CLINICAL INVESTIGATION

Lesbian, Gay, Bisexual, and Transgender Older Adults’

Experiences With Elder Abuse and Neglect
Elizabeth M. Bloemen, MD, MPH,* Tony Rosen, MD, MPH,† Veronica M. LoFaso, MD,‡
Allison Lasky, BA,‡ Skotti Church, MD,* Porsha Hall, MPH, MA,§ Tom Weber, BA,§ and
Sunday Clark, ScD, MPH†

not know who to report to. Strategies participants

BACKGROUND/OBJECTIVES: Little is known about suggested to improve outreach included: increasing aware-
elder abuse and neglect in the lesbian, gay, bisexual, and ness about available resources and researchers engaging
transgender (LGBT) community; however, this population with the LGBT community directly.
faces a greater risk of abuse and likely experiences abuse CONCLUSION: LGBT older adults conceptualize elder
differently and needs different resources. We conducted abuse differently and have different experiences with police
focus groups to investigate LGBT older adults’ perspectives and medical providers. Improved outreach to this poten-
on and experience with elder mistreatment. tially vulnerable population is critical to ensuring their
METHODS: We conducted three focus groups with 26 par- safety. J Am Geriatr Soc 00:1-8, 2019.
ticipants recruited from senior centers dedicated to LGBT
older adults. A semistructured questionnaire was developed, Key words: LGBT; neglect; elder abuse
and focus groups were audio recorded, professionally tran-
scribed, and analyzed using grounded theory.
RESULTS: Key themes that emerged included: definitions
and etiologies of abuse, intersectionality of discrimination
from multiple minority identities, reluctance to report, and
suggestions for improving outreach. Participants defined
elder abuse in multiple ways, including abuse from systems
and by law enforcement and medical providers. Commonly
reported etiologies included: social isolation due to discrimi-
E lder abuse, neglect, and exploitation are common and
have serious health, social, and financial consequences.
In surveys of older adults, it is estimated that 5% to 10%
nation, internalization of stigma, intersection of discrimina- experience mistreatment each year, including physical, sex-
tion from multiple minority identities, and an abuser’s ual, emotional/psychological, and financial abuse, or
desire for power and control. Participants were somewhat neglect.1,2 Victimization increases the risk of mortality,3
hesitant to report to police; however, most felt strongly that disability,4 hospitalization,5 and institutionalization,6 and
they would not report abuse to their medical provider. likely costs billions of dollars each year.
Most reported that they would feel compelled to report if While research in elder mistreatment has expanded in
they knew someone was being abused; however, they did recent years, there is a great need for a better understanding
of how minority populations experience abuse and access ser-
vices. Little is known about lesbian, gay, bisexual, and trans-
From the *Division of Geriatric Medicine, University of Colorado School of gender (LGBT) older adults’ unique experiences.
Medicine, Aurora, Colorado; †Department of Emergency Medicine, Weill LGBT older adults have faced a lifetime of discrimina-
Cornell Medical College, New York, New York; ‡Division of Geriatric and tion7; are more likely to have experienced sexual and intimate
Palliative Medicine, Weill Cornell Medical College, New York, New York;
partner violence8; more often have developed families of
and the §Services and Advocacy for Gay, Lesbian, Bisexual and
Transgender Elders, New York, New York. choice, resulting in reliance on aging friends and non-
biologically related caregivers9; and are more likely to be
Address correspondence to Elizabeth M. Bloemen, MD, MPH, Division of
Geriatric Medicine, University of Colorado School of Medicine, Mail Stop human immunodeficiency virus (HIV) positive. Each of these
B179, Academic Office One, Room 8107, 12631 E 17th Ave, Aurora, CO may place them at a higher risk for mistreatment in later life
80045. E-mail: [email protected] as their health declines, partners and loved ones pass away,
Presented at the 2017 Annual Meeting of the American Geriatrics Society, and the complications of HIV status, including HIV-related
Presidential Poster Session May 2017, San Antonio, TX dementia, increase.10 In the limited literature available,
DOI: 10.1111/jgs.16101 22.1% of LGBT adults older than 60 years reported that they

