The Relation Between Social Embeddedness and Loneliness among Older Lesbian,Gay, and Bisexual Adults in the Netherlands

Research has shown that aging lesbians, gay men, and bisexuals (LGBs) often experience feelings of loneliness. The main aim of this study was to examine whether older LGB adults in the Netherlands are lonelier than their heterosexual counterparts and, if so, whether the higher levels of loneliness can be attributed to a lower degree of social embeddedness. Using data from the Gay Autumn project and the NESTOR survey on Living Arrangements and Social Networks of Older Adults, we found that LGB elders were significantly lonelier and less socially embedded than heterosexual elders. Compared with their heterosexual peers, older LGBs were more likely to have experienced divorce, to be childless or to have less intensive contact with their children. They also had less intensive contact with other members of their families and they were less frequent churchgoers. Their weaker level of social embeddedness, however, only partially explained the stronger feelings of loneliness among older LGB adults. Nor could their higher levels of loneliness be attributed to other, non-social embeddedness factors (health, living conditions, self-esteem, and socioeconomic status). Emphasis on other aspects of social embeddedness, such as the quality of social relationships in the private domain and minority stress, is an important challenge for future research.

Minority Stress and Loneliness in a Global Sample of Sexual Minority Adults: The Roles of Social Anxiety,Social Inhibition,and Community Involvement

Research suggests that loneliness among sexual minority adults is associated with marginalization, but it is unclear which processes may underlie this relationship. This cross-sectional study examined five possibilities: stigma preoccupation, internalized homonegativity, sexual orientation concealment, social anxiety, and social inhibition. The study also examined the possible protective role of LGBTQ community involvement. Respondents were 7856 sexual minority adults aged 18–88 years from 85 countries who completed an online survey. Results of structural equation modeling indicated that marginalization was positively associated with both social and emotional loneliness, and that part of this relationship was indirect via proximal minority stress factors (especially stigma preoccupation) and, in turn, social anxiety and social inhibition. Moreover, while LGBTQ community involvement was associated with greater marginalization, it was also associated with lower levels of proximal stress and both forms of loneliness. Among those who were more involved in the LGBTQ community, the associations between marginalization and proximal stress were somewhat weaker, as were those between stigma preoccupation and social anxiety, and between social inhibition and social loneliness. In contrast, the associations between concealment and social anxiety were somewhat stronger. Model fit and patterns of association were similar after controlling for the possible confounding effect of dispositional negative affectivity, but several coefficients were lower. Findings underscore the continuing need to counter marginalization of sexual minorities, both outside and within the LGBTQ community, and suggest possible avenues for alleviating loneliness at the individual level, such as cognitive-behavioral interventions targeting stigma preoccupation and social anxiety.

     

A Comparative Analysis of a Community and General Sample of Lesbian,Gay, and Bisexual Individuals

Samples recruited at lesbian, gay, and bisexual (LGB) venues have certain benefits, but a major drawback is that these samples are prone to bias as they only contain LGB participants who visit such venues. Empirical data with regard to the potential differences between LGB community samples and LGB general samples may shed some light on the generalizability of research findings from convenience samples recruited through LGB venues. The current study attempted to contribute to existing knowledge by examining differences in social demographics, sexual orientation, minority stress, and mental health between a convenience sample recruited at LGB venues (“community sample,” N = 3,403) and an LGB sample recruited from a general research panel in the Netherlands (“panel sample,” N = 1,000). Various differences were found. In general, community participants were younger, reported a more exclusive same-sex sexual orientation, were more open about their sexual orientation, had lower levels of internalized homonegativity, and encountered more negative social reactions on their LGB status. They also reported higher levels of psychological distress and suicidality. The Nagelkerke R² of the analyses (which were adjusted for sociodemographic differences) ranged from .08 (suicide plans among men) to .27 (sexual attraction among women). However, while the estimates of sociodemographics, sexual orientation, minority stress, and mental well-being differed, the relationships between these constructs were comparable in both samples. Implications and suggestions for future studies are discussed.     

