzes the impact of religion on reported levels of subjective well‐being (general happiness) among lesbian, gay, bisexual, and transgender (LGBT) adults. Although previous studies find religious affiliation to be a significant predictor of subjective well‐being among the general population in the United States, limited quantitative research investigates general happiness among sexual and gender minorities. This study augments the existing literature by using a national survey of LGBT adults conducted by the Pew Research Center in 2013. The results show that religious affiliation is a significant predictor of LGBT individuals’ happiness. LGBT individuals who identify as Catholic, agnostic or atheist, or with no particular religious affiliation report lower levels of happiness compared to mainline Protestants. Surprisingly, no significant differences are found between mainline Protestants (whose church doctrine often accepts same‐sex relations) and evangelical Protestants (whose church doctrine often condemns same‐sex relations). In addition, income is the only control variable that affects general happiness. Our analysis reveals interesting differences in the determinants of subjective well‐being between the LGBT and general population.     

Lift Every Voice: Voices of African-American Lesbian Elders

Old lesbians of African descent have experienced racism, heterosexism, homophobia, and ageism. This article explores the topics of aging, ageism, heterosexism, and minority stress among older African-American lesbians. The narratives and subsequent analysis offer significant contributions to the dialogue regarding Black aging lesbians in the aging and lesbian, gay, bisexual, and transgender (LGBT) communities generally and in the African-American and African-American lesbian communities specifically.     

Psychotherapy with Lesbian,Gay, Bisexual,and Transgender Older Adults

A small literature has addressed psychotherapy with lesbian, gay, bisexual, and transgender (LGBT) samples over the past two decades. Older adults have also been investigated in a growing number of psychotherapy research studies. However, psychotherapy specifically with LGBT older adults has not received adequate investigation. This review relies on converging lines of research to provide an integrated discussion of evidence-based psychological treatments (EBTs) with current research and clinical observations in the field of gerontology and suggests ways in which these topics can inform psychotherapy practice with LGBT older adults. We summarize current research on aging in several areas of practical interest to psychotherapists seeking to apply EBTs in their work with LGBT older adults. These areas include: adult development, coping, stigmatization, social context, and the effects of cohort membership. The results of these studies belie stereotypes regarding both the aging process, in general, and more specifically LGBT older adulthood, with significant implications for the practice of psychotherapy. EBTs are adaptable to a variety of issues encountered in later life by LGBT older adults, and these modifications to therapeutic technique are addressed throughout.     

Planning for the Residential Needs of Lesbian,Gay, Bisexual,and Transgender Older Adults

Lesbian, gay, bisexual, and transgender (LGBT) older adults experience housing-related barriers. Previous research has described residential challenges experienced by this population, but few studies have examined implementation of housing solutions. This exploratory study conducted 7 semistructured phone interviews with program directors and/or development managers from initiatives offering residential services to LGBT older adults. Qualitative analysis identified themes that characterize the implementation of housing solutions. Study results suggest that future residential solutions for LGBT older adults should consider housing in relation to other aging-related barriers and frame solutions that promote collaboration among community actors (e.g., residential and service providers).     

The Cat and the Cloud: ACT for LGBT Locus of Control,Responsibility, and Acceptance

Advocating acceptance, committed action, and value-guided behavior over experiential avoidance, Acceptance and Commitment Therapy (ACT) may aid lesbian, gay, bisexual and transgender (LGBT) clients affected by hetero/homonormative social pressure. By conceptualizing LGBT paradigms of internal/external control/responsibility (IC-IR; EC-IR; IC-ER; EC-IR), ACT may be adapted to a myriad of multicultural worldviews. This article presents locus of acceptance as the attributed worth of internal/external cues perceived necessary by the client to achieve self-acceptance. Recognizing visibility and isolation as recurrent LGBT issues, locus of acceptances balances identity as individual (internal acceptance) with identity as community (external acceptance).     

Sustainability Processes among Naturally Occurring Retirement Community Supportive Service Programs

ABSTRACT

Sustainability remains a concern for community models to better support older adults’ aging in place in their own homes and communities. Based on qualitative data from leaders of 53 Naturally Occurring Retirement Community (NORC) Supportive Service Programs, which is among the most prominent community practice models in aging, we aimed to develop an empirically-grounded framework on sustainability processes. Results indicated that programs use funding, staff members, interorganizational partnerships, and volunteers to offer services to attract older adults, and that older adults’ participation, in turn, is perceived as influencing the accrual of additional resources. Across themes, respondents discussed the importance of being responsive to the community and facilitating consumer participation.     

Over the rainbow: Sexual minorities' bonding and bridging social capital and civic engagement

This study examines sexual minorities' participation in civic engagement using the theory of social capital. The analysis of the data from a US national survey shows that sexual minorities' bonding capital within the lesbian, gay, bisexual, and transgender (LGBT) community is positively associated with their civic engagement on LGBT issues, while it is negatively associated with their participation in activities addressing other social issues. Sexual minorities' bridging social capital as generalized trust is positively associated with their civic engagement for non-LGBT issues, but it has no statistically significant relationship with their civic engagement on LGBT issues. Overall, the findings reveal that sexual minorities' civic engagement beyond LGBT activism is closely related to their generalized trust and reciprocity in society. These findings suggest that an organizational culture of non-discrimination and equity will help create more diverse and inclusive philanthropy.     

Beyond Identity: Queer Values and Community

This essay traces the movement within the LGBT community from relying on identity politics to considering a politics of value as a political and community-forming strategy. In the process, the author uses the work of Michel Foucault to think through how the articulation of shared values might open up personal, communal, and political possibilities otherwise delimited when LGBT people think of themselves within the confines of separate, and often separating, identity categories.