In many areas of the world, June has become Pride Month, with celebrations continuing throughout the months that follow. Over the past decade, progress in equality and equity for the LGBTQ+ community has increased worldwide. Yet despite this progress, the health disparities experienced by members of the LGBTQ+ community persist. Experiences of violence and victimization continue for LGBTQ+ individuals and have long-lasting effects on the health of the individual and the community. These disparities include increased risk of suicide among LGBTQ+ youth, increased risk of sexually transmitted infections among gay men and transgender individuals, and increased incidence of chronic conditions and disability among LGBTQ+ older adults. You can find more information about these disparities on the National LGBT Health Education Center website.
My colleague Jason Flatt and I recently published an analysis of data from the 2015 Caregiving in the U.S.survey in the Journal of Gay & Lesbian Social Services. This survey is conducted annually by the National Alliance for Caregiving (NAC) and the American Association for Retired Persons (AARP). The survey in 2015 was the first to include an item asking caregivers if they identified as lesbian, gay, bisexual, and/or transgender, offering us the opportunity to look at outcomes among LGBT caregivers. Jason and I specifically looked at the data for those LGBT caregivers providing care for a loved one aged 50+ years given that our research programs focus on gerontology, with a particular interest in LGBTQ+ older adults.
Using these data, we compared characteristics of LGBT and non-LGBT caregivers of older adults and explored predictors of caregiver strain. LGBT caregivers were younger, more racially/ethnically diverse, and less frequently a spouse/partner compared with their heterosexual counterparts. LGBT caregivers more frequently reported helping with medical nursing tasks and reported higher levels of financial strain. While LGBT identity was not an independent predictor of greater strain, characteristics more frequently reported by LGBT caregivers were, for instance helping with medical nursing tasks. Additionally, LGBT individuals who were children of the older adult were more likely to report higher levels of emotional strain than other relationship types.
I was heartened that LGBTQ+ health was included in presentations at IFNC13 in Pamplona. For example, Camille Brown’s presentation titled “Pronoun use in Practice: Working with Gender Diverse Youth and Their Families” and the presentation by Natália Sá titled “The Experience of Parenting a Transgender Adolescent: An Integrative Review.” Still, as Kristin Cloyes presents in her recent systematic review in Research in Gerontological Nursing, research targeting LGBTQ+ older adults remains lacking, particularly in nursing.
One of the findings from the analysis that Jason and I conducted was that LGBT family caregivers of older adults were more frequently caring for a friend, neighbor, or other family member compared with a spouse or a child. These so-called alternative family structures seen within the LGBT community are a result of historical discrimination and stigma. LGBT older adults in particular have come of age during times in which sexual orientation and gender identity were hidden and considered a mental illness. Many LGBT older adults who might need care must often rely on other family members or friends versus spouses or children because of the denial of civil rights, including marriage equality, during much of their lives. This has significant research, practice, and policy implications because the majority of research regarding caregivers of older adults has focused on spousal caregiving and/or more “traditional” family structures (i.e., caregiving for a parent).
Lorraine Wright and Janice M. Bell defined family as a “group of individuals who are bound by strong emotional ties, a sense of belonging, and a passion for being involved in one another’s lives” in their book Beliefs and Illness: A Model for Healing (2009, p. 46). Lorraine and Maureen Leahey have presented a definition of family as Lorraine shares a story of the meaning of family on her blog, which I think aligns well with the concept of the “chosen family” that many within the LGBTQ+ community speak of. It also seems to me a clarion call for the role of family nurses and family health professionals in addressing the health disparities experiences by the LGBTQ+ community.
Joel G. Anderson, PhD, CHTP, FGSA, is an Associate Professor at the University of Tennessee College of Nursing and a member of the IFNA Communications Committee. His research examines family quality of life in dementia and issues related to caregiving, including the use of social media as part of the family caregiving experience and the unique needs of the LGBTQ+ caregiver population. You can follow him on Twitter at @JoelAndersonPhD or read his blog.
