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By Robert Beringer, Gloria Gutman, Helena Daudt, and Brian DeVries

This piece is an excerpt from the COVID-19 edition of the GRC News.

Covid-19 is a global pandemic that poses the greatest risk to older adults, especially those who have pre-existing medical conditions. However, little is known about how Covid-19 may be affecting marginalized groups such as older lesbian, gay, bisexual, and transgender (LGBT) persons. These individuals are especially vulnerable, given their overall poorer health and higher rates of disability, relative to cisgender, heterosexual older adults.¹ Research suggests that these effects are likely exacerbated by a general distrust of and reluctance to access healthcare on the part of LGBT persons based, in part, upon the cumulative effect of discrimination over the life course.² Complicating this further is that LGBT persons do not form a homogenous group; for example transgender individuals have unique health needs that often remain unmet given their invisibility within the health care system. This disengagement indicates that LGBT patients are left with healthcare needs that remain unmet. It is unknown if such unmet needs extend to older members of the LGBT community who have contracted Covid-19.

In addition to considering the impact of Covid-19 on older members of the LGBT community who have contracted the disease, it is also important to explore the experiences of those simply coping with the psycho-social environment created by the disease. Key to halting the spread of Covid-19 is physical and social distancing. This strategy includes maintaining a distance of two-metres from others when in public spaces; sheltering in place; and avoiding social gatherings. These latter two components of the strategy may have a differential impact on the LGBT community because LGBT older adults are more likely to live alone, be unpartnered, and not have children in comparison to their heterosexual peers. Further, LGBT older adults report high rates of loneliness, isolation, and depression in comparison to their heterosexual peers and it is unknown to what degree these conditions may be magnified by social distancing policies. Interestingly, a body of research also exists displaying that in response to discrimination over the life course, older gays and lesbians have developed a unique skillset to successfully cope with stigma, a phenomenon described in the research literature as positive marginality.⁴ This may provide LGBT older adults with an enhanced ability to cope with the stresses of social distancing with outcomes compared to their heterosexual peers. Understanding the interplay of these multiple hypotheses could inform the development of strategies to minimize the negative effects of loneliness, isolation, and depression in the current and future pandemics.

Further, the older LGBT community comprises many whose lived experiences include another pandemic: HIV/AIDS. Colloquial evidence suggests that this current pandemic reawakens many feelings, thoughts, and experiences of living through a crisis that evolved over time, killing many and fostering stigma. News reports of the numbers of those infected, the number who died, the fear expressed by so many all have a reverberating familiarity, along with the empty streets and the heavy toll that nurses and physicians report in ER and ICU wards. Similar to the above multiple hypotheses, so too are there diverse responses to this second pandemic: triggering an angry and retraumatizing experience (of the fear, inadequate responses, and endless reports of illness, loss and death) and/or reinforcing a sense of competence and resilience in the face of crisis. Overriding these responses is that being HIV+ renders one even more vulnerable to this new virus and disease.

Lastly, there is a potential synergetic negative effect for older adults who are both LGBT and a member of a visible minority, a concept referred to as intersectionality. Early data from United States suggests that Black and Latino populations of all ages are suffering to a greater degree both in terms of the infection rate and the death rate. Further, there has been a marked growth in anti-Chinese sentiment during the crisis and little is known how such sentiment may affect one鈥檚 decision to access care and/or cope under such conditions.

Based upon the framework that existing literature provides, it is vital that we explore the impact of Covid-19 on the population of frail older LGBT to ensure that they receive equitable care during the current pandemic and to better prepare for the future. Research needs to explore how a general distrust of healthcare systems among the older LGBT population might impact the decision and efforts to seek care during the Covid-19 crisis, and the degree to which intersectionality might amplify these concerns. In the present day, the buzzwords diversity and inclusion permeate mission statements throughout our country. To truly achieve these directives, it is essential that research is conducted with the goal of producing results that can inform policy and programs designed to address the unique needs and circumstances of the older LGBT community.

References

1. Fredriksen-Goldsen, K. I., Kim, H.-J., Hoy-Ellis, C., Goldsen, J., Jensen, D., Adelman,M., de Vries, B. (2013). LGBT older adults in San Francisco: Recommendations for the future (Report prepared for the LGBT Aging Policy Task Force). Institute for Multigenerational Health: University of Washington, Seattle.

2. Fredriksen-Goldsen KI, Emlet CA, Kim H, Muraco A, Erosheva EA, Goldsen J, Hoy-Ellis, CP. 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. The Gerontologist. 2013; 53(4): 664鈥�675

3. de Vries, B. 2013. 鈥淟G(BT) Persons in the Second Half of Life: The Intersectional Influences of Stigma and Cohort.鈥� LGBT Health 1(1): 16鈥�21.

4. de Vries, B. (2015). Stigma and LGBT aging: Negative and positive marginality. In N.A. Orel & C.A. Fruhauf (Eds.), The Lives of LGBT Older Adults (pp. 55-72). Washington, DC: American Psychological Association.