JAGS 00:1-8, 2019

© 2019 The American Geriatrics Society 0002-8614/19/$15.00
2 BLOEMEN ET AL. MONTH 2019-VOL. 00, NO. 00 JAGS

had been harmed, hurt, or neglected by a caregiver, 25.7% Participants were instructed to use coded identifiers rather
reported knowing someone who had been mistreated,11 and than their names to maintain confidentiality. No demographic
over 60% had experienced psychological abuse.12 In addition information nor abuse history was collected to foster an open
to being at increased risk, LGBT older adults may also have environment and encourage active participation by all partici-
had different relationships with service providers and likely pants. Focus groups were audio recorded and fully tran-
have developed different help-seeking behaviors.13 To address scribed. We used the Consolidated Criteria for Reporting
some of these issues, academic medical groups have provided Qualitative Research to guide collection, analysis, and
guidance to improve care for LGBT patients and have cited reporting of the data.24 The study was approved by the Weill
the need for research and improved understanding of issues Cornell Medicine Institutional Review Board.
pertinent to this population.14
Our goal was to improve our understanding of LGBT older Analysis
adults’ experiences with elder mistreatment, access to resources,
and interactions with medical and service providers. Grounded theory was used to analyze the focus groups. This
included iterative refinement of the questionnaire between each
group as participant responses and discussion directed future
METHODS conversations. Themes were identified by members of the
We conducted focus groups with LGBT older adults to gain research team after iterative review of the transcripts. Once
insight into their experiences with elder mistreatment, bar- codes were developed, the research team reviewed the themes
riers they face in accessing resources, and ways that medical for accuracy and the transcripts were rereviewed and coded.
and service providers can improve outreach and support to Any discrepancies were resolved by consensus. All the key
this community. Because little is known about elder abuse themes reached saturation by the end of the third focus group.
among LGBT older adults, qualitative methods are ideally
suited for the in-depth investigation of this complex social RESULTS
issue.15 Focus groups have previously been successfully used
in elder abuse16-18 and intimate partner violence among Three focus groups of 8 to 10 participants each (26 total)
younger LGBT adults.19,20 were conducted at three SAGE centers, each representing a
This study was conducted in collaboration with a different borough of New York City. Participants were all
national leader in LGBT older adult service provision, Services SAGE members, identified as LGBT, and were older than
and Advocacy for Gay, Lesbian, Bisexual, and Transgender 50 years.
Elders (SAGE). SAGE runs senior centers dedicated to LGBT
older adults in each of the five boroughs in New York City An Expanded Definition of LGBT Elder Mistreatment
and has more than 5000 members. These community centers
provide services, including: care management, social activities, Classically, elder abuse is defined as verbal, physical, sexual,
congregate meals, adult day programs, benefits counseling, or financial abuse of an older adult by a person of trust, such
nursing services, and physical activities. SAGE leads the as a family member, friend, significant other, or caregiver1;
National Resource Center on LGBT Aging to develop and participants identified this as occurring in their commu-
resources and trainings to improve the care of older adults nity: “I’ve known lots of physical relation, gay relationships
and has been actively engaged in research focused on improv- that have regrettably got involved with physical abuse from
ing the care and treatment of LGBT older adults.21,22 one to another.” However, participants reported an expanded
definition of abuse for their community, including ostracism
from family due to LGBT status and concerns about abuse
Questionnaire Development from service providers, such as medical providers and police
We developed a semistructured questionnaire that was (Table 1). For example, one participant explained: “When I
adapted iteratively throughout the research process. The initial go to my doctor, I’m afraid to talk about who I am and ask
questionnaire included questions from previous studies16,23 as for help…And for me, that’s a form of abuse.”
well as those developed by the authors. All questions were pil-
oted with SAGE members and staff to ensure sensitivity and
Etiologies of Abuse
comprehensibility. Questions focused on the definition of elder
abuse, prevalence in the community, members’ willingness to Participants identified multiple etiologies, including: the
report or reach out to services, and barriers to reporting and desire for power and control; cycles of family violence;
accessing care (Supplementary Table S1). changing roles and increased dependency; the intersection of
LGBT and aging identity; isolation of family and lack of
advocates; and discrimination by medical providers
Participant Recruitment
(Table 1). The intersection of being LGBT and aging was
Focus groups were held in June and July 2016 at SAGE cen- often highlighted as increasing the risk for abuse: “We have
ters. Participants were recruited from among SAGE members more than one thing to fight against. The discrimination of
through regular programming advertisements. Participants being LGBT and…then you have the double whammy of
were only included if they spoke English and were believed by being elderly.” This was of great concern as participants
SAGE staff to have the capacity to consent. A SAGE staff were worried that some may believe that they could “get
member with social work training (P.H.) observed each focus away with…abuse towards homosexuals via the senior,”
group to assist any participant who became distressed during and this may represent a different etiology unique to their
the conversation or if a participant reported abuse. community. Participants also identified causes of abuse
JAGS MONTH 2019-VOL. 00, NO. 00 LGBT OLDER ADULTS’ EXPERIENCES WITH ABUSE 3

