Older LGBTQIA+ adults often face challenges when trying to get health care or long-term support. Many of these problems come from a lifetime of discrimination, being ignored by the medical system, and not having the same support systems that non-LGBTQIA+ people have. These issues continue to compound and grow as people age.
For many years, being LGBTQIA+ was considered a mental illness. Because of this, many older LGBTQIA+ adults grew up avoiding doctors and hiding who they are. Healthcare systems often excluded or mistreated these individuals, creating a lifetime of mistrust. This invisibility in research and policy meant many older LGBTQIA+ people, especially trans people, lived with unmet health needs. These unmet needs lead to higher rates of depression, dementia, chronic illness, and social isolation. This history still affects LGBTQIA+ people of all ages.
Many LGBTQIA+ people still avoid healthcare due to discrimination built into our healthcare system. Many transgender individuals report being called the wrong name or being referred to as the wrong gender, even after reminding healthcare workers about correct names and pronouns. Many also report a lack of respect from providers and often find themselves having to educate their providers about their needs.
Research shows LGBTQIA+ people, including transgender and gender non-conforming individuals, often have worse health outcomes, mental health needs, and higher rates of chronic conditions compared to non-LGBTQIA+ individuals. Avoiding healthcare due to discrimination only compounds that fact. For example, research published in the American Journal of Student Research found 25% of LGBTQIA+ people report fair or poor health, and 67% have sought out mental health treatment in the last two years. In comparison, 18% of non-LGBTQIA+ people reported fair or poor health, and 39% sought out mental health treatment.
Social support is critical as we age. Social isolation can lead to higher rates of dementia, chronic illness, heart disease, and mental health conditions. LGBTQIA+ are disproportionately affected. Compared to cisgender heterosexual individuals, LGBTQIA+ people are twice as likely to be single and four times less likely to have children. Additionally, 40% of older LGBTQIA+ adults report being rejected by their family. This lack of support can lead to fewer familial caregivers as they age, increased risk of loneliness, and delays in receiving medical care.
Long-term care like nursing homes and assisted living facilities can be unsafe and unwelcoming for LGBTQIA+ older adults. Many fear discrimination from staff or other residents. These fears are not unfounded. One survey from the National Senior Citizens Law Center found 89% of respondents believed they would face discrimination due to their sexuality or gender identity. 77% responded being isolated in long-term care facilities. As a result, many older adults hide their identities to avoid potential discrimination and rejection. For transgender older adults, this is almost impossible. When assistance with bathing, dressing, or toileting is required, the risk of mistreatment and physical abuse increases.
On the other hand, many LGBTQIA+ individuals are also caregivers. They often provide unpaid care to aging parents, partners, or chosen family. Yet, they do it with far less support than non-LGBTQIA+ people. According to a 2024 AARP survey, 58% of LGBTQIA+ adults aged 45 and older are current or former caregivers. They are 1.2 times more likely to be primary caregivers than their non-LGBTQIA+ peers, and 3.5 times more likely to provide care for friends and chosen family.
However, LGBTQIA+ individuals are half as likely to have family support and 45% less likely to have neighbor or coworker support. Additionally, the same 2024 AARP survey found 14% of LGBTQIA+ adults felt obligated to care for family members who are not accepting of their identity. This lack of support from society, and the pain of providing unpaid care to someone who is not accepting, raises the risk of burnout among LGBTQIA+ caregivers.
There are also many systemic barriers in healthcare that make it more difficult for LGBTQIA+ older adults. Some of these include a lack of provider training on LGBTQIA+ aging, electronic health records that omit gender-affirming care histories, cuts to Medicaid and other government health programs, and a lack of enforcement of anti-discrimination procedures. Medicare is also an additional barrier to many older LGBTQIA+ adults. While a person who lacks the needed work history can still get Medicare if their spouse (living or deceased) meets the requirements, this option leaves LGBTQIA+ individuals at a disadvantage since same-sex marriage was only legalized in America ten years ago.
There is a lot of work that needs to be done to improve the health outcomes for LGBTQIA+ older adults. For starters, healthcare providers need to be trained in gender affirming care and the needs of older LGBTQIA+ adults. Policy reforms to ensure inclusive practices, insurance coverage, and anti-discrimination protections are also important. Finally, training for long-term care staff that focuses on respect for identity and chosen family is needed in long-term care facilities.
Despite these challenges, there are encouraging signs of progress. In recent years, research on LGBTQIA+ aging has grown as more LGBTQIA+ people get older. At the same time, chosen families are becoming more accepted across communities, offering greater support and connection. Although it may not always seem like it, meaningful progress is being made, showing that inclusive care is possible.
Older LGBTQIA+ adults have survived decades of discrimination, but still face major barriers in health care and caregiving. Many live with poor health, limited support, and fear of mistreatment and discrimination within the healthcare system. To help them age with dignity, new systems must be built that are safe, respectful, and affirming. Every older adult deserves care that sees, respects, and supports who they are.
Ty Mynes is a Communications Specialist and writer at JABA.