Minority stress and community connectedness among gay,lesbian and bisexual Australians: a comparison of rural and metropolitan localities

Objective: To determine whether lesbian, gay and bisexual (LGB) Australians residing in rural‐remote and other non‐inner metropolitan localities experience increased levels of minority stress and reduced social support relative to their inner metropolitan counterparts. Methods: A convenience sample of (n=1306) LGB Australians completed an online survey that assessed minority stressors, level of connection with other LGB individuals and social isolation. Postcodes provided were coded into three metropolitan and two rural zones. A series of hierarchical regression analyses were undertaken to examine the effect of locality on minority stress and social support independent of sex, age, ethnicity, education and income. Results: Those residing in rural‐remote localities reported significantly increased concealment of sexuality from friends, more concern regarding disclosure of sexuality, less LGB community involvement, fewer friendships with other LGB people and, among men, higher levels of internalised homophobia than those residing in inner metropolitan areas. Unexpectedly, those residing in outer metropolitan areas of major cities experienced comparable levels of minority stress and LGB disconnection to those in rural and remote Australia. Conclusions: LGB individuals in rural‐remote and outer metropolitan areas of major cities face increased exposure to a number of minority stressors and less LGB community connectedness. These are risk factors associated with psychiatric morbidity in LGB populations. Implications: Health promotion targeted at reducing homophobia and discrimination in rural‐remote and outer metropolitan communities and additional services to assist LGB Australians struggling with stigma and isolation in non‐inner city areas may help mitigate the disadvantages faced by these LGB populations.     

Minority Stress and Substance Use in Sexual Minority Adolescents: A Meta-analysis

Lesbian, gay, and bisexual (LGB) adolescents report disparate rates of substance use, and often consume more cigarettes, alcohol, marijuana, cocaine, and ecstasy than their heterosexual peers. It is therefore crucial to understand the risk factors for substance use among LGB adolescents, particularly those unique to their minority status. In an effort to organize the current knowledge of minority-related risk factors for substance use among LGB youth, this study presents results from a systematic review and meta-analysis of the published research literature. Results from 12 unique studies of LGB youth indicated that the strongest risk factors for substance use were victimization, lack of supportive environments, psychological stress, internalizing/externalizing problem behavior, negative disclosure reactions, and housing status. Results are discussed in terms of their implications for targeted intervention programs that address minority stress risk factors for substance use among LGB youth.     

“It's a nice country but it's not mine”: Exploring the meanings attached to home,rurality and place for older lesbian,gay and bisexual adults

An ageing population across European nations, including the United Kingdom, brings with it new challenges for health and social care services and precipitates social policy initiatives targeted at meeting the care and support needs of a rapidly expanding number of older people. Ageing in place is one such policy driver—policy efforts that seek to promote the maintenance of older citizens residing in their own homes for as long as possible with minimal state intervention. Current generations of older lesbian, gay and bisexual (LGB) people have endured homophobia throughout their life histories, and sexual identity can shape perceptions and experiences of ageing, including experiences of home life, community and place. Our objective is to examine the meanings attached to home and place for older LGB adults living independently across three dimensions: rural places as “home,” connections to LGB communities, and social care provision in the home. We present interview findings from a mixed‐methods study on the social inclusion of older LGB adults in Wales. Twenty‐nine LGB‐identifying adults (50–76 years) self‐selected to participate in semistructured interviews between 2012 and 2013. Thematic findings from interviews indicate varying and contradictory meanings attached to home life in rural places, the importance of connection to communities of identity across geographical and online localities, and a high degree of ambivalence towards the prospect of receiving social care services in the home. We argue that a more nuanced understanding of the subjective meanings attached to home, rurality and community for older LGB people is needed to fully support LGB citizens to continue to live independently in their homes.     

Evaluation of a community-based health promotion program for the elderly: lessons from Seniors CAN

PURPOSE: To evaluate the effects of a community-based educational program designed to promote health by enhancing older adults' mastery while decreasing loneliness and stress. METHODS: Between 1999 and 2004, 339 older adults who participated in Seniors CAN completed standardized assessments of mastery, loneliness, and stress, prior to and upon completion of the 4-month intervention. Participants'scores were compared using paired t-tests to measure changes from preintervention to postintervention. Change scores were then subjected to three-way ANOVA to assess the relative effectiveness based upon participants' sociodemographic characteristics. RESULTS: Participants demonstrated significant improvements from preintervention to postintervention for mastery, loneliness, and stress. Additional analysis revealed that improvement in loneliness was significantly greater among low-income ethnic minorities and minorities with a high level of formal education, p < .05. CONCLUSION: The 16-week intervention resulted in significant improvements in constructs associated with better health and a higher quality of life for independent-living older adults. These findings suggest that a community-based educational intervention can be an effective strategy to reduce risk and promote the health and independence of older adults.     

