Introduction
Members of the LGBT or Lesbian, Gay, Bisexual and Transgender community in 2016 probably are accepted more in society than even a decade ago. A research report published by the Pew Research Center in 2013 showed that over 55% Americans viewed LGBT members favorably which was a rise by almost 20% when compared to 2003. Lesbians were viewed slightly more favorably than gay men – 58% people had a favorable opinion about lesbians while only 55% had a favorable opinion about gay men. In contrast 92% of LGBT community felt that they had been accepted by society. In sharper contrast, 45% Americans felt that homosexual behavior constitutes sin. Also one in five adults said that they would be very upset if their child announced that he or she was homosexual. While there is more support for gay marriages, LGBT members also report discrimination of various forms against them. Major religious institutions continue to be unfriendly towards the LGBT community. In fact, in the survey the respondents who had felt that homosexuality should be discouraged reported feeling that way because the lifestyle conflicted with their religious views. This shows that homosexuality is per se still not an acceptable lifestyle. The biases that are reflected in the statistics continue to affect the quality of life of homosexuals especially those who are 65 years and older. For the younger generation, homosexuality is a natural part of an individual’s identity and social life. But for the generations before them, historically and socially, homosexuality was not an acceptable or respectable identity. This impacted their lives when they were young and continues to impact their lives in their old age. With this backdrop, this paper will identify, through a literature review, some of the pertinent issues faced by lesbian and gay members of the society, especially when they are 65 years or older or what is known as the elderly community.
Literature Review
It is estimated that in the US presently there are around 1.5 million elderly people who identify as LGBT. This number will double by 2030 . However, very little literature is available regarding the elderly members of the LGBT community due to lack of targeted research both at government and academic levels. Research of the aged seldom includes topics on sexual orientation. However, available literature all point similar issues and mostly centered on access to public services that are designed for the elderly. The main cause of access problems is the still-prevalent bias against homosexuality.
The LGBT community faces a lot of hardship in a society that traditionally accepts only heterosexuality as the orientation that is socially relevant and other orientations are deemed deviant . In many jurisdictions same-sex couples do not enjoy the same legal rights as heterosexual couples which leads to disadvantages in access to social protection schemes such as health care and pensions. Fear of discrimination also causes many workers to hide their sexual orientation for fear of losing jobs. Fear of discrimination leads to mental stress for many members of the LGBT community. Social marginalization that begins in the youth affects the elders in the community as well. Close to 30% of LGBT youth in the US have been sexually abused as children due to their orientation, 40% of homeless youth identify themselves as LGBT which reduces their choices in social shelters and public housing; these don’t allow same-sex couples and also require transgenders to choose one gender. Homelessness leads to health problems and drug addictions. Even well-off lesbian and gay individuals are reported to drink more and continue this habit into later life as well. Psychological stressors from anti-gay bias, limited socialization hubs, and targeted marketing by tobacco and alcohol companies aggravate substance abuse issues that continue to impact their lives as elders. Continued discrimination in society and in health care and other public services has a severe impact. Gay and lesbian elders are less likely to access these facilities compared to their heterosexual counterparts. Also, these service providers may not be familiar with LGBT community and how to manage their requirements.
Another issue is that the lesbian, gay, transgender and bisexual people are generally clubbed together in all settings, which results in lack of targeted services for each community. They are not recognized as a heterogeneous group . In fact, most services including healthcare are not equipped to manage the requirements of people who don’t conform to any sexual identity. Health care is a sector that LGBT members are unable to access with the same ease as heterosexuals. There are no clinicians for handling LGBT specific diseases, same-sex partners are less likely to have adequate self health insurance coverage, and health care workers are not trained to manage their specific needs. While men who have sex with men are the most likely to contract HIV and also witnessed the largest number of new cases of HIV, they face several types of discrimination. Access to antiretroviral medication is limited beyond the white communities. These issues get aggravated for the elderly, especially the current cohort. They grew up when there was far less acceptance of their lifestyle and their fears of being stigmatized prevent them from accessing even available care. They are also less likely to have familial support as they age, when compared to the younger generation. They are more likely to die impoverished because they have no access to spousal, survival and death benefits of Social Security. They also have no automatic next-of-kin rights in hospitals visits and medical decisions . At their workplace they may not have automatic entitlements for family leave, bereavement leave and legally their inheritance and joint property ownerships all need to be explicitly legalized.
Poverty is a major issue facing the elderly gay and lesbian community. 24% elderly lesbians and 15% of elderly gay men are poor compared to 19% and 13% for their heterosexual counterparts . The current group of elderly was in the workforce when discrimination against sexual orientation was quite common. This has lead to a situation of poor or non-existent pension and inadequate social security benefits. Also this cohort of elders is less likely to have married and generally do not have children to support them financially. The safety net programs are designed to support surviving spouses in heterosexual marriages but not in same-sex marriages. Long term care facilities are not built to meet the needs of elderly homosexuals and many report mistreatment from staff in such facilities. Fear of mistreatment leads elderly people to not opt for such facilities, a condition which exacerbates their poverty.
Loneliness is another age related issue that is of particular significance to the elderly gay and lesbian population. It has been noted that the elderly who lived with a partner were more likely to have better physical and mental health . They also had wider support networks and were generally more satisfied with the network when compared to the elderly living alone.