Table 1. Themes, Categories, and Representative Quotations from Focus Groups with LGBT Older Adults Regarding
the Themes of Definitions and Etiologies of Abuse
Categories Representative quotations

Definitions of Abuse
Typical definition of elder abuse “elder abuse is an…intentional act, which may be medical, physical, mental or social,…a
failure to act by a caregiver or a person or people in a relationship…which causes harm to a
person who is 60 plus years old”
Ostracism due to LGBT status “he move away…and then when [his mother] died the sister of all of his relatives, only they
inform him that she passed away but he doesn’t go to the funeral,…because the family…
doesn’t like to mingle with him. So I think it is abusive mentally”
“And I find that a lot of us are isolated and ostracized by our families”
Service providers “…if you have to call the police for a situation and they come and it’s SGL, same gender
loving people, they think it’s a joke.”
“I mean it’s not the physical abuse I suffered at the hands of New York’s finest”
“When I go to my doctor, I’m afraid to talk about who I am and ask for help, and that to me is
a hindrance for me getting the care that I need. And for me, that’s a form of abuse…I’m not
going to get the right kind of medical care that I deserve.”
Etiologies of Abuse
Desire for power and control “I think it’s a power trip that people in terms of if they feel inferior it helps their self-definition to
hurt someone lower than themselves.”
Cycles of family violence “But besides that, we’ve got to, we’ve really got to go back into our family and our history and
people in general because abuse just doesn’t start…as a child, some of us are abused by our
parents…They could be hating for whatever reason, but when they grow, as a child they’re
abused, and they bring that up through the ages with the kids beating up their kids, the kids
beating up their kids, and it goes up on the line. It’s just not one, bad thing, it’s ongoing.”
Abuse due to increased dependency “The grown children might not have the patience. It’s like when…the children were small you
and changing roles had so much patience to teach them this…but when you get up in age they don’t have that
patience.”
“I think a lot of times through the years, I mean, it was loving and everything, but after while
when one gets kind of ill, they become like co-habitating…it’s like you’re in a prison without
bars. You want to leave, but there’s no place to go; you’re up in age now. So you have to
deal with whatever happens….And you resent that…and the loving that you had before, it’s
kind of like fades away.”
Increased victimization due to LGBT “And the answer is there are still people today who think that they can get away with…abuse
status and aging towards homosexuals via the senior.”
“But I bet if you took a survey, you’d find there’s a lot of still harbored resentment against this
community and because of the resentment…the LGBT community is much more susceptible
to abuse and then when you become elderly and frail and defenseless, even more.”
“We have more than one thing to fight against. The discrimination of being LGBT and…then
you have the double whammy of being elderly.”
Isolation of family and lack of “And I find that a lot of us are isolated and ostracized by our families, so when we have to
advocates depend on nursing homes and medical facilities and we don’t have anybody to advocate and
come and visit us to make sure that we’re alright and that things are going fine for us, those
are the times when we are abused. You see it happening all the time, you know…riddled with
bed sores because nobody cares. Nobody’s visiting, nobody’s taking heed to what’s
happening to the older adult in the community.”
Providers’ communication “When I go, ‘What’s your pain level?’ It’s so and so. Okay, bah, bah, bah, into the computer.
Alright, bah, bah, bah, you’re out.”
Medical providers’ personal bias “My mother was in a nursing home, 95, terrible problem with her knee. I went out and I found
a doctor in the hall…he said to my mother, ‘Alright, what’s the problem?’ She says, ‘My left
knee is in terrible pain,’ so the doctor didn’t give her anything…‘What do you want at your
age? You’re 95.’”
“Also we need to be careful when other gay people go especially to the doctors…Try to let
them know that you are gay and that way they…comfortable to take care of us because
some of them no”
Underresourced long-term care “Because my impression is that a lot of people were hired because economically it was
cheaper to get people who are less qualified.”