Social participation among older adults (55+): Results of a survey in the region of South Limburg in the Netherlands

Social participation may improve the health and well‐being of older adults, and may increase the social and human capacity of their communities. This study investigates the level and forms of social participation among older adults (aged 55 years or older) in the region of South Limburg, the Netherlands, and their association with socio‐demographic and health‐related characteristics. The study provides evidence that can be used by policy makers to enhance social participation in the region. We use cross‐sectional data collected in a survey in 2012 among a sample of older adults (aged 55 years or older) representative for the region of South Limburg. The results indicate that 56% (N = 16,291/weighted sample N = 213,332) of the older adults in the region participate in social activities. Specifically, 25.5% perform paid labour, 20% give informal care and 25% participate in volunteer work. Older adults with a higher education (OR = 2.49 for the highest education group) or higher income (OR = 1.70 for the highest income group) are significantly more likely to participate in social activities compared with the respective reference categories. Increased age (OR = 0.23 for the oldest age group), female gender (OR = 0.83), loneliness (OR = 0.75 for severe loneliness) and restrictions (OR = 0.78 for restrictions on the OECD scale, OR = 0.68 for restrictions on the HDL scale, OR = 0.52 for transportation restrictions) significantly hinder social participation. The lower social participation rate among older adults that we observe compared with the national statistics can be explained by the relatively higher proportion of people with low or average socioeconomic status in South Limburg. And as South Limburg is the unhealthiest region of the Netherlands, this also contributes to the low social participation. Prevention of poor physical and mental health, and provision of care services are important to encourage social participation among the older adults in South Limburg.     

Health Disparities Among Lesbian,Gay, and Bisexual Older Adults: Results From a Population-Based Study

Objectives. We investigated health disparities among lesbian, gay, and bisexual (LGB) adults aged 50 years and older.Methods. We analyzed data from the 2003–2010 Washington State Behavioral Risk Factor Surveillance System (n = 96 992) on health outcomes, chronic conditions, access to care, behaviors, and screening by gender and sexual orientation with adjusted logistic regressions.Results. LGB older adults had higher risk of disability, poor mental health, smoking, and excessive drinking than did heterosexuals. Lesbians and bisexual women had higher risk of cardiovascular disease and obesity, and gay and bisexual men had higher risk of poor physical health and living alone than did heterosexuals. Lesbians reported a higher rate of excessive drinking than did bisexual women; bisexual men reported a higher rate of diabetes and a lower rate of being tested for HIV than did gay men.Conclusions. Tailored interventions are needed to address the health disparities and unique health needs of LGB older adults. Research across the life course is needed to better understand health disparities by sexual orientation and age, and to assess subgroup differences within these communities.Changing demographics will make population aging a defining feature of the 21st century. Not only is the population older, it is becoming increasingly diverse.1 Existing research illustrates that older adults from socially and economically disadvantaged populations are at high risk of poor health and premature death.2 A commitment of the National Institutes of Health is to reduce and eliminate health disparities,3 which have been defined as differences in health outcomes for communities that have encountered systematic obstacles to health as a result of social, economic, and environmental disadvantage.4Social determinants of health disparities among older adults include age, race/ethnicity, and socioeconomic status.5 Centers for Disease Control and Prevention (CDC) and Healthy People 2020 identify health disparities related to sexual orientation as one of the main gaps in current health research.6 The Institute of Medicine identifies lesbian, gay, and bisexual (LGB) older adults as a population whose health needs are understudied.7 The institute has called for population-based studies to better assess the impact of background characteristics such as age on health outcomes among LGB adults. A review of 25 years of literature on LGB aging found that health research is glaringly sparse for this population and that most aging-related studies have used small, non-population-based samples.8Several important studies have begun to document health disparities by sexual orientation in population-based data and have revealed important differences in health between LGB adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, and limitations in activities.9,10 Studies have found higher rates of excessive drinking among lesbians and bisexual women9,10 and higher rates of obesity among lesbians10,11 than among heterosexual women; bisexual men and women are at higher risk of limited health care access than are heterosexuals. In addition, important subgroup differences in health are beginning to be documented among LGB adults. For example, bisexual women are at higher risk than lesbians for mental distress and poor general health.12 A primary limitation of most existing population-based research is a failure to identify the specific health needs of LGB older adults. Most studies to date address the health needs of LGB adults aged 18 years and older9 or those younger than 65 years.10 This lack of attention to older adult health leaves unclear whether disparities diminish or persist or even become more pronounced in later life.A few studies have begun to examine health disparities among LGB adults aged 50 years and older.13,14 Wallace et al. analyzed data from the California Health Interview Survey and found that LGB adults aged 50 to 70 years report higher rates of mental distress, physical limitations, and poor general health than do their heterosexual counterparts. The researchers also found that older gay and bisexual men report higher rates of hypertension and diabetes than do heterosexual men.14 To better address the needs of an increasingly diverse older adult population and to develop responsive interventions and public health policies, health disparities research is needed for this at-risk group.Examining to what extent sexual orientation is related to health disparities among LGB older adults is a first step toward developing a more comprehensive understanding of their health and aging needs. We analyzed population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS) to compare lesbians and bisexual women and gay and bisexual men with their heterosexual counterparts aged 50 years and older on key health indicators: outcomes, chronic conditions, access to care, behaviors, and screening. We also compared subgroups to identify differences in health disparities by sexual orientation among LGB older adults.     

