Out On The Couch
By Teresa Theophano, LCSW
National Senior Citizens Day is August 21st, and what better time to talk about how to honor and support older adults? A significant, though frequently overlooked, segment of the aging population identifies as lesbian, gay, bisexual, and transgender (LGBT): at present there are nearly 3 million LGBT adults over age 50 in the United States, and 1.1 million of them are age 65+ (Movement Advancement Project and SAGE, 2017). Those of us who provide mental health care may encounter more and more of these community members as the Baby Boomer generation ages. Maybe you are already working with an aging LGBT person, or maybe you want to be prepared for the first time an older LGBT client approaches you. Here are some tips to help you treat these community members with the TLC they deserve!
First, in order to inform your approach to community members, it helps to know a little about LGBT history. LGBT elders came of age when it was both legal and socially acceptable for major social institutions, as well as individuals, to discriminate against them. For instance, the “Lavender Scare” of the 1950s meant that LGBT people were subject to witch hunts and fired en masse from government employment. The repeal of state sodomy laws did not begin until the 1960s, and homosexuality was classified as a mental illness in the DSM until 1973. AIDS patients in the 1980s were frequently turned away from medical care, and in the 1990s antigay legislation such as Don’t Ask Don’t Tell and the Defense of Marriage Act were instituted.
Consider that your client is walking into your office having survived these traumatic historical events – and now witnessing the enactment of newer anti-LGBT legislative measures. Such experiences can contribute to a lifetime of minority stress, described by Choi and Meyer (2016) as “LGBT individuals experienc[ing] stressors that stem from stigma and prejudice in social environments toward their sexual and gender minority identity…includ[ing] stressful major life events (e.g. assaulted because of being LGB), micro aggressions or everyday discrimination (e.g. receiving poor services in stores), expectations of rejections, concealment, and internalized stigma. The minority stress theory suggests that these stressors have adverse health effects on LGBT individuals.” However, LGBT older adults also display significant resilience through social support, including the formation of familial relationships with other LGBT people (i.e. “families of choice”), and other coping strategies. It is vital, in light of the social and health disparities that exist for older LGBT adults, that providers encourage their connection to community and to service providers.
To that end, isolated LGBT older adults may need your assistance with making linkages. It is not uncommon for community members to experience hesitation in accessing services at traditional senior centers, where they may face discrimination or harassment. Providers to which you are referring clients must approach them compassionately and knowledgeably. SAGE: Advocacy and Services for LGBT Elders, a national nonprofit organization, provides training and credentialing for aging service providers. You can also contact your local Area Agency on Aging (AAA) to inquire about LGBT-affirmative organizations serving seniors in your area. Last but not least, consult the National Resource Center on LGBT Aging for information on local providers.
I hope this will help you to begin thinking about best practices and approaches to this community, which has paved the way for our current LGBT rights and visibility! In future articles I will explore in more detail issues related to LGBT aging. Those include the ins and outs of terminology; cognitive and mental health concerns; assessing and addressing suicidality; and informal/unpaid caregiving within the community.
Learn more about working with LGBTQ+ Older Adults
Choi, S.K. & Meyer, I.H. (2016). LGBT Aging: A Review of Research Findings, Needs, and Policy Implications. Los Angeles: The Williams Institute
Fredriksen-Goldsen K. I. (2016). The Future of LGBT+ Aging: A Blueprint for Action in Services, Policies, and Research. Generations (San Francisco, Calif.), 40(2), 6–15.
Movement Advancement Project and SAGE. May 2017. “Understanding Issues Facing LGBT Older Adults.” http://www.lgbtmap.org/policy-and-issue-analysis/understanding-issues-facing-lgbt-older-adults (July 9, 2019).