1. The invisible minority

2. Population
 Approximately between one and 3.5 million lesbians
and gay older adults live in the United States
 Oldest Baby Boomers (a 76 million cohort) turned 65
years old in 2011
 The LGBT older adult population will double by 2030,
thanks to the Baby Boomers
 The “boomers” have a history of making social
changes, therefore they are more likely to assert their
rights as older LGBT Americans
Haber, 2009

3. Invisibility
 Gerontology research over the past 10 years reveal a
insufficiency of research in the area of gay aging
(Haber, 2009)
 Psychotherapy with LGBT older adults has not
received enough attention in research and literature
(Baron & Cramer, 2000)
 “LGBT seniors are only 20% as likely as heterosexuals
elder to access needed services ” (Haber, 2009)

4. Significant Events
 Membership to different generational cohorts may
affect the way individuals perceive and respond to
stigma. The following are examples of these events.
a. Stonewall 1969
b. In 1952 homosexuality was listed as a mental illness
in the DSM
c. 1973 homosexuality was removed from the DSM.
d. AIDS epidemic 1980s
Haber, 2009

6. Stressors: Housing
 According to a study done by Johnson(2005) 34
percent of 127 participants said they thought hiding
their sexual identity would be necessary if they moved
to a retirement home
 According to Area Agencies on Aging survey, one half
of senior centers do not welcome gay men and lesbians
who are open about their sexual orientation (Knauer,
2009).
 Gay elders are likely to be rejected by retirement
communities and nursing homes (Haber, 2009)

7. Stressors: Public Benefits
 A study by the Congressional Budget Office (2004)
has found 1,138 statutory provisions in which marital
status is a factor used to determine eligibility for
benefits, rights, and privileges (Goldsen, Hyun-
Jun, Muraco, &Mincer, 2009).
 LGBT older adults are not eligible for Social Security
spousal and survivors benefits (Knauer, 2009)
 Older LGBT adults lack Medicaid protection for
inheritance associated to same sex partner
(Haber, 2009)

8. Public Benefits (cont)
 Spousal benefits: No matter how long same sex
couples have been together they do not qualify for this
benefit.
 Survivor benefits: non-married partners can not count
on a portion of the deceased’s partner regardless of
time cohabitating.
Grant, 2010

9. Medicaid Long-Term Care Benefits
 Married couples have the option of excluding their
main residence from their assets in order to qualify for
this benefits
 Same sex couples are excluded from this
benefit, therefore they may be forced to sell their
property in order to have the other partner qualify for
Medicaid long term protection
Grant, 2010

10. Stressors: Medical Decisions
 Because same sex couples are not legally recognized they
may be excluded from visiting their ill partners (Grant,
2010)
 End of life preferences are also denied to same sex partners
and automatically assigned to biological family to make
decisions-unless they have a durable power of attorney
(Grant, 2010)
 Family and Medical Leave Act does not guarantee coverage
for same sex partners-only family and spouses(Haber,
2009)
 Federal government recommendations for routine
HIV/AIDS screening goes up only to age 64 (Haber,2099)

11. Factors Enhancing Resilience
 Learn to cope with stigma from an early age
 Role flexibility
 Ability to cope with crises
 Importance of social support in successful aging: social
support from other LGBT members is crucial in
healthy aging
Berger, 1982

12. Clinical Implications
 Generational effects: cohort differences influence the
way individuals manage stigma
 Accelerated aging: experienced self as old at an earlier
age (affects specially gay men)
 Coping with the crisis of coming out early in life,
provides a sense of crisis competence that prepares
the person for later crises
Baron & Cramer

13. Clinical Implications (cont)
 Older men prefer the term homosexual, younger men
prefer the term gay
 The term lesbian is equally preferred between younger
and older women
 Lesbians are less vulnerable to the changes aging
brings to their bodies
 By the time an LGTB person reaches old age the
likelihood of victimization is very high
Haber, 2008

14. EBTs with Older Adults
 CBT and relaxation training was found effective to treat
GAD
 Multi-component CBT and sleep-restriction compression
therapy, found effective to treat insomnia
 Structured behavior approaches as well as individual
interventions are efficacious in treating disruptive
behaviors for individuals with dementia
 CBT, psycho-education with behavior management, anger
and depression management skills training were effective
for family care-giver distress treatment
 Older adults seem more inclined to the use of talk therapy
over pharmacological interventions
David &Cernin, 2008

15. EBTs for (LGBT older adults)
 Cognitive Behavioral stress-management group intervention was
found effective for HIV symptomatic gay men
 Antidepressant medication and group CBT was effective for gay
men who met major depressive disorder criteria and had co-
morbid HIV status
 CBT along with medication adherence training was found
effective on stress reduction
 Strong working relationship, alliance, empathy, and positive
regard make psychotherapy more effective
 Clinical attention to individual’s context, cohort, maturity, and
specific challenges, appears to be important in making
treatment more effective
David &Cernin, 2008

16. Resources
 Services and Advocacy for Gay Elders
(SAGE):http://sageusa.org/about/
 American Society on Aging (ASA)
 The LGBT Aging Issues Network (LAIN)
 LGBT older adults in Long term care facilities:
http://www.lgbtlongtermcare.org/
Haber, 2009

17. Conclusions
 LGBT community faces an array of psychosocial needs
impacting their experiences
 Mental health clinicians need to be aware of this
community’s needs in order to offer treatments that
are sensitive to their experiences
 It is important for clinicians working with the LGBT
community to work within a multidisciplinary
perspective

18. References
Baron, A., & Cramer, D. (2000). Potential Counseling Concerns Of Aging Lesbian, Gay, And Bisexual
Clients. In R. M. Perez., K. A. Debord., K. J. Bieschke (Eds.), Handbook of counseling and
psychotherapy with lesbian, gay, and bisexual clients (pp. 207-223). Washington, DC:
American Psychological Association, 2000.
Berger, R. M. (1982)."The Unseen Minority: Older Gays and Lesbians. Social Work,27(3),236-242.
Retrieved from http://web.ebscohost.com/ehost/resultsadvanced?sid=f8029f21-5b85-4031-
bab5-544c27478aba%40sessionmgr10&vid=6&hid=15&bquery=(Potential+Counseling+Concerns
+of+Aging)&bdata=JmRiPXBzeWgmdHlwZT0xJnNpdGU9ZWhvc3QtbGl2ZSZzY29wZT1zaXRl
David, S., &Cernin, P.A. (2008) Psychotherapy with Lesbian, Gay, Bisexual, and Transgender Older Adults.
Journal of Gay & Lesbian Social Services 20(1), 31-49. doi:10.1080/10538720802178908

19. References (cont)
Fredriksen-Goldsen, K.I., Kim, H., Murac,,A., &Mincer, S. (2009). Chronically Ill Midlife and Older
Lesbians, Gay Men, and Bisexuals and Their Informal Caregivers: The Impact of the Social
Context." Sexuality Research and Social Policy: Journal of NSRC 6 (4), 52-64. Retrieved from http://
web.ebscohost.com/ehost/resultsadvanced?sid=f8029f21-5b85-4031-bab5-544c27478aba
%40sessionmgr10&vi
Grant, J.M. (2010). Outing Age 2010: Public Policy Issues Affecting Lesbian, Gay, Bisexual and Transgender
Elders. Retrieved from National Gay and Lesbian Task Force website:
http://www.thetaskforce.org/reports_and_research/outing_age_2010
Haber, D. (2009) Gay Aging. Gerontology & Geriatrics Education 30 (3) 267-80. doi: 10.1080/02701960903133554