Social support and health-related quality of life among older adults--Missouri, 2000

Overall health can be influenced by multiple factors, including a person's psychological, behavioral, and social well-being. Studies have demonstrated an association between increased levels of social support and reduced risk for physical disease, mental illness, and mortality. Social support includes real or perceived resources provided by others that enable a person to feel cared for, valued, and part of a network of communication and mutual obligation. Social support can be critical for those older adults who rely on family, friends, or organizations to assist them with daily activities, provide companionship, and care for their well-being. The 1965 Older Americans Act recognized the need for social support by requiring that agencies on aging provide in-home services and group meals to foster social interactions. To examine how social support is related to health-related quality of life (HRQOL), CDC analyzed data from the 2000 Missouri Older Adults Needs Assessment Survey (MOANAS) of adults aged > or =60 years. This report describes the results of that analysis, which indicated that visits with friends or relatives, having close friends for emotional support, and the perception of help being available if sick or disabled were associated with better HRQOL and particularly with better mental health among older adults. Implementing effective prevention programs for older adults and encouraging interventions by agencies on aging can help improve HRQOL among older adults who have little social support.     

Correlates of loneliness among older Newar adults in Nepal

OBJECTIVE: The purpose of this study was to identify significant factors for loneliness in older adults METHODS: The subjects (N = 195) were members of the Newar caste/ethnicity, aged 60 years and above (mean(+/- SD) 68.81 (+/- 7.69) years and 52% male) and living in Katmandu City. Data were collected by face-to-face interview using a three-item loneliness scale, developed based on the University of California at Los Angeles (UCLA) Loneliness Scale and prepared with a translation and back translation technique from English into Nepalese. The data were analyzed using logistic regression analyses. RESULTS: More than two-thirds of Newar elderly experience some type of loneliness. A statistically significant correlation was found between feelings of loneliness and age, sex, household status, total family size, network size, social participation, self-reported health, chronic health problems, working status, instrumental activities of daily living (IADL), and perceived economic satisfaction. Results of logistic regression analyses showed age, network size, and perceived economic satisfaction to be significant factors for loneliness. CONCLUSION: Loneliness is an important public health issue, predicting low quality of life among older adults. The present results indicate many elderly Nepalese experience some form of loneliness, with age, network size and perceived economic satisfaction as significant factors. However, this result may not be generalized to the greater population of Nepalese older adults and the external validity of the UCLA Loneliness Scale is an important criterion to examine in future research.     

Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community‐dwelling Korean adults

The purpose of this study was to examine whether loneliness mediates the relationship between social engagement and depressive symptoms and to determine how age moderates the mediation effect. Data for this study came from the survey with community‐dwelling adults aged 18 and older in South Korea, from March to April 2017. The total of 1,017 respondents were drawn from three age groups (18–44, 45–64, or 65 and older). The mediating effect of loneliness was tested between each of three social engagement‐related variables (family network, friend network, and perceived community support) and depressive symptoms. The results showed age differences in mediation: the effect was most pronounced in the relationship of family network with loneliness for the older group, whereas the size of friend network significantly predicted loneliness for younger adults. Both younger and older groups felt less lonely when they had a higher level of perceived community support; the middle age group remained uninfluenced by the mediation effects. Our findings confirm that loneliness is one of the mechanisms by which social engagement exerts its effect on depressive symptoms. As the Korean society embraces its growing proportions of older adults, the results of the study provide implications for adaptive strategies for changing social engagement need and mental health associated with ageing.     

Fear of crime is associated with loneliness among older adults in Singapore: Gender and ethnic differences

Fear of crime is a complex perception and has underlying psychological, social and health repercussions. The influence of fear of crime on psychosocial outcomes, however, may be moderated by various social factors. This study examined how fear of crime influences loneliness among low-income older adults attending a Senior Activity Centre (SAC) in multiethnic Singapore. In addition, we tested whether these associations were moderated by gender and ethnicity. We analysed cross-sectional data (N = 1,266) from The SAC Study, a survey conducted with older adults who were attending a SAC between March 2015 and August 2015. Multilevel models were used to test whether fear of crime was associated with loneliness; and whether the association was moderated by gender and ethnicity. We found that fear of crime was positively associated with loneliness, and that this association was stronger among men than women, but ethnicity did not moderate this relationship. Findings from our study suggest that fear of crime may have a stronger negative effect on men's psychological well-being, even though they report lower fear of crime. This highlights the importance of sociocultural context when examining the psychosocial implications of fear of crime in the population.     

Loneliness among older European adults: results from the survey of health,aging and retirement in Europe

Purpose

Previous research has suggested that individuals are mostly prone to loneliness in their later years of life because of exposure to several risk factors typical of old age. The current study aims to examine possible demographic, health and social determinants of loneliness among older adults in Europe.

Methods

Data on a nationally representative sample of 5074 Europeans aged ≥ 65 years were drawn from the first wave of the Survey of Health, Aging and Retirement in Europe (SHARE, 2004/2005). Frequency of feelings of loneliness was examined according to adverse health conditions, stressful life events and social isolation indicators.

Results

Female gender, older age, lower socioeconomic status, living unpartnered, being childless and having no activity involvement were significantly associated with frequent feelings of loneliness (p?<?0.001). The proportion of the respondents who declared enduring loneliness most of the time compared with none of the time was significantly higher among Southern Europeans relative to their Northern counterparts (p?<?0.001). Recent departure of offspring from the parental nest was a significant predictor of loneliness in both the second (ORs?=?2.08; 95% CI 1.24–3.48) and the third (ORs?=?1.75; 95% CI 1.03–2.96) multiple regression models.

Conclusion

In this sample of older Europeans, several demographic characteristics, specific adverse health conditions, stressful life events and social isolation indicators were associated with feelings of loneliness. Policy initiatives for the alleviation of loneliness in older age should therefore aim at improving psychosocial and health-related difficulties faced by this population.

     

The relationship between wealth and loneliness among older people across Europe: Is social participation protective?

Objective1. Examine the relationship between household wealth, social participation and loneliness among older people across Europe. 2. Investigate whether relationships vary by type of social participation (charity/volunteer work, sports/social clubs, educational/training course, and political/community organisations) and gender. 3. Examine whether social participation moderates the association between wealth and loneliness.MethodsData (N = 29,795) were taken from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), which was collected during 2013 from 14 European countries. Loneliness was measured using the short version of the Revised-University of California, Los Angeles (R-UCLA) Loneliness Scale. We used multilevel logistic models stratified by gender to examine the relationships between variables, with individuals nested within countries.ResultsThe risk of loneliness was highest in the least wealthy groups and lowest in the wealthiest groups. Frequent social participation was associated with a lower risk of loneliness and moderated the association between household wealth and loneliness, particularly among men. Compared to the wealthiest men who often took part in formal social activities, the least wealthy men who did not participate had greater risk of loneliness (OR = 1.91, 95% CI: 1.44 to 2.51). This increased risk was not observed among the least wealthy men who reported frequent participation in formal social activities (OR = 1.12, 95% CI: 0.76 to 1.67).ConclusionParticipation in external social activities may help to reduce loneliness among older adults and potentially acts as a buffer against the adverse effects of socioeconomic disadvantage.     

