A review of minority stress as a risk factor for cognitive decline in lesbian, gay, bisexual, and transgender (LGBT) elders

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a unique and growing subset of the aging population. The historical context in which they came of age was imbued with victimization and discrimination. These experiences are subjectively stressful and collectively known as minority stress. Older LGBT adults continue to face stressors related to their gender and sexual identities in their daily lives. Importantly, chronic minority stress (CMS), like other forms of chronic stress, is harmful to health and well-being. CMS contributes to LGBT health disparities, including cardiovascular disease and depression, conditions that in turn increase risk for premature cognitive decline. Furthermore, long-term exposure to stress hormones is associated with accelerated brain aging. Yet, the cognitive functioning of LGBT elders and the influence of CMS on their cognition are all but unexplored. In this review, we examine the influences of CMS in LGBT elders and connect those influences to existing research on stress and cognitive aging. We propose a testable model describing how CMS in LGBT elders heightens risk for premature cognitive aging and how ameliorating factors may help protect from CMS risk. Research is desperately needed to calibrate this model toward improving LGBT quality of life and mental health practices.

Keywords:

• LGBT
• disparities
• healthcare needs
• cognition

Notes

Acknowledgments

An earlier version of this manuscript fulfilled a portion of the requirements for the Doctor of Philosophy degree at Marquette University.

Conflicts of interest

The authors have no conflicts of interest to report.

Notes

1 Definitions of older adulthood vary across the literature and in popular culture. Although research on LGBT aging tends to focus on those age 50+ (cf. Fredriksen-Goldsen & Muraco, 2010), studies vary, with some focusing on age 65+ and others on ages 45–75. Herein “older adult” and “elder” are synonymous and defined as age 65 and older.

2 Internalized stigma has also been described as “self-stigma,” “internalized homophobia,” “internalized heterosexism,” and “internalized homonegativity.”

3 Sexual identity was not reported.

Additional information

Funding

This work was supported by a National Science Foundation Graduate Research Fellowship (#1452781), a Summer Fellowship from Marquette University’s Graduate School and Vice President of Research and Innovation, a Milwaukee Gay Sports Network & Windhover Foundation LGBTQ+ Scholarship from the Cream City Foundation, and grants from the National Center for Advancing Translational Sciences and the National Institutes of Health (UL1TR001436 and TL1TR001437).