“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care

Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.     

Training,Geography, and Provision of Aging Services to Lesbian,Gay, Bisexual,and Transgender Older Adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Training, geography, and provision of aging services to lesbian, gay, bisexual, and transgender older adults

This research study surveyed leaders of Area Agencies on Aging (agencies) to understand their services, training, and beliefs about serving lesbian, gay, bisexual, and transgender (LGBT) older adults. Half of the existing agencies in the United States (320) participated. Few agencies provided LGBT services or outreach. One-third had trained staff around LGBT aging and four-fifths were willing to offer training; these numbers were significantly higher for urban-based agencies. Agencies that had provided staff training and urban-based agencies were more likely to provide LGBT outreach and services, to believe in addressing LGBT issues, and to receive LGBT assistance requests. Training, policy, organizing, and research implications are considered.     

Pathways to age-friendly communities in diverse urban neighborhoods: Do social capital and social cohesion matter?

ABSTRACT

Using a social capital and social cohesion lens, we reposition the concept of civic engagement among older adults to examine pathways for building age-friendly communities. We analyzed data drawn from a Community-Based Participatory Research study in the Southern U.S. that explored lived experiences of older adults, age 55 and above, who participated in individual interviews (n = 15) and six focus group discussions (n = 45) to examine their perceptions of social identity, social connectedness, and civic engagement geared toward an age-friendly city. Findings indicated that several older adults had access to social networks and socially invested resources, thereby having opportunities for civic engagement and building age-friendly neighborhoods. However, social, cultural, linguistic, and structural barriers were more evident among certain diverse ethnic populations. Marginalized low-income minorities and immigrants, such as Hispanic participants, felt the lack of social cohesion among the larger society limited their ability to give back, thus decreasing their civic engagement activities. In contrast, Caucasian and African-American older adults were able to contribute to the political process through more civic participation activities. We provide implications for examining the role of social capital and social engagement to bolster civic engagement among older adults in building age-friendly communities.     

Creating Supportive Environments for LGBT Older Adults: An Efficacy Evaluation of Staff Training in a Senior Living Facility

ABSTRACT

Supportive housing later in life tends to be a key concern for lesbian, gay, bisexual, and transgender (LGBT) elders. Most senior care providers are un(der)prepared to meet the needs of older LGBT adults. This study evaluated the efficacy of a 4 hours, face-to-face, research-based, LGBT-diversity training designed to improve senior housing facility staff’s cultural competency regarding the needs of LGBT elders. Findings from this study found a significant increase in LGBT content knowledge between pre- and post-intervention assessments and a significant decrease in perceived preparedness when working with LGBT elders. These effects remained significant after controlling for staff designation, religion, educational attainment, and training session. Findings suggest that staff’s cultural competence affected their perceived readiness to address LGBT elders’ needs. Implications are related to the concept of cultural humility or the lifelong process of understanding others’ experiences based on the recognition of lack of un(der)preparedness to create a culturally supportive residential environment.     

Community older adults’ attitude towards the use of assistive devices

This study investigates how older adults’ attitude patterns affect assistive devices’ (AD) use in a small-household context of Singapore. Community older adults with physical limitations (n = 481) completed face-to-face interviews for 90 min. Latent Profile Analysis analysed multiple indicators of attitudes towards ADs. Three groups were classified: positive attitude group (PAG); negative attitude group (NAG); and unwillingness to pay for ADs (UPG). PAG was most likely to use ADs, while UPG was least likely to use ADs. The findings are expected to help older adults age in place by improving equal distribution of technology resources that assist with daily tasks and activities.     

Comparing Supports for LGBT Aging in Rural Versus Urban Areas

Studies of rural populations typically underrepresent lesbian, gay, bisexual, and transgender (LGBT) older adults. This secondary analysis examined data from a nationwide sample of LGBT baby boomers (n?=?1201). Geographic differences with respect to self-reported outness, acceptance of sexual identity, social and familial support, and household income were assessed with one-way analyses of variance. Guardedness about one's sexual identity and household asset levels were assessed with chi-square analyses. Rural individuals reported lower levels of outness, guardedness with people including siblings and close friends, and lower levels of household income. Providers should consider strategies for connecting older rural LGBT adults for potential care and support.     

