LGBT Older Adults: The invisible minority.


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LGBT Older Adults: The invisible minority.

  1. 1. The invisible minority
  2. 2. Population Approximately between one and 3.5 million lesbians and gay older adults live in the United States Oldest Baby Boomers (a 76 million cohort) turned 65 years old in 2011 The LGBT older adult population will double by 2030, thanks to the Baby Boomers The “boomers” have a history of making social changes, therefore they are more likely to assert their rights as older LGBT Americans Haber, 2009
  3. 3. Invisibility Gerontology research over the past 10 years reveal a insufficiency of research in the area of gay aging (Haber, 2009) Psychotherapy with LGBT older adults has not received enough attention in research and literature (Baron & Cramer, 2000) “LGBT seniors are only 20% as likely as heterosexuals elder to access needed services ” (Haber, 2009)
  4. 4. Significant Events Membership to different generational cohorts may affect the way individuals perceive and respond to stigma. The following are examples of these events.a. Stonewall 1969b. In 1952 homosexuality was listed as a mental illness in the DSMc. 1973 homosexuality was removed from the DSM.d. AIDS epidemic 1980s Haber, 2009
  5. 5. Stressors: Housing According to a study done by Johnson(2005) 34 percent of 127 participants said they thought hiding their sexual identity would be necessary if they moved to a retirement home According to Area Agencies on Aging survey, one half of senior centers do not welcome gay men and lesbians who are open about their sexual orientation (Knauer, 2009). Gay elders are likely to be rejected by retirement communities and nursing homes (Haber, 2009)
  6. 6. Stressors: Public Benefits A study by the Congressional Budget Office (2004) has found 1,138 statutory provisions in which marital status is a factor used to determine eligibility for benefits, rights, and privileges (Goldsen, Hyun- Jun, Muraco, &Mincer, 2009). LGBT older adults are not eligible for Social Security spousal and survivors benefits (Knauer, 2009) Older LGBT adults lack Medicaid protection for inheritance associated to same sex partner (Haber, 2009)
  7. 7. Public Benefits (cont) Spousal benefits: No matter how long same sex couples have been together they do not qualify for this benefit. Survivor benefits: non-married partners can not count on a portion of the deceased’s partner regardless of time cohabitating. Grant, 2010
  8. 8. Medicaid Long-Term Care Benefits Married couples have the option of excluding their main residence from their assets in order to qualify for this benefits Same sex couples are excluded from this benefit, therefore they may be forced to sell their property in order to have the other partner qualify for Medicaid long term protection Grant, 2010
  9. 9. Stressors: Medical Decisions Because same sex couples are not legally recognized they may be excluded from visiting their ill partners (Grant, 2010) End of life preferences are also denied to same sex partners and automatically assigned to biological family to make decisions-unless they have a durable power of attorney (Grant, 2010) Family and Medical Leave Act does not guarantee coverage for same sex partners-only family and spouses(Haber, 2009) Federal government recommendations for routine HIV/AIDS screening goes up only to age 64 (Haber,2099)
  10. 10. Factors Enhancing Resilience Learn to cope with stigma from an early age Role flexibility Ability to cope with crises Importance of social support in successful aging: social support from other LGBT members is crucial in healthy aging Berger, 1982
  11. 11. Clinical Implications Generational effects: cohort differences influence the way individuals manage stigma Accelerated aging: experienced self as old at an earlier age (affects specially gay men) Coping with the crisis of coming out early in life, provides a sense of crisis competence that prepares the person for later crises Baron & Cramer
  12. 12. Clinical Implications (cont) Older men prefer the term homosexual, younger men prefer the term gay The term lesbian is equally preferred between younger and older women Lesbians are less vulnerable to the changes aging brings to their bodies By the time an LGTB person reaches old age the likelihood of victimization is very high Haber, 2008
  13. 13. EBTs with Older Adults  CBT and relaxation training was found effective to treat GAD  Multi-component CBT and sleep-restriction compression therapy, found effective to treat insomnia  Structured behavior approaches as well as individual interventions are efficacious in treating disruptive behaviors for individuals with dementia  CBT, psycho-education with behavior management, anger and depression management skills training were effective for family care-giver distress treatment  Older adults seem more inclined to the use of talk therapy over pharmacological interventions David &Cernin, 2008
  14. 14. EBTs for (LGBT older adults) Cognitive Behavioral stress-management group intervention was found effective for HIV symptomatic gay men Antidepressant medication and group CBT was effective for gay men who met major depressive disorder criteria and had co- morbid HIV status CBT along with medication adherence training was found effective on stress reduction Strong working relationship, alliance, empathy, and positive regard make psychotherapy more effective Clinical attention to individual’s context, cohort, maturity, and specific challenges, appears to be important in making treatment more effective David &Cernin, 2008
  15. 15. Resources Services and Advocacy for Gay Elders (SAGE): American Society on Aging (ASA) The LGBT Aging Issues Network (LAIN) LGBT older adults in Long term care facilities: Haber, 2009
  16. 16. Conclusions LGBT community faces an array of psychosocial needs impacting their experiences Mental health clinicians need to be aware of this community’s needs in order to offer treatments that are sensitive to their experiences It is important for clinicians working with the LGBT community to work within a multidisciplinary perspective
  17. 17. ReferencesBaron, A., & Cramer, D. (2000). Potential Counseling Concerns Of Aging Lesbian, Gay, And Bisexual Clients. In R. M. Perez., K. A. Debord., K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 207-223). Washington, DC: American Psychological Association, 2000.Berger, R. M. (1982)."The Unseen Minority: Older Gays and Lesbians. Social Work,27(3),236-242. Retrieved from bab5-544c27478aba%40sessionmgr10&vid=6&hid=15&bquery=(Potential+Counseling+Concerns +of+Aging)&bdata=JmRiPXBzeWgmdHlwZT0xJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRlDavid, S., &Cernin, P.A. (2008) Psychotherapy with Lesbian, Gay, Bisexual, and Transgender Older Adults. Journal of Gay & Lesbian Social Services 20(1), 31-49. doi:10.1080/10538720802178908
  18. 18. References (cont)Fredriksen-Goldsen, K.I., Kim, H., Murac,,A., &Mincer, S. (2009). Chronically Ill Midlife and Older Lesbians, Gay Men, and Bisexuals and Their Informal Caregivers: The Impact of the Social Context." Sexuality Research and Social Policy: Journal of NSRC 6 (4), 52-64. Retrieved from http:// %40sessionmgr10&viGrant, J.M. (2010). Outing Age 2010: Public Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender Elders. Retrieved from National Gay and Lesbian Task Force website:, D. (2009) Gay Aging. Gerontology & Geriatrics Education 30 (3) 267-80. doi: 10.1080/02701960903133554