Abbreviation: LGBT, lesbian, gay, bisexual, and transgender.

from medical providers, including lack of communication Reaching Out for Help
skills; personal biases, including both heteronormative and Many participants reported willingness to reach out for
ageist beliefs; and underresourced long-term care options help and advocate for themselves, while others reported
that contribute to psychological abuse and neglect. nervousness about reaching out to law enforcement or
4 BLOEMEN ET AL. MONTH 2019-VOL. 00, NO. 00 JAGS

other providers (Table 2). Participants also recognized that Barriers to Reporting and Accessing Services
while they may be willing and able to advocate for themselves
Participants reported a multitude of factors that created
at the time of the focus groups, this may greatly change if barriers to reporting and accessing services (Table 2).
they become frail or cognitively impaired and dependent on Many participants reported distrust of police or medical
others. Additionally, participants reported a great willingness providers, and others merely did not know who to talk to
to advocate on the behalf of others, and several identified or call if they had a concern or problem, for example:
themselves as “fighters” who could help others. As one par- “Participant 7: who do you call if you can’t call a police
ticipant described: “You see another human being being officer to address an issue? Who do you call? Participant
battered and you want to do something.” 8: Ghostbusters.”

Table 2. Themes, Categories, and Representative Quotations from Focus Groups with LGBT Older Adults Regarding
the Themes Reaching Out for Help, Barriers to Accessing Services, and Potential Solutions

Categories Representative quotations

Reaching Out for Help

Willing to advocate for self “I always pray I have my right mind all the time because when you don’t have your mind then
you know, your body might be there, but you still got to depend on these people, but then they
start treating you a certain way where, let’s say I have my right mind now, it’s something
somebody told abuse to me, I can go to the police and tell them or I can go someplace else and
tell them….But when I get much older, I may not have that type of mind. And I hope and pray I
always have that mind.”
Willing to advocate for others “And you know, you say, ‘Well, it’s not my problem. Do I or don’t I want to get involved in
somebody else’s domestic quarrels?’ But if you see it, how can you not react? I mean…you see
another human being being battered and you want to do something”
Barriers to Accessing Services
Not knowing who to call “Participant 7: And I have witnessed these kind of things happening, so we need to know who do
you call if you can’t call a police officer to address an issue? Who do you call? Participant 8:
Ghostbusters. Participant 7: Oh, Ghostbusters? Oh, do you know, what do you do?”
Participant X: "That’s good to know. I didn’t realize 311” Participant Y: "Right, the trick is if…I
heard about elder abuse from my friend in the nursing home…then you call 3-1-1, yeah. The
cops don’t need to be disturbed with…they have enough trouble.”
Lack of housing options “What I fear is that if I have to go into a nursing home and you find out that I’m a gay person and
they’re not accepting of that, how will I be treated? So, that’s a fear that I have.”
“They usually do fear going [to a nursing home]…because they might have seen it one time
visiting a nursing home how they’re really treated….and they’re just sitting there with food sitting
in front of them. No one’s helping them to eat it…I might stay at home and be abused rather than
be abused you know by other strangers.”
Denial as coping strategy “She has fear in her, but she’s saying to herself, if I don’t say anything it will go away. You know,
and that’s, that’s their form of healing.… You just covered it up; but it’s always there. Because if
you talk about it, then it becomes more painful…. Leave it alone….I won’t bother with it, it don’t
bother me. Even though they always still remember it.”
Potential Solutions
Using review committees to “But I suppose there are committees on morbidity, okay….I don’t see any reason why they
discuss discrimination shouldn’t use the same kind of committee structure that the medical staff are familiar with to
police their behavior.”
Interviewing patients alone and “Maybe as far as like noticing their conversations, things that, you know, stir up conversations
repeatedly asking without them knowing what you’re really getting at and just look out for the answers and, you
know, just kind of watch out for it and then…there’s stuff that you might be able to do.”
Extending existing programs “I sit in my own neighborhood right up the street…my folding chair that I usually take to the
beach, putting it in my neighborhood and just watching and, you know, anybody, you know, I just
pull out my phone and say, ‘Hey, you know, there’s something going on here.’…so if we had one
less case of abuse or well, I mean it could be a mugging, that’s an abuse, or a robbery. If we
had one less, then I say it was successful.”
“Yeah. Right now the city is, I think, only giving [cell phones] to abused women…Okay. But I
guess abused anybody should get those little phones. The city has a huge free supply of them.
Everybody throws them out. They get programmed for 9-1-1 push button.”
Improving mental healthcare “I think what you all need to really focus on as a medical profession is psychiatry, psychological,
and…mental abuse.”
Desire to work with researchers “Our doctors, our lawyers, you know, our professional people, and I thank you for coming out
and…Moderator: Thank you for having me. Participant 7: Yes, and addressing this issue
because if you don’t know and if you don’t come out and do these kind of things and listen, you
won’t know what to do.”

