Seeing Silver in the Spectrum LGBT Older Adult Health , Aging , and Gerontological Nursing Research

On June 26, 2015, the United States Supreme Court ruled that the Constitution protects the rights of any U.S. citizen to marry someone of the same sex if they so choose, joining 20 other countries who extend these same rights to all citizens. Many advocates of the civil and human rights of individuals who identify as lesbian, gay, bisexual, and transgender (LGBT) hailed this as a definitive sign of increasing public acceptance in recent years. Others, particularly members of the LGBT community, have called for cautious optimism tempered by the recognition that serious issues affecting the health and well-being of this community endure, including economic and employment insecurity, workplace and housing discrimination, long-term effects of minority-related stress, substance abuse, and poorer health and aging outcomes, including high rates of chronic and comorbid illness, depression, and anxiety. For older adults who identify as LGBT, the Supreme Court decision on same-sex marriage may be a welcome indicator of a significant sociocultural shift, perhaps one that many LGBT older adults did not imagine happening in their lifetime. But while individuals of many generations are celebrating progress, LGBT older adults have reported feeling a sense of double invisibility in relation to both mainstream heterosexual society and the LGBT community (LGBT Aging Project, 2012; Shankle, Maxwell, Katzman, & Landers, 2003). Members of the same generations who advocated for LGBT visibility and social justice during the Stonewall uprising and the AIDS epidemic have found themselves rendered marginal again due to ageism within the LGBT community (Espinoza, 2013; Woody, 2014) and the risk for discrimination and mistreatment as health status changes, and more formal “outside” support is needed. This situation is especially complex for LGBT older adults of racial, ethnic, and linguistic minority status (Woody, 2014). Gerontological nursing research is well-positioned to be on the forefront of improving the visibility and outcomes of LGBT older adults, to raise awareness of the issues affecting their health and aging experiences, and to produce studies with the potential to inform both intervention and education. Unfortunately, nursing as a whole has largely ignored LGBT health, and this is particularly true for the health of LGBT older adults. In a survey of nursing literature published in the top 10 nursing journals (based on 5-year impact factor) between 2005 and 2009, Eliason, Dibble, and DeJoseph (2010) found that only 0.16% of all articles in this sample focused on LGBT health issues for individuals of any age—none of these articles focused on or included LGBT older adults. Applying similar methods, I updated this search to articles published between 2010 and 2014, extending the review to include publications on LGBT older adult health. Since 2009, there has been an overall increase in the number of nursing articles addressing LGBT health, but a significant lack of focus on LGBT older adults persists. Of articles published in the top 10 nursing journals (based on impact factor) during 20102014, only one focused on LGBT older adults (<0.01%). In what follows, a brief review of key issues compromising health and aging outcomes and quality of care for LGBT older adults provides context for understanding the importance of gerontological nursing research stepping it up in this area. Rates of chronic and comorbid illness, systematic barriers to services, experiences of discrimination, lack of provider knowledge and competency, and the failure of nursing research to include LGBT older adults are interrelated factors that collude to enable invisibility and disparities to persist despite other advancements in civil and human rights.