Hardly Silent: Exploring Civic Engagement and Participation among a Panel of Adults Ages 85+

ABSTRACT

The past twenty years have seen a surge of resources for and public attention devoted to civic participation opportunities for older adults in the United States. At the same time, technology has transformed the way information related to political and social issues is spread and shared. As more older adults migrate to using a wider range of communication tools and the internet, technology-mediated forms of engagement represent a new way for the oldest old to participate in society. In this study, a panel of adults ages 85 and older was surveyed to understand their experiences engaging with political and social issues. Responses to a questionnaire (N = 24) and focus groups (n = 22) indicate the oldest old are interested in social and political issues, and there are opportunities for technology to facilitate the oldest olds’ civic and political action. This study identifies roles social workers may play in helping the oldest old engage with social and political issues in their communities.     

Perceived Usefulness and Easiness of Information and Communication Technologies and Volunteering among Older Adults

ABSTRACT

This study investigates the association between older adults’ perception of usefulness and easiness (PUE) of Information Communication and Technologies (ICTs) and volunteering, and if this association differs across their income status. Data were obtained from the 2012 wave of the Health and Retirement Study (HRS), and the sample was restricted to respondents aged between 60 and 84 (N = 901) and who completed the 2012 HRS technology module. Multinomial logistic regression was employed to examine the independent and joint influence of PUE of ICTs and of low-income status on volunteering. The results show that only people with high PUE engaged in more than 100 hours of volunteering among older adults after controlling for covariates. The positive effect of high PUE was found to be more significant in the low-income group. This is the first known research to investigate the PUE of ICTs and volunteering among older adults. This study expands the knowledge of volunteering among older adults by exploring ICTs which can be considered as one of the most influential macrosocial changes in the current society. Moreover, our findings provide some insights and an empirical foundation in volunteering programs for older adults of different PUE levels.     

Assessment of multiple constructs of social integration for older adults living in nursing homes

ABSTRACT

A variety of terms and measures have been used in the literature to denote being socially integrated, and many studies of older adults focus on only social networks or social support and often only include those living in the community. The purpose of this study was to assess multiple constructs of social integration (i.e., social networks, social capital, social support, and social engagement) for older adults in nursing homes. Data were collected from 140 older adults at 30 nursing homes in Kansas. We interviewed older adults’ in-person using a survey questionnaire, and used multilevel confirmatory factor analysis to analyze the data. The final model that included the four constructs had acceptable fit (χ² = 174.71; df = 112; p < .01; CFI = .93; RMSEA = .06; SRMR-W = .06; SRMR-B = .12). The results showed that the proposed model was supported at the individual level. At the between-level, social networks and social support were supported. Study results have methodological and practice/policy implications for the study of older adults in long term care settings. In particular, this study contributes to understanding how to operationally define and differentiate social integration variables in studies of older adults, particularly when study data are hierarchical.     

Older LGBT Adult Training Panels: An Opportunity to Educate About Issues Faced by the Older LGBT Community

Older lesbian, gay, bisexual, and transgender (LGBT) adults face unique issues that can impede their well-being. Although many advances have helped address these issues, there is a need for education efforts that raise awareness of service providers about these issues. This study explores evaluation data of training panels provided by older LGBT adults and the views of training participants on issues faced by the older LGBT community after attending the panels. Participants were 605 students and professionals from over 34 education and communication settings. Implications for trainings on participants and older LGBT trainers are discussed.     

Awareness of LGBT Aging Issues Among Aging Services Network Providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Resident-Managed Elder Intentional Neighborhoods: Do They Promote Social Resources for Older Adults?

Social isolation has serious negative public health impacts for older adults. Survey data were collected at three resident-managed elder intentional neighborhoods in the United States (n = 59), to determine if these neighborhoods, each based on the cohousing model, promote development of social resources for their residents. Social resources were measured on three dimensions: social networks, neighborly support, and satisfaction with the neighborhood community. Respondents were White, mean age of 73.3 (range = 63–91), primarily female (76.3%), and generally had high levels of education and self-reported health. Almost half (47%) were never married/divorced and 37% were childless. Inclusion of neighborhood ties ameliorated risk of social isolation. Satisfaction with support and a variety of neighboring behaviors were reported. These neighborhoods are meeting the needs of a potentially at-risk population as an avenue to promote social resources and reduce social isolation. The implications for gerontological social workers include a role in helping to mobilize and support these types of neighborhoods as a way to encourage mutual support among older adults. With the increase in the aging population, such models of proactive interdependence and communal coping have the potential to lessen or delay the demands that socially isolated elders place on social workers.     