Abbreviation: LGBT, lesbian, gay, bisexual, and transgender.

JAGS MONTH 2019-VOL. 00, NO. 00 LGBT OLDER ADULTS’ EXPERIENCES WITH ABUSE 5

Lacking alternative options for housing and care provi- DISCUSSION

sion was often discussed as a barrier to reporting and
accessing services. Many participants felt that as members Members of SAGE participating in these focus groups
of the LGBT community, ending up in a nursing home may reported themes previously described in other populations
be worse than dealing with the abuse from one’s family, as and highlighted perspectives and experiences unique to their
one described “I might stay at home and be abused rather LGBT identity and lives. They defined elder abuse in ways
than be abused…by other strangers.” Another barrier dis- that are broader than definitions currently used, identified
cussed was the feeling that by reporting the abuse, the vic- numerous etiologies for abuse specific to their communities,
tim would have to acknowledge that it was real and that and proposed potential solutions to barriers for accessing
denial often can serve as an important coping mechanism. services and care. In addition, they also reported concerns
about other types of victimization that have not been
explored in the elder justice literature to date. Overall, par-
Potential Solutions ticipants described experiences from both early and later life
that are different because they are LGBT, are often exacer-
Participants had ideas for solutions and expressed a great
bated by the aging process, increase their vulnerability to
willingness to work with researchers (Table 2). Specifically,
abuse, and reduce the likelihood that they would report
recommendations were made to improve medical providers’
(Figure 1).
interaction with LGBT older adults, including: using review
Participants defined identified etiologies and barriers for
committees to discuss issues of discrimination, interviewing
reporting, and suggested solutions for elder abuse that have
patients alone, and being persistent in asking patients about
been previously reported in the literature for other
abuse.
populations. Family violence was a central concern of partic-
Recommendations for community members focused on ipants, and many felt that this was due to shifting roles and
extending existing programs, such as neighborhood watch increased care burden as loved ones aged, while others
or cell phone applications, which can record instances of reported mental illness playing a large role in the etiology of
abuse. Participants also suggested solutions that addressed this type of abuse. Many discussed that cycles of family vio-
what they considered to be the root of the problem, such as lence exist within the LGBT community and are perhaps fur-
mental illness among perpetrators and ignorance on the ther exacerbated by their LGBT identity and the stigma that
part of service providers. surrounds it, highlighting how the intersections of age and
LGBT identity can increase risk. Barriers to reporting elder
abuse were also similar to the general population and
Concerns About Other Types of Victimization
included: a lack of housing or care options; shame, denial,
In addition to elder abuse, many participants were con- and guilt; and a desire to maintain family connections.25
cerned about the potential for violence at the hands of The particular lack of options for housing and care pro-
strangers; being targeted for mass violence; and having vision was often cited as a reason that an older LGBT adult
inadequate support from social safety net systems. For may not choose to report.13 Unfortunately, for many elder
example, the shooting in Orlando, FL, that occurred before abuse victims, the safest discharge is often placement in a
the focus groups took place concerned some that gay com- long-term care setting, and elder abuse shelters are often
munities may be particularly targeted for violence, and that operated out of nursing facilities.26 While this may make
older members of their community may be more vulnerable some people physically safer, these settings can be particu-
to this violence. As one participant explained: “I can now larly difficult for LGBT older adults who may receive inade-
take my feelings, my prejudices and I can use them against quate care and social isolation from other residents due to
you because you’re harmless, you’re defenseless.” their sexual orientation.10,27,28 Additionally, LGBT older

Vulnerabilities That Increase the Risk for Abuse and Reduce Access to Services
Throughout the Life Course Exacerbation in Later Life
Ostracism from family due to LGBT Reduced access to caregivers and housing
status options
Prior abuse/violence Increased risk of abuse
Increased prevalence of HIV Increased vulnerability due to physical and
cognitive impairment
Income discrimination Reduced access to housing and caregiving
Lack of spousal benefits resources due to lower income/lack of private
health insurance
Poor interactions with law Reduced likelihood of reporting to law
enforcement enforcement
and medical providers Discomfort with medical providers, unlikely to
report or ask for help
Heteronormative experiences Reluctance to engage with traditional support
services
Avoidance of long-term care

Figure 1. Vulnerabilities that increase the risk of abuse and reduce likelihood to report elder abuse throughout the life course that
are exacerbated in later life in the lesbian, gay, bisexual, and transgender (LGBT) community. HIV indicates human immunodefi-
ciency virus.
6 BLOEMEN ET AL. MONTH 2019-VOL. 00, NO. 00 JAGS

adults may have more limited informal caregiver networks as adjusting forms to identify sex identity.13,33,34 While univer-
many did not have or adopt children and lost partners and sal screening in primary care is not currently recommended
friends in the AIDS epidemic of the 1980s, thus limiting their for elder abuse,35 the Elder Abuse Suspicion Index may be
options for safe housing and caregivers. The fear of long- used to start a conversation with patients about abuse.36
term care, both from their perceived increased risk of abuse There are several resources available to older adults
due to being LGBT and from experiences with loved ones experiencing abuse, which can be found through the
whom they perceived had received inadequate care, was cited National Center for Elder Abuse, and specialized resources
by many participants as a key reason not to ask for help. can be found through local SAGE programs.
If an older LGBT victim tries to access services in the Other service providers and service systems as a whole
community, he/she may also face unique barriers. Domestic also concerned participants. LGBT older adults are more
violence service providers, such as shelters, which predomi- likely to have lower incomes due to a lifetime of discrimina-
nantly serve younger victims, feel unprepared to serve tion due to their LGBT status, are less likely to have tradi-
LGBT adults, often citing a lack of training, funding, or tional spousal support from retirement and health plans due
dedicated resources for victims of same-sex partners or male to this discrimination, and depend more on social service
victims of intimate partner violence.29 Most importantly, programs.29 The budget constraints of these programs were
victims themselves have found these resources to be particularly concerning to participants in the Bronx, one of
unhelpful, and in some cases even harmful, and often turn the lower-income boroughs in New York City. Participants
to family of choice members first.19,20 Older adults trying often felt that the limitations of these programs were a form
to access these resources may face the dual challenge of of systemic abuse as their daily needs were commonly unmet
being an older adult and LGBT, both of which these pro- by the support offered by programs such as Medicaid.
viders may be uncomfortable in serving. Many LGBT older adults have faced victimization
In each group, participants were concerned with, and throughout their lives, often in the form of stranger or street
many had experienced, abuse from medical providers, repli- violence, and many participants worried that this type of vio-
cating concerns reported in prior studies.12 This varied from lence would escalate in later life as LGBT older adults became
verbally derisive or discriminatory comments to providing easier targets for homophobic hate crimes. They felt that much
inadequate care. This relationship with the medical system of this was rooted in discrimination and bias that will hopefully
may be rooted in history for many participants as they have change as legalization of gay marriage and other rights that
experienced a different healthcare system than their hetero- have been won in recent years start to impact the culture. Most
sexual peers. While great strides have been made, this popu- would willingly report this kind of abuse and had suggestions
lation grew up during a time when homosexuality was to use technology or neighborhood watch programs to help
illegal7 and considered a mental illness,30 and for many peo- ensure the safety of everyone in the community.
ple, law enforcement and medical professionals helped to Participants were able to recommend concrete ways
further victimize, rather than advocate for, this community. that service providers could help to start identifying and
As such, LGBT older adults’ relationships with service pro- treating this kind of abuse, and felt that this was important.
viders may be drastically different than non-LGBT older Some suggested improvements included: interviewing older
adults and younger LGBT adults, and may impact their will- adults alone, being persistent in asking about their home
ingness to seek help if they were in an abusive situation. life, believing older adults when they do report, and treating
While the laws have changed and the medical profession has the mental illnesses of perpetrators. In addition, they
worked to rectify some of these relationships,14 these efforts suggested using systems already in place to improve medical
have been recent and many LGBT older adults may still face care, such as using a morbidity and mortality review format
discrimination in the physician’s office. In a recent survey, for complaints or incidents of discrimination in healthcare.
40% of LGBT people, aged 60 to 75 years, said their physi- They also expressed an understanding of budgetary limita-
cian does not know their sexual orientation,24 and 46% of tions in the healthcare system and felt this lead to inade-
transsexual older adults have reported being denied or pro- quate training and hiring unqualified staff, particularly in
vided inferior healthcare because of their sex identity.21,31 long-term care, which lead to abuse and discrimination.
The participants in our study reported discomfort with their Despite their complex history with all types of service
healthcare providers, particularly about how open to be providers, including medical providers, participants were
about their LGBT identity, and were concerned about this willing to engage with researchers from a medical institution,
impacting their medical care. This greatly impacted their and wanted to improve things for themselves and the next
willingness to report abuse, particularly if the abuse were generation. Participants profusely thanked researchers for
related to their LGBT status. coming to them and eliciting their opinions and expressed
Best practices for providing medical care for older their desire to engage more actively with researchers and pro-
LGBT adults can be found from several sources. viders who want to serve the LGBT community.
Fredriksen- Goldsen et al provide recommendations to pro-
viders caring for older LGBT adults to improve cultural
Limitations
competency, including examining their own attitudes about
LGBT communities and understanding the historical and This study was only conducted in three boroughs of
social context that LGBT patients live in.32 Providers can New York City, limiting its applicability to other
also take simple steps to provide a more inclusive care set- populations and contexts. New York has the largest net-
ting, including posting signage indicating an inclusive envi- work of LGBT senior centers in the country, making it an
ronment, adjusting social history questions to ask about ideal place to start the investigation of this topic; however,
family of choice rather than just biological family, and it also has a larger LGBT community and a fundamentally
JAGS MONTH 2019-VOL. 00, NO. 00 LGBT OLDER ADULTS’ EXPERIENCES WITH ABUSE 7

