Transgender older adults' prior military service: Mental health differences by gender identification.

Despite a proportionally higher likelihood of serving, the role of prior military service in the mental health of transgender individuals is understudied. Research on the impact of military service on mental health tends to be proximal. We examined the distal relationship between prior military service, identity stigma, and mental health among transgender older adults, drawing comparisons between transgender men and women. We conducted a series of weighted multivariate linear models to predict the relationships between prior military service, identity stigma, perceived stress, and depression among 183 transgender women and men aged 51-87 (M = 60.11, SD = 0.668) using 2014 data from the National Health, Aging, and Sexuality/Gender Study. Prior military service was negatively associated with depression and perceived stress; identity stigma was positively associated with both. Prior military service and lower depression and perceived stress were significant for transgender men, but not women. Identity stigma was significant with depression and perceived stress among transgender women, but not transgender men. Our preliminary findings suggest that prior military service may serve as a protective factor for mental health among transgender men, but not transgender women. We need to better understand how military experience interacts with other characteristics, such as differing gender identities influences the mental health of transgender service members. Further research is needed to inform underlying mechanisms whereby military service differentially impacts mental health by gender identity so all active-duty personnel can share in the many benefits that accrue from military service, including protective effects on mental health in later life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Multidimensional social connectedness of sexual and gender minority midlife and older adults: Findings from the National Health, Aging, and Sexuality/Gender Study (NHAS).

This article introduces the multidimensional properties of social connectedness among sexual and gender minority (SGM) midlife and older adults and examines the relationship between these properties and general health. Data were analyzed from Aging With Pride: National, Aging, and Sexuality/Gender Study, including 2,450 SGM adults aged 50 and older in the United States. The structure, function, and quality of interpersonal relations as well as community-level activities and engagement were measured through a self-administered survey and an in-person interview. Findings indicated that SGM midlife and older adults, on average, had a large social network with high bridging potential and low density, consisting of more nonrelative family members than immediate family members. They also showed frequent availability of social support, moderate or higher satisfaction with interpersonal relations, and moderate SGM community engagement. Properties of social connectedness differed by gender, sexual identity, and gender identity, with SGM men, sexually diverse women, and transgender people showing distinct challenges in interpersonal relations. All aspects of social connectedness were positively associated with good general health, particularly network diversity, outdoor leisure activity engagement, and access to health-related decision support, controlling for age and chronic conditions. Care receiving and loneliness were negatively associated with good general health. Intervention development can target these factors to promote social and community connectivity and reduce the negative health effects of persistent social stressors. This study underscores the necessity of addressing all facets (i.e., structure, function, and quality) of interpersonal relations encompassing both immediate and chosen family as well as community-level social connectedness. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Health, Economic, and Social Disparities among Lesbian, Gay, Bisexual, and Sexually Diverse Adults: Results from a Population-Based Study.

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health outcomes, chronic conditions, health care access, health behaviors, and preventive care by gender and sexual identity. Sexual minority adults reported heightened risks of poor general health, physical and mental health, disability, subjective cognitive decline, and financial barriers to health care, compared with their straight counterparts. Economic disparities and disability were evident for lesbians and both bisexual adult women and men. We found higher rates of smoking and excessive drinking among lesbians and bisexual women, and higher rates of smoking and living alone among gay men. Sexually diverse adults experience disparities in health care access. This study is one of the first to identify disparities among sexually diverse populations, in addition to lesbian, gay, and bisexual adults. More research is required to understand the mechanisms of disparities within these groups to address their distinct intervention needs.

Lifetime Violence, Lifetime Discrimination, and Microaggressions in the Lives of LGBT Midlife and Older Adults: Findings from Aging with Pride: National Health, Aging, and Sexuality/Gender Study.

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimination, and contemporary microaggressions among LGBT adults, aged 50 and older, utilizing data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. We examined subgroup differences, the interrelationships between adverse experiences, and the association with health, taking into consideration interactions by age. Results: Distinct aspects of these experiences were effectively captured by tailored measures. Important subgroup differences emerged with high levels of lifetime violence among sexually diverse adults, gay and bisexual men, and transgender adults. Experiences of violence remained a significant predictor across all three health outcomes, after controlling for both lifetime discrimination and microaggressions. Microaggressions had a significant contribution to comorbidity for those with a low level of lifetime violence. The interaction effects suggest that comorbidity increases as the number of lifetime violence experiences increases for those who are younger. As age increased, the lifetime violence effect on comorbidity diminished whereas the microaggressions effect became stronger. Conclusion: Greater attention to the sequelae of lifetime violence and other adverse events among midlife and older adults is needed as well as the development and testing of both downstream and upstream interventions to reduce and mitigate the impact of these experiences on the well-being of LGBT midlife and older adults.

Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA).

Background: Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods: This paper describes the virtual adaptation process of the first-ever randomized controlled clinical trial intervention, Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA), that was designed for SGM older adults living with dementia and their care partners and built upon the foundation of RDAD and NHAS. Results: The virtual adaptation of IDEA was guided by the goals of accessibility, quality, ease of delivery, sustainability, and cultural relevance. The implementation required the development of a HIPPA-compliant online virtual platform, coach and participant virtual training, and modification of necessary intervention elements and materials, as needed. Based on the preliminary findings, the participants and intervention coaches responded well to the virtual adaptation of IDEA. When comparing to in-person delivery, the virtual delivery decreased attrition among both intervention participants and coaches. Discussion: The virtual adaptation of the IDEA intervention resulted in preliminary, unexpected, yet potentially important benefits, including the ability to expand the reach of the intervention and decreased attrition. Virtual interventions are an emerging field for people living with dementia and their care partners and additional systematic research is needed to fully assess the benefits and limitations as well as to evaluate if specific subgroups are better served by differing delivery modalities.

Preliminary Efficacy of Let's Talk Tech: Technology Use Planning for Dementia Care Dyads.

Background and Objective: Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, "Let's Talk Tech," for people living with mild dementia and their care partners. This paper presents preliminary efficacy findings of this intervention designed to educate and facilitate dyadic communication about a range of technologies used in dementia care and to document the preferences of the person living with dementia. It is the first-of-its-kind decision-making and planning tool with a specific focus on technology use. Research Design and Methods: We used a 1-group pretest-post-test design and paired t tests to assess change over 2 time periods in measures of technology comprehension, care partner knowledge of the participant living with mild Alzheimer's disease's (AD) preferences, care partner preparedness to make decisions about technology use, and mutual understanding. Thematic analysis was conducted on postintervention interview transcripts to elucidate mechanisms and experiences with Let's Talk Tech. Results: Twenty-nine mild AD dementia care dyads who live together completed the study. There was statistically significant improvement with medium and large effect sizes on outcome measures of care partners' understanding of each technology, care partners' perceptions of the person living with dementia's understanding of each technology, knowledge of the person living with dementia's preferences, decision-making preparedness, and care partners' feelings of mutual understanding. Participants reported that it helped them have important and meaningful conversations about using technology. Discussion and Implications: Let's Talk Tech demonstrated promising preliminary efficacy on targeted measures that can lead to informed, shared decision making about technologies used in dementia care. Future studies should assess efficacy with larger samples and more diverse sample populations in terms of race, ethnicity, and dementia type.

Design and development of the first randomized controlled trial of an intervention (IDEA) for sexual and gender minority older adults living with dementia and care partners.

BACKGROUND: Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. OBJECTIVE: This study describes the design of the first randomized controlled trial (RCT) testing a culturally responsive cognitive behavioral and empowerment intervention, Innovations in Dementia Empowerment and Action (IDEA), developed to address the unique needs of SGM older adults living with dementia and care partners. METHODS: IDEA is a culturally enhanced version of Reducing Disability in Alzheimer's Disease (RDAD), an efficacious, non-pharmaceutical intervention for people with dementia and care partners. We utilized a staggered multiple baseline design with the goal to enroll 150 dyads randomized into two arms of 75 dyads each, enhanced IDEA and standard RDAD. RESULTS: IDEA was adapted using findings from the longitudinal National Health, Aging, and Sexuality/Gender study, which identified modifiable factors for SGM older adults, including SGM-specific discrimination and stigma, health behaviors, and support networks. The adapted intervention employed the original RDAD strategies and enhanced them with culturally responsive empowerment practices designed to cultivate engagement, efficacy, and support mobilization. Outcomes include adherence to physical activity, reduction in perceived stress and stigma, and increased physical functioning, efficacy, social support, engagement, and resource use. CONCLUSION: IDEA addresses contemporary issues for underserved populations living with dementia and their care partners. Our findings will have important implications for marginalized communities by integrating and evaluating the importance of cultural responsiveness in dementia and caregiving interventions.

