Charles A. Emlet

The Physical and Mental Health of Lesbian, Gay Male, and Bisexual (LGB) Older Adults: The Role of Key Health Indicators and Risk and Protective Factors

PURPOSE Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults. DESIGN AND METHODS A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics. RESULTS The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed. IMPLICATIONS High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

“I'm Not Going to Die from the AIDS”: Resilience in Aging with HIV Disease

PURPOSE Adults aging with HIV/AIDS can experience resilience in spite of the deleterious affects of the disease. This study seeks to examine the lived experiences of older adults with HIV/AIDS as it relates to strengths and resilience in dealing with this devastating disease. DESIGN AND METHODS Semistructured in-depth interviews were conducted with 25 adults, 50 years and older, living with HIV/AIDS. The interview transcripts were analyzed using constant comparative methodology following the tenets of adaptive theory. RESULTS The majority of informants expressed experiences of resilience and strengths as related to living with HIV/AIDS. Seven major themes emerged from the analysis including self-acceptance, optimism, will to live, generativity, self-management, relational living, and independence. IMPLICATIONS The research identified the importance of strengths and resilience among older adults living with HIV/AIDS. Further research is needed to explore these phenomena with larger samples. Practitioners should identify and implement methods for assessing resilience among older HIV-infected adults.

Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group

PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) people are a health disparate population as identified in Healthy People 2020. Yet, there has been limited attention to how LGBT older adults maintain successful aging despite the adversity they face. Utilizing a Resilience Framework, this study investigates the relationship between physical and mental health-related quality of life (QOL) and covariates by age group. DESIGN AND METHODS A cross-sectional survey of LGBT adults aged 50 and older (N = 2,560) was conducted by Caring and Aging with Pride: The National Health, Aging, and Sexuality Study via collaborations with 11 sites across the U.S. Linear regression analyses tested specified relationships and moderating effects of age groups (aged 50-64; 65-79; 80 and older). RESULTS Physical and mental health QOL were negatively associated with discrimination and chronic conditions and positively with social support, social network size, physical and leisure activities, substance nonuse, employment, income, and being male when controlling for age and other covariates. Mental health QOL was also positively associated with positive sense of sexual identity and negatively with sexual identity disclosure. Important differences by age group emerged and for the old-old age group the influence of discrimination was particularly salient. IMPLICATIONS This is the first study to examine physical and mental health QOL, as an indicator of successful aging, among LGBT older adults. An understanding of the configuration of resources and risks by age group is important for the development of aging and health initiatives tailored for this growing population.

Measuring Stigma in Older and Younger Adults with HIV/AIDS: An Analysis of an HIV Stigma Scale and Initial Exploration of Subscales.

The purpose of this study is to explore the validity of a scale designed to measure HIV stigma and identify potential subscales. A nonrandom sample of 88 individuals, 44 between the ages of 20 and 39 and 44 ages 50 and older, living with HIV/AIDS were interviewed and completed a 13-item HIV Stigma Scale. An exploratory factor analysis (EFA) found 12 of the 13 items loaded cleanly into three subscales labeled as Distancing, Blaming, and Discrimination, with an overall Cronbach’s alpha of .83. The three newly identified subscales were found to have convergent validity with social support as expected. Overall, older adults were found to have higher, but nonsignificant scores on the Blaming subscale, whereas those 20 to 39 years old had significantly higher scores related to discrimination. The 13-item HIV stigma scale can discriminate experiences of stigma in older adults and support three subscales while maintaining internal consistency.

Creating a Vision for the Future: Key Competencies and Strategies for Culturally Competent Practice With Lesbian, Gay, Bisexual, and Transgender (LGBT) Older Adults in the Health and Human Services

Sexual orientation and gender identity are not commonly addressed in health and human service delivery, or in educational degree programs. Based on findings from Caring and Aging with Pride: The National Health, Aging and Sexuality Study (CAP), the first national federally-funded research project on LGBT health and aging, this article outlines 10 core competencies and aligns them with specific strategies to improve professional practice and service development to promote the well-being of LGBT older adults and their families. The articulation of key competencies is needed to provide a blueprint for action for addressing the growing needs of LGBT older adults, their families, and their communities.