different culture than other places in the country and the 5. Dong X, Simon MA. Elder abuse as a risk factor for hospitalization in older
persons. JAMA Intern Med. 2013;173:911-917.
world where LGBT populations may face more discrimina-
6. Dong X, Simon MA. Association between reported elder abuse and rates of
tion and violence. Further investigation in the other parts of admission to skilled nursing facilities: findings from a longitudinal
the country, including in rural areas, is necessary. In addi- population-based cohort study. Gerontology. 2013;59:464-472.
tion, while we were able to talk to many participants, 7. Fredriksen-Goldsen KI. Resilience and disparities among lesbian, gay, bisex-
demographics and abuse history were not collected, making ual, and transgender older adults. Public Policy Aging Rep. 2011;21:3-7.
8. Mikel L, Walters JC, Breiding MJ, The National Intimate Partner and Sexual
it difficult to assess whether a broad range of perspectives Violence Survey (NISVS). Findings on Victimization by Sexual Orientation.
within the LGBT community were represented. Further National Center for Injury Prevention and Control, Centers for Disease Control
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supported by an MSTAR (Medical Student Training in violence in later life. J Interpers Violence. 2015;31:3039-3062.
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AG048109) and a Paul B. Beeson Emerging Leaders Career
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Development Award in Aging (K76 AG054866) from the community support systems for lesbian and bisexual women who have expe-
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Conflict of Interest: No authors have any conflicts of 22. Scott French LC-D, Munson M, Herman J, Greene K, Greytak E. Inclusive
interest to disclose. Questions for Older Adults: A Practical Guide to Collecting Data on Sexual
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Author Contributions: All authors contributed signifi- 2011. https://nutritionandaging.org/inclusive-questions-older-adults-practical-gui
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