Sexual Minority Disparities in Subjective Cognitive Impairment: Do They Persist After Accounting for Psychological Distress?

Objectives: Sexual minority older adults are a health disparate group with disproportionate rates of subjective cognitive impairment (SCI) and psychological distress. This study estimated risks of SCI by sexual orientation and gender, accounting for variations in psychological distress. Methods: We aggregated National Health Interview Survey data (2013-2018) of adults aged 45 and older and implemented logistic regressions of SCI indicators on sexual orientation and psychological distress, adjusting for covariates. Results: Sexual minority adults showed higher likelihoods of SCI in terms of status, severity, frequency, extent, and activity limitations than heterosexuals, even after controlling for psychological distress. SCI risk was significantly higher among sexual minority vs. heterosexual women, with no significant difference among men. Conclusions: Public health initiatives should address this health disparity in SCI and support informal care networks for sexual minorities. Future research is needed that further investigates SCI at-risk groups, with attention to sexual minority women.

Identifying Latent Patterns and Predictors of Health Behaviors and Healthcare Barriers Among LGBT Older Adults.

Heightened risk of adverse health behaviors is of major concern among lesbian, gay, bisexual, and transgender (LGBT) older adults. Yet, no previous research has investigated heterogeneity of LGBT older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to identify latent classes of the behavior and barrier patterns and examine differences in physical and psychological health-related quality of life (HRQOL) by the specified latent classes while exploring predictors of the class membership. Three-step latent class analysis applying survey weights was conducted with 14 indicators of health-risk behavior, health-promoting behavior, preventive care use, and healthcare barriers from baseline data of the Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS, N = 2450). The best empirical and substantive fit was determined with four classes consisting of (1) healthy behaviors and minimal barriers (C1, 39%), (2) less healthy behaviors and high barriers (C2, 31%), (3) healthy behaviors and healthcare system barriers (C3, 19%), and (4) optimal health behaviors with risks of limited healthcare access (C4, 11%). Compared to C1, C2 and C3 had lower physical HRQOL and C2 also had lower psychological HRQOL. C4 did not differ in HRQOL from C1. C2 was associated with more day-to-day discrimination, lower mastery, and lower social support. Efforts to lower healthcare barriers are warranted in addition to interventions to strengthen social support and reduce marginalization. Positive relationships between LGBT older adults and healthcare need to be established via trust-building and cultural competency.

Stress and Resilience among Sexual and Gender Diverse Caregivers.

Little is known about caregiving outcomes of sexual and gender diverse, including LGBT, caregivers. Informed by the Health Equity Promotion Model (HEPM) and Pearlin's Stress Process Model, we utilized data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), to examine perceived stress among a sample of 754 sexual and gender diverse caregivers using regressions on background and caregiving characteristics and risk and protective factors. Among caregivers, 38% were providing care to a spouse or partner and about one-third to a friend (29%). Higher stress was associated with younger age, lower income, higher education, partner/spouse care, personal care provision, longer caregiving hours, and caregiver cognitive impairment. After including the risk and protective factors from HEPM, victimization, social support, and community engagement significantly predicted perceived stress. Findings contribute to emergent research on caregiving in diverse populations.

Predictors of Loneliness Among Older Lesbian and Gay People.

This study sought to understand the social and individual factors that predict loneliness among older lesbian and gay people in Australia. A sample of 508 gay men and 241 lesbian women, aged 60 and over, completed a survey including measures of loneliness, internalized homonegativity, sexual orientation discrimination, and connectedness to lesbian and gay communities. A multivariable linear regression predicting loneliness was conducted. Not being in an intimate relationship and having less connection to lesbian and gay communities were significant predictors of loneliness for both older lesbian women and gay men. For the men, younger age, internalized homonegativity and more frequent lifetime experiences of sexual orientation discrimination also appeared to predict greater likelihood of loneliness. More frequent recent experiences of sexual orientation discrimination predicted loneliness for the women. The findings confirmed loneliness as an issue of concern among older lesbian and gay people and identified factors amenable to intervention to address loneliness.

Determinants of Physical Functioning and Health-Related Quality of Life among Sexual and Gender Minority Older Adults with Cognitive Impairment.

Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study with a sub-sample of 855 SGM older adults who reported difficulties in cognitive performance. Results: Physical functioning and HRQOL linearly declined over time, and the decline of physical functioning was steeper for those with low levels of physical and outdoor leisure activities. The overall levels of physical functioning and HRQOL over time were associated with physical and outdoor leisure activities, optimal sleep, and sufficient food intake. HRQOL was negatively associated with lifetime discrimination and victimization, identity stigma, and smaller social network. Discussion: These findings can be used to develop interventions to improve physical functioning and HRQOL of SGM older adults living with cognitive impairment.

Key Determinants of Physical and Psychological Health-Related Quality of Life Over Time Among Midlife and Older LGBTQ and Sexual and Gender-Diverse Caregivers.

BACKGROUND AND OBJECTIVES: Prior research has shown informal caregiving among older adults can negatively affect the caregiver's physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers. RESEARCH DESIGN AND METHODS: Informed by the Health Equity Promotion Model and Caregiver Stress Process Model and utilizing longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, this analysis examined modifiable risk and protective factors associated with psychological and physical HRQOL over time among 754 LGBTQ caregivers aged 50-98. RESULTS: Psychological and physical HRQOL declined over a 3-year period. After controlling for background characteristics, mastery, social support, socialization, LGBTQ community engagement, and physical activity were positively associated with psychological HRQOL while day-to-day discrimination, identity stigma, and insufficient food intake were negatively associated. Steeper declines were observed for older and with no physical activity. Mastery, social support, socialization, and physical activity were positively associated with physical HRQOL while day-to-day discrimination and insufficient food intake were negatively associated. Steeper declines were found for those with high mastery and no physical activity. DISCUSSION AND IMPLICATIONS: Although generalized factors including mastery, socialization, and social support are protective for HRQOL among LGBTQ caregivers, factors including day-to-day discrimination and identity stigma are more unique to historically disadvantaged populations and should be considered in future research and practice. Caregiving interventions incorporating physical activity are promising given its buffering effect for decreased physical and psychological HRQOL over time.

Generational and Social Forces in the Life Events and Experiences of Lesbian and Gay Midlife and Older Adults Across the Iridescent Life Course.

ObjectivesUtilizing Iridescent Life Course, we examine life events among three generations of lesbian and gay adults: Invisible (born 1920-1934), Silenced (born 1935-1949), and Pride (born 1950-1964) Generations. Methods: We utilized a subsample (n = 2079) from the 2014 wave of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). Demographic characteristics, life events, and gender and generational interactions were compared. Results: Compared to other generations, the Invisible Generation disclosed their identity at older ages, were more likely to be retired, served in the military, and survived a partner's death. Compared to the other generations, the Pride Generation was more likely to have disclosed their identities earlier and experienced higher levels of victimization/discrimination. Discussion: This paper is the first to examine the lived experiences of the oldest lesbians and gay men and compare them to other generations. The findings illustrate the heteronormative nature of most life course research.

Blueprint for Future Research Advancing the Study of Sexuality, Gender, and Equity in Later Life: Lessons Learned From Aging With Pride, The National Health, Aging, and Sexuality/Gender Study (NHAS).

While interest in sexuality\research is growing, in the past, it has been largely invisible in gerontology. By exploring the full range and dimensions of sexuality and their interrelationships with multiple factors, this article presents conceptual, substantive, and methodological advances for the field of sexuality in later life. Based on the Sexual Equity Framework, an extension of the Health Equity Promotion Model, this article highlights the heterogeneity and intersectionality of sexuality across the life course, examining how historical and contemporary contexts frame key dimensions of sexuality at multiple levels (intrapersonal, interpersonal, sociocultural, and structural) and their relationship with sexual quality of life. Utilizing findings from Aging with Pride: National Health, Aging and Sexuality/Gender Study, the heterogeneity and intersectionality of age, gender, race, and ethnicity are critical to understanding sexuality and its dimensions in later life. Many adults experience changes in sexual and gender identities over time. Affirming sexual and gender identities, social connections, and health-promoting behaviors are positively associated with sexual quality of life, while sexual stigma and marginalization have adverse consequences. The study of sexuality needs to be fully integrated into gerontology. The Sexual Equity Framework explicates the potential deleterious effect of historical and contemporary structures on sexuality as well the important roles of affirmation, agency, and resilience among older adults, and recognizes the important role of human rights to advance sexual quality of life. Important directions for future research, practices, and policies are outlined.