Risk and Protective Factors Associated with Health-Related Quality of Life Among Older Gay and Bisexual Men Living With HIV Disease

PURPOSE To identify risk and protective factors associated with mental and physical health-related quality of life, after controlling for key background characteristics, in a population of older gay and bisexual men living with HIV disease. Previous research examining quality of life among persons living with HIV rarely includes older adults. DESIGN AND METHODS Survey responses from 226 gay and bisexual men aged 50 and older, and living with HIV disease, which were part of the Caring and Aging with Pride study, were analyzed using multivariate linear regression models. RESULTS Findings reveal that comorbidity, limitations in activities, and victimization are significant risk factors for decreased physical and mental health-related quality of life. Stigma and HIV progression did not contribute to the overall outcome variables in multivariate models. Social support and self-efficacy serve as protective factors although social support was only significant with mental health-related quality of life. IMPLICATIONS Comorbidity, functional limitations, and lifetime victimization are risks to quality of life among older gay and bisexual men with HIV disease. Self-efficacy and social support represent intrapersonal and interpersonal resources that can be enhanced through interventions to improve health-related quality of life.

The Importance of Social Connectedness in Building Age-Friendly Communities

The purpose of this paper is to further elucidate the importance of social relationships and social connectedness with aging in place and in developing elder-friendly communities. The process used in this study was inclusive of younger adults (age 40–65) as well as older adults (65+) in order to further understand how they envision a community that could support their own aging in place. A community forum, using the World Café format, was conducted in order to engage community members, 40 years and older, in conversation about the importance of social connectedness in elder-friendly communities. A second purpose of this forum was to obtain data on what would keep aging boomers in their community as they age. Three major themes emerged from qualitative analysis of the forum: social reciprocity, meaningful interactions, and structural needs/barriers. The results of this study reinforce the importance of social connectedness in creating and maintaining elder-friendly communities for older adults, as well as soon-to-be retired individuals, wishing to maintain life connectedness to their community. The study suggests the possibility of using more nontraditional research techniques (such as the World Café process) for gathering community level data.

Truth and consequences: a qualitative exploration of HIV disclosure in older adults

Abstract While the number of older adults living with HIV/AIDS has increased substantially in recent years, research on HIV disclosure among this population is extremely limited. Studies on disclosure have typically not recruited older persons or have excluded age as a variable in the analysis. This study reports qualitative data from 25 in-depth interviews with older adults living with HIV disease. The ages ranged from 50–72 (mean 56.1; SD = 5.75). The interviews resulted in a model of disclosure patterns consisting of seven themes including protective silence, anticipatory disclosure, violations of confidentiality, unintentional disclosure and intentional disclosure. Approximately one quarter of informants had the confidentiality of their HIV status violated by others. Reasons for disclosure and non-disclosure given by older persons were similar to research among younger persons. Older individuals who intentionally disclosed their status to the broader society held generativity and the education of others (particularly younger adults) as important reasons for their actions.

Correlates of Service Utilization Among Midlife and Older Adults With HIV/AIDS: The Role of Age in the Equation

Objectives: To determine the role of age on service utilization among persons with HIV/AIDS. Methods: The study examined 571 individuals diagnosed with symptomatic HIV or AIDS ranging in age from 30 to 81 years. All individuals had been enrolled in case management services from July 1995 through June 1996. It was hypothesized that older persons would utilize higher rates of health and medical services and lower rates of psychosocial services. Results: The study found that in the older age groups the proportion of women, those living alone, and those having private health insurance increased. Mortality also increased in the older age groups, whereas survival time from AIDS diagnosis to death decreased. Age did not emerge as a significant variable in a multiple regression of service utilization. Functional dependence and mortality were significant predictors of medical services, whereas geographical location and insurance coverage explained the majority of variance in home care services.

Protective and risk factors associated with stigma in a population of older adults living with HIV in Ontario, Canada

Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalized stigma subscales in a sample of OCS participants age 50 and over (n=378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed.