Aging lesbian, gay and bisexual adults in California have higher rates of chronic disease, mental distress and isolation than their heterosexual counterparts, according to a report released yesterday by the UCLA Center for Health Policy Research.
An estimated 170,000 adults ages 50 to 70 in California identified as lesbian, gay or bisexual in 2007. Researchers estimate that the national population of lesbian, gay and bisexual adults age 65 and older will double to 3 million by 2030. The report's findings indicate their current and growing health needs, and the unique challenges they face as they age.
Based on data from the 2003, 2005 and 2007 California Health Interview Survey, the surveys include more than 1,000 lesbian, gay and bisexual adults ages 50 to 70 in every county in the state. The report offers the first published data on aging lesbian, gay and bisexual adults based on a large statewide population.
In California, these aging lesbian, gay and bisexual adults were more educated and were less racially diverse than heterosexual adults of the same age.
Whereas 16.6 percent of heterosexual adults had advanced degrees, 35 percent of lesbian, gay and bisexual adults did. Nearly 41 percent of heterosexual adults were people of color – African American, American Indian, Asian American, Latino, Native Hawaiian or Pacific Islander, other or mixed race – compared to 22.5 percent of lesbian, gay and bisexual adults.
"By a lot of markers, this should be a fairly privileged population, but it actually wasn't," said Steven Wallace, lead researcher of the report and associate director of the center. "In spite of high education, there were still high levels of chronic illness, and a sort of average level of health insurance."
Wallace noted, however, that the proportion of racial and ethnic minorities among lesbian, gay and bisexual adults could be underreported. The survey has only a couple of questions about sexual identity, he said, and certain communities do not identify with the terms "gay," "lesbian" or "bisexual."
Health differences were most common for men. Aging gay and bisexual men were 1.5 times more likely to rate their own health as fair or poor than were heterosexual men with similar demographics. They also had significantly higher rates of hypertension, diabetes, psychological distress and physical disability.
And 50.5 percent of gay and bisexual men lived alone, compared to just 13.4 percent of their heterosexual counterparts.
"They are in a particularly vulnerable situation," Wallace said. "If you have a fall, if you need somebody to take you to the doctor, need somebody to help you with medications, that's more of a challenge."
The same was true for women. One in four lesbian and bisexual women lived alone, compared to one in five heterosexual women. The report found significantly higher rates of psychological distress, physical disability and self-reported health as fair or poor among lesbian and bisexual women.
Still, there were few differences between heterosexual, and lesbian, gay and bisexual adults in their access to and use of health care services.
Gay and bisexual men delayed care or prescriptions and visited the emergency room at about the same rate as heterosexual men. However, they were 1.19 times more likely to have visited the doctor more than three times in the past year.
But among lesbian and bisexual women, more than one in four reported delaying care – a rate 1.28 times greater than that of heterosexual women. They were also 1.09 times more likely to have had three or more doctor visits in the past year.
Because fewer lesbian, gay and bisexual adults have children, they also have less generational support than do heterosexual adults as they age.
"Most LGBT elder adults don't have the informal family networks that many seniors have, whether that's a son or a daughter, or even a spouse or a partner," said Seth Kilbourn, executive director of Openhouse, a community services and housing organization for LGBT seniors in San Francisco.
San Francisco will be home to an estimated 25,000 gay, lesbian, bisexual and transgender adults over age 60 within the next five years, Kilbourn said. Given the city's expensive housing market, many struggle to find affordable housing.
Openhouse is in the process of building 109 units of low-income, subsidized housing for LGBT seniors. Located in the city's Duboce Triangle neighborhood, the $50 million project has partnered with a developer and is starting to apply for local, state and federal funding to build it, Kilbourn said.
Similar housing exists in Los Angeles. Triangle Square in Hollywood, a project of Gay & Lesbian Elder Housing, was the nation's first affordable housing development for LGBT seniors. More than 800 people applied for a spot in its 104 units in 2006.
Neither project meets the demand in their communities. San Francisco would need thousands more units of affordable housing, Kilbourn said.
Still, aging gay, lesbian and bisexual Californians have more access to resources in these cities than they do in much of the state.
"If you look at where gay and lesbian elders live, half of them live in larger urban counties," – Los Angeles, San Francisco, San Diego and Contra Costa, Wallace said. "That means half of them live elsewhere … where there are gay and lesbian elders, of course, but there's even fewer services."
The report recommends increasing cultural competency and sensitivity among health care providers as a first step toward improving access to and quality of care for aging lesbian, gay and bisexual adults.
It also calls for policies that extend full Medicaid and Social Security spousal benefits to same-sex partners to reduce financial barriers to health care that some older lesbian, gay and bisexual adults encounter.
Lastly, more research on this population is needed, the report says. Most population surveys do not collect data on sexual orientation, and research on older lesbian, gay and bisexual adults has been on a small scale. All major data systems in California, the report says, should include lesbian, gay and bisexual identity as a standard demographic question.