Loneliness and social support of older people living alone in a county of Shanghai,China

China has an ageing population with the number of older people living alone increasing. Living alone may increase the risk of loneliness of older people, especially for those in China where collectivism and filial piety are emphasised. Social support may fill the need for social contacts, thereby alleviating loneliness. However, little is known about loneliness and social support of older people living alone in China. This study investigated loneliness and social support of older people living alone, by conducting a cross‐sectional questionnaire survey with a stratified random cluster sample of 521 community‐dwelling older people living alone in a county of Shanghai. Data were collected from November 2011 to March 2012. The instruments used included the UCLA Loneliness Scale version 3 and the Social Support Rate Scale. The participants reported a moderate level of loneliness. Their overall social support level was low compared with the Chinese norm. Children were the major source of objective and subjective support. Of the participants, 53.9% (n = 281) and 47.6% (n = 248) asked for help and confided when they were in trouble, but 84.1% (n = 438) never or rarely attended social activities. The level of loneliness and social support differed among the participants with different sociodemographic characteristics. There were negative correlations between loneliness and overall social support and its three dimensions. The findings suggest that there is a need to provide more social support to older people living alone to decrease their feelings of loneliness. Potential interventions include encouraging more frequent contacts from children, the development of one‐to‐one ‘befriending’ and group activity programmes together with identification of vulnerable subgroups.     

The Relationship Between Discrimination and Substance Use Disorders Among Lesbian, Gay, and Bisexual Adults in the United States

Objectives. We examined the associations between 3 types of discrimination (sexual orientation, race, and gender) and substance use disorders in a large national sample in the United States that included 577 lesbian, gay, and bisexual (LGB) adults.Methods. Data were collected from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions, which used structured diagnostic face-to-face interviews.Results. More than two thirds of LGB adults reported at least 1 type of discrimination in their lifetimes. Multivariate analyses indicated that the odds of past-year substance use disorders were nearly 4 times greater among LGB adults who reported all 3 types of discrimination prior to the past year than for LGB adults who did not report discrimination (adjusted odds ratio = 3.85; 95% confidence interval = 1.71, 8.66).Conclusions. Health professionals should consider the role multiple types of discrimination plays in the development and treatment of substance use disorders among LGB adults.Substance use disorders have been shown to be more prevalent among lesbian, gay, and bisexual (LGB) adults than among heterosexual adults in the United States.^1–6 Despite this evidence, little empirical work has focused on why such differences exist between LGB and heterosexual adults. Many studies have posited that differences in rates of mental health problems and substance abuse are related to social stressors such as discrimination,^7–11 yet no large-scale national studies have examined the relationship between multiple types of discrimination and substance use disorders. Meyer''s minority stress model posits that discrimination, internalized homophobia, and social stigma can create a hostile and stressful social environment for LGB adults that contributes to mental health problems, including substance use disorders.^10,11 An assumption of this model is that minority stress is unique and additive to general stressors that all people experience.Meyer''s model connects the literature demonstrating higher odds of mental health problems and substance use disorders among LGB populations with well-established social science research that demonstrates the link between stress or stressful life events and poor health outcomes.^12–15 Lesbian, gay, and bisexual adults experience discrimination at the structural and institutional level, such as in access to housing, employment, medical care, and basic civil rights,^16,17 as well as at the individual level in the form of harassment and violence.^18–22 Discriminatory experiences have been shown to operate as stressors in the lives of LGB people and, in turn, they are significantly associated with psychiatric disorders,⁹ psychological distress,^9,20,23 and depressive symptoms.^20,24Although the minority stress model provides a useful theoretical framework for understanding health disparities among LGB adults, only a handful of studies have directly assessed discrimination among LGB populations, and even fewer have examined the relationships between discrimination and health outcomes. Extant research on health outcomes related to discrimination has focused on blood pressure,¹⁷ psychological distress,^24,25 mental health disorders,⁹ and general psychological and physical health.²⁶ Given that exposure to both acute and chronic stress has long been associated with substance abuse and relapse in the general population,^26,27 research on the association between experiences of discrimination and substance use disorders among LGB adults is warranted.In our investigation, we assumed that LGB adults are at heightened risk for substance use disorders as a consequence of cultural and environmental factors associated with being part of a stigmatized and marginalized population, not because of their sexual orientation. Building on previous work documenting the impact of multiple stigmatized statuses among sexual minority people^11,28,29 as well as the work of Krieger et al.,¹⁶ we sought to examine the relationships between 3 types of discrimination (sexual orientation, race/ethnicity, and gender) and substance use disorders. We used data from wave 2 of the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to test the hypothesis that LGB adults who reported more types of discrimination would be more likely to meet criteria for substance use disorders than would those who reported fewer types or who did not report discrimination.     

