market use their LGBT-friendly status as a marketing advantage,
says Travis, others aren’t so welcoming.
“I can’t overstress the potential fears that people have about
discrimination,” she says. As a result, she says, LGBT older
adults can be reluctant to see health-care providers until their
problems become so bad they can no longer avoid doing so.
Travis, who trains health-care providers and students to
be more LGBT-friendly, says even innocent questions about
marital status and the like can make LGBT older adults feel
unwelcome. Providers and intake forms should ask about
relationship status instead, she says. And instead of making
assumptions, they should ask about sexual orientation, gender
identity and the pronouns patients use to describe themselves.
Websites depicting same-sex couples and other forms of
diversity can also help, says Travis, who has written fact
sheets on LGBT aging for health-care providers (see “Further
It’s not just service providers who may discriminate against
LGBT older adults, however. Research by Weston Donaldson,
a graduate student in counseling psychology at Colorado State
University, reveals that fellow long-term care residents may
cause problems, too.
In a small, qualitative study published this year in Clinical
Gerontologist: The Journal of Aging and Mental Health,
Donaldson and colleagues found that while some fellow
residents had favorable views of LGBT individuals, others were
ambivalent or even hostile. Interviewees typically assumed that
none of their peers at the facility were gay or lesbian, although
in fact some were. Many interviewees said it would be OK to
have gay and lesbian residents — as long as they didn’t talk
about their orientation.
“The gay and lesbian people in the facility didn’t feel safe
or comfortable to be out there,” says Donaldson, an intern at
Aurora Mental Health Center.
Being forced to stay or go back in the closet like that can
have serious health consequences, says Donaldson. “We know
that social isolation has a significant negative impact not only
on mental health but also on physical health,” he says. “Gay and
lesbian residents are at more risk of being socially isolated.”
Meanwhile, sexual activity can be a particularly fraught
area for staff and other residents alike, says Kate Martin
Hinrichs, PhD, a psychologist at the VA Boston Healthcare
System’s Community Living Center. The problem goes
beyond the usual concerns about whether long-term care
facility residents have the cognitive capacity to consent to
sexual activity, she says.
“There’s often an ‘ick’ factor when people imagine two older
adults having sexual contact,” says Hinrichs. “Most older adults
are perceived as fairly asexual.”
When the two adults are LGBT older adults, reactions can
be even more intense, says Hinrichs. Long-term care staff may
assume that gay or lesbian sex is pathological and must be
stopped. And the fact that LGBT older adults may have life
partners or legal spouses may not even cross staff members’
minds, she adds, explaining that facilities need to accommodate
couples’ desire to share a room or just get some privacy.
The issue will come up more as a new generation of LGBT
people ages, Hinrichs predicts.
“The oldest old — those from the World War II era — are
folks who lived in the closet,” she says. “The baby boom cohort
has had more freedom to be who they are and are demanding
the right not to have to go back into the closet as they age.” n
Rebecca A. Clay is a journalist in Washington, D.C.
• APA. (2011). “Guidelines for Psychological
Practice with Lesbian, Gay and Bisexual LGB
Clients.” Available at www.apa.org/pi/lgbt/
• APA. (Undated). “Lesbian, Gay, Bisexual and
Transgender Aging.” Available at www.apa.org/
• Gay and Lesbian Medical Association.
Resources website available at www.
• Institute of Medicine. (2011). “The health of
lesbian, gay, bisexual and transgender people:
Building a foundation for better understanding.”
Washington, D.C.: The National Academies.
Available at www.iom.edu/reports/2011/the-
• Orel, N. A., & Fruhauf, C. A. (Eds.). (2014).
The Lives of LGBT Older Adults: Understanding
Challenges and Resilience. Washington, D.C.: APA.
• Pathai, S., Bajillan, H., Landay, A. L., & High,
K. P. (2014). “Is HIV a model of accelerated or
accentuated aging?” Journals of Gerontology:
Medical Sciences, 69( 7).
• SAGE. National Resource Center on LGBT
Aging. Available at www.lgbtagingcenter.org/.
• Travis, L. A. (2011). “What you should
know about LGBT older adults.” Tucson, Ariz.:
University of Arizona. Available at https://
• Travis, L. A., & Heasley, B. J. (2011). “LGBT
older adults in long-term care facilities.” Tucson,
Ariz.: University of Arizona. Available at https://