Awareness of LGBT aging issues among aging services network providers

Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.     

Prison Experiences and Psychological Distress among Older Inmates

This study investigates relationships between older prisoners’ social experiences and their levels of distress. One hundred and seventy-three older prisoners (aged ≥ 50 years) from 8 Australian prisons were administered the Kessler Psychological Distress (K10) Scale, with additional information collected via individual interviews. Psychological distress scores were significantly associated with measures of self-reported safety (p < .001), prison victimization (p < .05), perceived social support from staff (p < .01) and inmates (p < .001), current employment (p < .05), and level of exercise (p < .001) among older inmates. Findings suggest that strategies for improving sense of safety, social support and level of exercise may ameliorate distress among older prisoners.     

Measuring intention to refer: Older adults and social service agencies

The public is encouraged to engage in socially responsible behaviors such as helping people get needed services, possibly by referring them. However, referral behavior is little researched. Informed by the theory of planned behavior, intent to refer older adults in need to the Connecticut’s Gatekeeper Program (GP) which identifies elders at risk and connects them with community resources was studied and the Social Service Agency Referral Scale (SSARS) was developed. Senior center attendees, seniors who received GP training, and referrers to the state’s GP were involved. SSARS and its subscales were internally consistent (Cronbach’s α = .90, with α ≥ .733 for each subscale). SSARS was strongly correlated with a validated social responsibility scale (r = .48). Knowledge gained from the training enhanced the associated intention subscale. With little modification, SSARS could be used to elucidate similar efforts. Additionally, the process used to create SSARS could be replicated to develop related instruments.     

“As Needed” Case Management Across Aging Services in Response to Depression

A lack of clarity on how and where case management for older adults is delivered persists, even as evidence supports its use to respond to depression. We used in-depth interviews with managers (n = 20) and staff surveys (n = 142) from 17 service agencies to explore the provision of case management services in adult day services, homecare, senior centers, and supportive housing. Limited case management services were found. Barriers included limited time and resources, especially for senior centers and supportive housing. Results revealed a concern about the role, feasibility, and availability of case management for older adults within these settings.     

Too old to test? Prevalence and correlates of HIV testing among sexually active older adults

ABSTRACT

Older adults account for 17% of new HIV diagnoses in the US and are more likely to be diagnosed with HIV later in the course of the disease compared to younger people. We calculated the prevalence and associated factors of having ever been tested for HIV among sexually active older adults. We analyzed data from the 2008–2016 General Social Survey Limited to respondents ≥65 years of age who reported more than one sex partner(s) in past 12 months (n = 757). HIV testing prevalence, prevalence ratios, and 95% confidence intervals were calculated by demographic variables and HIV-related risk behaviors. An estimated 16.3% of sexually active older adults have tested for HIV, and 15.9% were at increased risk for HIV infection (reported injection drug and/or crack–cocaine use, exchanging money for sex, more than three sex partners in the past year, or men who reported having sex with another man). In the adjusted model, adults aged 65–70, not married, self-identified as gay/bisexual, and at increased risk for HIV infection were more likely to have tested for HIV. An estimated 83.7% of sexually active older adults never tested for HIV. Strategies are needed to increase HIV awareness and testing among potentially high-risk older adults.     

The Forgotten: Dementia and the Aging LGBT Community

Although research documenting the experience of lesbian, gay, bisexual, transgendered (LGBT) aging in general is gaining traction, and literature on dementia continues to proliferate, few articles attend to how dementia affects members of the aging LGBT community. This article reviews the current state of knowledge on the experience of dementia for LGBT older adults, and suggests areas for further research. In addition, it aims to promote social work’s engagement with related disciplines and global dementia care. The article’s ultimate goal is to encourage development of care practices tailored to the experiences, expectations and needs of older LGBT individuals affected by dementia.