Differences by Sexual Orientation in Expectations About Future Long-Term Care Needs Among Adults 40 to 65 Years Old

Objectives. We examined whether and how lesbian, gay, and bisexual (LGB) adults between 40 and 65 years of age differ from heterosexual adults in long-term care (LTC) expectations.Methods. Our data were derived from the 2013 National Health Interview Survey. We used ordered logistic regression to compare the odds of expected future use of LTC among LGB (n = 297) and heterosexual (n = 13 120) adults. We also used logistic regression models to assess the odds of expecting to use specific sources of care. All models controlled for key socioeconomic characteristics.Results. Although LGB adults had greater expectations of needing LTC in the future than their heterosexual counterparts, that association was largely explained by sociodemographic and health differences. After control for these differentials, LGB adults were less likely to expect care from family and more likely to expect to use institutional care in old age.Conclusions. LGB adults may rely more heavily than heterosexual adults on formal systems of care. As the older population continues to diversify, nursing homes and assisted living facilities should work to ensure safety and culturally sensitive best practices for older LGB groups.According to some estimates, approximately 4% of American adults aged 18 years or older self-identify as lesbian, gay, or bisexual (LGB),1 including more than 1.5 million LGB adults aged 65 years or older.2 This number is projected to grow to nearly 3 million by 2030.2 Research has shown that LGB individuals report worse physical and mental health outcomes and are more likely to engage in harmful health behaviors than their heterosexual peers.3,4 Public health studies often attribute LGB health disparities to minority stress, or the chronic stress associated with being a member of a marginalized minority group.5–9Elderly LGB individuals are particularly vulnerable to poor health outcomes owing to minority stress because of their experiences of stigma, discrimination, and violence.10–12 Recent studies involving data from California and Washington State indicate that LGB adults aged 50 years or older are more likely than their heterosexual counterparts to report symptoms of psychological distress, physical disability, and chronic disease; they are also more likely to report that their overall health status is poor.13–15Older LGB adults in same-gender relationships, especially women, are more likely than older heterosexual adults to need assistance with activities of daily living (ADLs) such as dressing, bathing, and doing errands alone,16 signaling a greater need for long-term care (LTC) services and support in later life.17 Such services and support might include assistance with ADLs (e.g., dressing, bathing, eating), instrumental ADLs (e.g., running errands, managing medications, preparing meals), and clinical or nursing tasks (e.g., pain management, physical or occupational therapy, management of incontinence). LTC may be provided in the home or community setting, by paid or unpaid caregivers, or in institutional settings. Although LGB individuals may have an elevated need for LTC services in later life, we are not aware of any studies examining differences in LTC expectations according to sexual orientation.Most Americans will need LTC at some point in their lives.18 According to current projections, nearly three quarters of all Americans will use LTC during their lives, and nearly half of Americans aged 65 years or older will spend time in a nursing home.18,19 However, middle-aged Americans have unrealistically low expectations of needing LTC,20 and very few people plan for it by either purchasing LTC insurance or making other advanced arrangements.21 This situation may be partly attributable to the high cost of LTC insurance premiums.22 Another major reason why people may not plan ahead for LTC is that they expect family members or close relatives to step in and provide care should they need it.20 This aligns with current use of unpaid caregivers, with approximately 80% of older adults reporting that family members provide the majority of their noninstitutional care.23However, older LGB adults may have different family structures than older heterosexual adults1; for example, they are less likely to be married, less likely to have children, and more likely to experience conflict with their family of origin.2,24,25 Older LGB adults, especially men, are more likely than their heterosexual counterparts to live alone,13,15,26,27 which is a major risk factor for both needing LTC and having unmet care needs.28–30Furthermore, although LGB individuals often exhibit distrust in formal LTC systems,31,32 one study showed that older LGB adults are only half as likely as older heterosexual adults to depend on close relatives for help.2 More than a quarter of LGB older adults report apprehension about discrimination as they age and how it may be manifested in institutional discrimination on the part of health care providers, including LTC providers.33 This should concern practitioners and policymakers given that the older LGB population is growing and our current system of LTC may be inappropriate to meet the needs of this group.Unfortunately, very little is known about LTC expectations among LGB populations. Research on the general population has shown that LTC expectations and planning behaviors are patterned according to demographic characteristics. Characteristics that may promote LTC planning include older age, female gender, being married, being White, having a college education or above, and having previous experience with LTC.21 Research suggests that LGB older adults are poorer and less financially secure than heterosexual older adults, in part because of limited employment opportunities resulting from institutional and personal discrimination34 and limited (or lack of) ability to receive partner benefits or property inheritances.35 Yet, as noted, there is a dearth of literature examining differences in LTC expectations by sexual orientation.3The few studies that have examined LTC expectations in older LGB populations indicate that these individuals may use nursing homes sooner than the general population owing to a lack of caregivers at home.2,33 LGB older adults in institutional facilities may be at heightened risk of neglect and abuse as a result of limited knowledge and training among providers and, sometimes, blatant discrimination on the part of staff and fellow residents.36One survey of LGB older adults and their families indicated that LGB adults were more likely than heterosexual adults to be harassed or mistreated in LTC facilities.37 Altogether, 328 respondents reported 853 instances of mistreatment among LGB older adults in LTC settings.37 Thus, some LGB older adults may avoid nursing homes because of barriers such as fear of discrimination and abuse, concerns about going “back into the closet,” and a reluctance to be separated from their partners.2,32 Instead of using formal LTC settings, some older LGB adults rely on friends and LGB-specific community organizations for assistance in later life.33 Older LGB adults who do reside in institutional settings may keep their sexual orientation a secret or seek out welcoming service providers.In this study, we sought to fill gaps in existing research by comparing LTC expectations among LGB and heterosexual adults aged 40 to 65 years. Whereas older heterosexual adults may expect to rely on their children and spouses for support in later life, the same may not be true for LGB adults. The findings of this study will be especially important for public health practitioners and policymakers planning for future LTC needs in aging populations.     