The Role of Contextual Factors in the Health Care Utilization of Aging LGBT Adults.

BACKGROUND AND OBJECTIVES: Research suggests lesbian, gay, bisexual, and transgender (LGBT) populations have unique health care challenges. The purpose of this study was to understand contextual factors, including minority stress and social resources, associated with the health care utilization of LGBT middle-aged and older adults. RESEARCH DESIGN AND METHODS: Using data from the Caring and Aging With Pride: National Health, Aging, and Sexuality/Gender Study (N = 2,560), multiple logistic regression investigated associations between minority stress (i.e., internalized stigma and LGBT identity disclosure) and health care utilization (i.e., health screenings, emergency room use, routine checkups, and regular provider). We also examined the moderating effect of social resources (i.e., social network size, social support, and LGBT community belonging) in these associations. RESULTS: Internalized stigma was negatively associated with having a routine checkup in the previous year. LGBT identity disclosure was positively associated with having a health screening within the past 3 years. Social support moderated the association between LGBT identity disclosure and health screenings. DISCUSSION AND IMPLICATIONS: Health and human service professionals and their clients should be educated about the ways that LGBT identity disclosure can affect health care utilization. Providers should consistently assess the social support of their aging LGBT clients and inform them about the potential risk of low social support in health care utilization.

Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool.

BACKGROUND: Monitoring technologies are used to collect a range of information, such as one's location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult's dignity and wishes. OBJECTIVE: We designed, developed, and piloted a communication and education tool in the form of a web application called Let's Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention's motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners. METHODS: We surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants' experiences and recommendations to improve the intervention. RESULTS: The study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others. CONCLUSIONS: This study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.

Experiences of informal caregiving among older lesbian and gay adults in Australia.

OBJECTIVE: This study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving. METHODS: Interviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach. RESULTS: Most participants were caring for a friend or partner and regarded caregiving as a form of love and did not seek external support despite noting several impacts. Some participants found that they too were beginning to require care. For some, formal care was being considered, but with a degree of reluctance. CONCLUSIONS: Older lesbian and gay adult caregivers experience a range of challenges and support needs in relation to their experiences with the caregiving role. This research highlights a need for ensuring that caregiving policies and practices be responsive to the experiences and challenges faced by older lesbian and gay people.

Health, economic and social disparities among transgender women, transgender men and transgender nonbinary adults: Results from a population-based study.

We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from the Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence by gender identity for background characteristics, economic, social and health indicators. We performed regressions of these indicators on gender identity, including transgender versus cisgender adults and transgender nonbinary adults compared to cisgender adults, followed by subgroup analyses: transgender women and men compared to each cisgender group and to one another, adjusting for covariates. Compared to cisgender adults, transgender adults overall were significantly younger and lower income with less education; more likely single with fewer children; and had several elevated health risks, including poor physical and mental health, and higher rates of chronic conditions and disability. Alternatively, transgender men and women had higher rates of flu vaccination than cisgender men. Between transgender subgroups, transgender men and transgender nonbinary adults were younger than transgender women; transgender men were significantly less likely married or partnered than transgender women; and, transgender women were more likely to live alone than nonbinary respondents. This is one of the first population-based studies to examine both between and within subgroup disparities among cisgender, transgender binary, and transgender nonbinary adults, revealing patterns of inequities across subgroups. More research understanding the mechanisms of these disparities and the development of targeted interventions is needed to address the unique needs of subgroups of transgender people.

Utilization of Recommended Preventive Health Screenings Between Transgender and Cisgender Older Adults in Sexual and Gender Minority Communities.

ObjectivesTransgender older adults are among the most health disparate populations in the United States; they also face some of the most significant barriers in accessing high quality, affordable, preventive healthcare services. We compare utilization rates of eight recommended preventive health screenings for adults aged 50 and older, by gender identity. Methods: We analyzed data from 2514 lesbian, gay, bisexual, and transgender adults aged 50 and older, testing associations between gender identities and screening service utilizations by applying a series of multivariate logistic regression analyses, controlling for sociodemographics. Results: Compared to cisgender LGB participants, transgender participants had significantly lower odds to have met four of the recommended screenings. Transgender men had significantly lower odds than transgender women to have met two of the recommended screenings. Discussion: Increasing transgender older adults' access to preventative health screening tests is critical to reduce the health burden in this aging population.