Discussion
The literature review brings to light the dearth of aging in the context of sexuality related data on the homosexual population in general and the homosexual elderly in particular. Lesbians are poorly represented as are people from other races. The available data appears to be constructed on predominantly a white, middle-class demographic . Yet some characteristics have come forward as common. The elderly gay and lesbian community are especially impacted in their access to healthcare, are more likely to be socially isolated, live in fear of discrimination and more likely to die impoverished.
What becomes clear is that there is a cohort effect that is seen uniformly in all the available literature. The current cohort of the elderly was young adult and adult in times when the acceptance of homosexuality was rare . They did not have the positive legal or social position enjoyed by the younger members of the society today. Most of them were raised to believe that homosexuality was deviant behavior. Amongst African American gay men, the elderly were brought up to view their sexual orientation as a disease . Few elderly black gay men openly associate with other black gay men. For them being black and gay are mutually exclusive. In 2015, the US Supreme court has legalized same sex marriage throughout the country and in early 2016 provided legal rights to same-sex to adopt children in all 50 states , neither of which was available to the present day elderly population. This has resulted in isolation and loneliness for the current cohort.
A life-course perspective of the elderly cohort included a review of articles published between 1984 and 2008 was used to understand the age, period, cohort effect. The current social issues of the elderly cohort can be traced back to the cultural and sociopolitical constraints of the world they lived in. Early research on elderly homosexual individuals was focused on dismantling the stereotype that the community was depressed and isolated. The research suggested that elderly gay men and lesbians are able to navigate through life better because of their handling of the crisis of their sexual identities. Other research was aimed at evaluating the psychosocial adjustments of the population. Related research was also carried out on the identity development and psychosocial adjustment to aging. It is only recently that more research has begun on the social support and community needs of the elderly.
It can be seen that contextual factors influence psychological and social functioning among older homosexual adults in positive and negative ways. Notably, the particular factors that have been identified via existing research as contributing to successful aging in older homosexual adult populations include a positive identity, financial resources, adequate and unbiased access to health care and public services, and the community-based and informal support systems. In contrast, negative contextual factors such as institutional discrimination, discrimination in the dispensation of eldercare services and victimization based on sexual orientation more often than not contribute to poor psychosocial adjustment and an increase in cohort effect.
Notable biases in the study
In the literature that was studied, certain biases came to light. The most notable was perhaps the lack of acknowledgment of heterogeneity in the LGBT community. Nearly all literature clubbed the varying sexual orientations under the umbrella term. This means that any research that has been carried out was not targeted for specific groups. Therefore, while the needs of a community as a whole have been identified, group specific requirements have not. Racial biases are noted. Studies do not clearly demarcate racial demographic making it difficult to appreciate how different races are impacted. It is unclear even whether any demographic other than white was part of the studies reviewed. Most of the studies in the past were not empirical which makes it difficult to create a theoretical basis for studying this subject. The recent studies are again hobbled by being generic in their approach to the LGBT community as a whole rather than target groups within the community. There is also continued bias towards segmenting sexual behavior in the binary form and giving it an identity . The various sexual orientations have been studied as a contrast to heterosexuality and never compared among themselves.
Overcoming the cohort effect
The review did not identify address the cohort effect. While it was noted that such effect exists, a lack of adequate quantitative analysis made it difficult to identify what measures could be applied to overcome the effect. Earlier research literature revealed that homosexual elders were leading satisfactory lives , but recent literature suggests that this demographic is struggling with several issues . While measures like improving approach to homosexuality in healthcare services , social security, and legal aid have been suggested as methods to create a positive social environment for the elderly homosexual, lack of literature on the experiences of the community makes it difficult to assess the effectiveness of such measures.
Conclusion
A history characterized by lack of tolerance and acceptance for homosexuality has shaped the psychosocial quotient and the identity development of many people in the current cohort of older homosexual adults. Many are finding that coming out with their sexual orientation has left them susceptible to a potential dearth of social support and legal aid . It appears that although older homosexual adults still prefer to remain ‘in the close’ and are largely invisible, the people who have been studied have displayed a vast range of experiences with respect to creating and maintaining family structures and also accruing informal social supports. However when the formal systems of support are examined, it is apparent that large portions of the elderly homosexual population remains underserved. They do not access these services because of their own individual experiences of victimization and discrimination as well as their historical isolation and continued institutional marginalization. Another factor that affects access to support services is the ageism in these communities. It further contributes to the elderly homosexual adults’ experiences of marginalization and isolation.
The research makes it clear that very little by way of empirical research has been conducted to study the lives of elderly homosexuals. It is only recently that more targeted research into their specific needs has been conducted . One barrier to research is the reluctance on part of the elderly to “come out” for fear of victimization. The other barriers are institutional. Current public service providers for the elderly are not equipped to manage the requirements of this group. It is therefore imperative that steps be taken to improve the access to healthcare and other public services for this group of people.
Further research
There is plenty of scope for research into the effects of aging for the elderly homosexual population.
There is scope to study how homosexual elders have evolved in their sexual behavior over time. A significant direction for future research is to identify means to capture the experiences of sexuality. A more theoretical analysis that identifies and quantifies the distinctions and movements between sexuality, sexual behaviors, and identity of individuals would help to highlight issues that are not captured by the present research methods.
Research should recognize the heterogeneity of the LGBT and gender non-conforming groups and conduct studies targeted at each group specifically to understand and evaluate their unique experiences and needs.
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