Associations among neighborhood poverty,perceived neighborhood environment,and depressed mood are mediated by physical activity,perceived individual control,and loneliness

Few studies have documented the pathways through which individual level variables mediate the effects of neighborhoods on health. This study used structural equation modeling to examine if neighborhood characteristics are associated with depressive symptoms, and if so, what factors mediated these relationships. Cross-sectional data came from a sample of mostly rural, older adults in North Carolina (n = 1,558). Mediation analysis indicated that associations among neighborhood characteristics and depressive symptoms were mediated by loneliness (standardized indirect effect = −0.19, p < 0.001), physical activity (standardized indirect effect = −0.01, p = 0.003), and perceived individual control (standardized indirect effect = −0.07, p = 0.02) with loneliness emerging as the strongest mediator. Monitoring such individual mediators in formative and process evaluations may increase the precision of neighborhood-based interventions and policies.     

Objective and perceived neighborhood environment, individual SES and psychosocial factors, and self-rated health: an analysis of older adults in Cook County, Illinois

This article investigates the relationship among objectively assessed neighborhood socio-economic status (SES), subjective perceptions of neighborhood environment, individual SES and psychosocial factors, and self-rated health among middle-aged and older adults. Analysis of data from a representative sample of adults, aged 50-67 years in Cook County, Illinois, shows a significant association between objective neighborhood SES and self-rated health after controlling for age, gender, and race/ethnicity, but the effect is substantially explained by individual SES and neighborhood perceptions. By contrast, perceived neighborhood quality (i.e., subjective ratings of neighborhood physical, social, and service environments) exhibits a significant effect after controlling for individual socio-demographic factors as well as neighborhood SES. In turn, the effects of perceived neighborhood environment on health are partially explained by the psychosocial factors of loneliness, depression, hostility, and stress, but not by perceived social support or social networks. In sum, the research supports a model in which the effects of neighborhood SES on self-rated health act through sequential pathways of individual SES, perceptions of neighborhood quality, and psychosocial status.