Do supportive work environments matter for minority aging? Work stress and subjective cognitive impairment among middle-age and older lesbian, gay, bisexual, transgender, and queer adults

LGBTQ+ identity social support and care access among LGBTQ+ caregivers of individuals living with mild cognitive impairment, Alzheimer's disease, and related dementias

INTRODUCTION

This study examines the associations of caregiver role with lesbian, gay, bisexual, transgender, and queer (LGBTQ+) identity social support, relationships, and care outcomes among LGBTQ+ older adults.

METHODS

We use LGBTQ+ Social Networks, Aging, and Policy Study Wave 3 data (QSNAPS; N = 982). Descriptive and logistic regression analyses were conducted to examine associations between caregiver role and outcomes.

RESULTS

Eighty respondents (8.1%) care for 90 individuals with neurocognitive disorders, a majority of whom are parents of the respondent. LGBTQ+ older adult caregivers were half as likely to have family support (p < 0.05); 40.6% less likely to have coworker support (p < 0.1); and 45.6% less likely to have neighbor support (p < 0.05) for LGBTQ+ identities. Caregivers were more likely to receive practical help from others (p < 0.01), but experienced issues related to their own access to health care.

DISCUSSION

Understanding LGBTQ-identity social support and care access can inform targeted interventions to reduce LGBTQ+ caregiver health disparities.

HIGHLIGHTS

Transgender and gender diverse adults were more likely to be mild cognitive impairment/Alzheimer's disease and related dementias (MCI/ADRD) caregivers. LGBTQ+ MCI/ADRD caregivers primarily provide care to parents and familial relatives. MCI/ADRD care recipients hold differing political views than LGBTQ+ caregivers. LGBTQ+ caregivers were less likely to have family, coworker, and neighbor support. LGBTQ+ caregivers were less likely to receive LGBTQ-affirming care communication.

Associations of Faith Community Rejection With Social Support and Health Outcomes Among LGBTQ+ Older Adults

OBJECTIVES

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) older adults have varied experiences with faith communities, ranging from affirmation to religious trauma. We investigate how faith community rejection affects social support and health outcomes among LGBTQ+ older adults in the Southern United States.

METHODS

We analyze Wave 1 data from the LGBTQ+ Social Networks, Aging, and Policy Study (QSNAPS), collected between April 2020 and September 2021. This sample included 1,256 LGBTQ+ adults aged 50+ residing in four Southern U.S. states. Bivariate and Poisson regression analyses were conducted to examine associations of LGBTQ-related faith community rejection with social support and health outcomes.

RESULTS

Nearly half (44%) of QSNAPS respondents reported LGBTQ-related faith community rejection. Respondents who reported rejection were more likely to be: transgender or gender diverse (p < .01) and from a minoritized racial/ethnic background (p < .01). Compared with respondents who never experienced faith community rejection, respondents who experienced LGBTQ-related faith community rejection reported a lower prevalence of family support (APR = 0.80; p < .001); higher prevalence of symptoms related to moderate to severe psychological distress (APR = 1.27; p < .001); higher prevalence of poor sleep quality (APR = 1.17; p < .05); and high blood pressure diagnosis (APR = 1.13; p < .05). We also find a marginally statistically significant association between faith community rejection and higher prevalence of symptoms related to subjective cognitive decline (APR = 1.35; p < .10).

DISCUSSION

Experiences of faith community rejection come with substantial social support and health costs for LGBTQ+ older adults. Our findings highlight the importance of integrating faith and promoting inclusion within affirming faith communities for LGBTQ+ aging-related care and prevention.

Differential Impact of Risk Factors for Cognitive Decline in Heterosexual and Sexual Minority Older Adults in England

BACKGROUND/OBJECTIVES

Sexual minority older adults (SMOAs) report greater subjective cognitive decline (SCD) than heterosexual older adults (HOAs). This study aimed to compare the impact of multiple psycho-social risk factors on objective and subjective cognitive decline in HOAs and SMOAs.

METHODS

Two samples of self-identified HOAs and SMOAs were selected from the English Longitudinal Study of Ageing. Reliable change indices for episodic and semantic memory were created to assess cognitive decline. SCD was self-reported for memory and general cognition. Depressive symptoms, loneliness, marital status and socio-economic status were investigated as risk factors.

RESULTS

No between-group differences were found in cognitive decline. Higher depression was associated with greater SCD risk and worse semantic memory decline. The latter effect was stronger in SMOAs. The findings were largely replicated in the sensitivity analysis.

CONCLUSIONS

Poor mental health may represent the strongest driver of cognitive decline in SMOAs and to a greater extent than in HOAs.

Neurological care for LGBT+ people

Sexual and gender minority (LGBT+) people face unique health disparities that must be considered by health-care providers to ensure equitable and inclusive care. Although traditionally LGBT+ health has not been integrated into neurology training, sexual orientation and gender identity have direct relevance to neurological health, driven by both systemic and interpersonal factors. In this Review, we summarize the evidence for associations between sexual orientation and gender identity with the prevalence and outcomes of various neurological conditions, including neurodegenerative diseases, epilepsy, stroke and neurodevelopmental disorders, among others. We describe important clinical considerations pertaining to LGBT+ people and recommend language and practices to promote inclusive care, as well as highlight gaps in need of further research and possible strategies to minimize these, including systematic collection of sexual orientation and gender identity and use of inclusive language.