LGBTQ aging: Illness, disability and aging in place

LGBTQ aging: Illness, disability and aging in place

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The third in a three-part series.

“I never thought about what it would mean to be old.” Tom Gentile turned 72 at Thanksgiving, a week after he got diagnosed with prostate cancer and diabetes. “A double whammy,” he said of the news. “It really made me feel like my time was up.”

Gentile lives in a rowhouse in Philadelphia’s newly trendy East Passyunk neighborhood with his dog Benny. He says he is fortunate to have close friends and neighbors he can depend on. “So many people have no one. We’ve been lucky,” Gentile said.

Gentile had shared the home with his partner of 15 years, Nick, who died in 2018. Gentile had retired sooner than he had wanted in order to nurse Nick through his final illness.

“When you watch someone die of cancer, you suddenly know what you can and cannot cope with yourself,” Gentile said. “So my immediate questions for my doctor were all about survival and self-sufficiency. The thought of having a stranger do for me what I did for Nick — that just isn’t me.”

The first generation of Stonewall survivors is aging. SAGE, the nation’s largest organization serving LGBT elders states, “We’re still in the early stages of grasping what it really means to be LGBT and older. … Now, a confluence of a cultural and legal shift — along with sheer population size — is changing how we approach the needs of the LGBT senior community.”

The last of the Baby Boomers will turn 65 in 2030, at which point a fifth of the U.S. population — and LGBTQ community — will be elders. Many LGBTQ Philadelphians feel the community hasn’t kept up with their needs.

Alva Diaz, 69, and Rita Jones, 73, expected to live out what Jones calls their “crone years” together. But now their lives are in flux because Diaz’s health has been deteriorating and Jones isn’t sure they can manage on their own anymore without regular help.

“You see all these ads on TV about ‘aging in place’ or

joining one of these glitzy communities in the suburbs,” Jones said. “But those places always look very white and very straight, and we’re neither.”

Money is a real concern for the couple, who have fixed and limited incomes. But as they have talked about Diaz’s increasing incapacitation from heart disease and rheumatoid arthritis, “aging in place” may require that they find a younger caregiver to live in — something neither woman wants.

“You get used to a certain level of intimacy as a couple,” Diaz explains. “Having a third person here would be like always having company, always being ‘on.’ I don’t think that would be good for us — I think it would be stressful. Too stressful.”

Yet neither woman is sure how long they will be able to manage their home and their health on their own.

According to the National Council on Aging, LGBT elders are at higher risk for cancer, mental illness and cardiovascular disease.

NCOA explains that for LGBT elders, barriers to health care, lack of health insurance and fear of discrimination by doctors “threatens the healthy aging of a generation.”

Most elders PGN spoke with for this series had health issues and concerns about dealing with the medical system. Jones said she “had always hated going to the doctor.”

Diaz was in the hospital several times in 2019 and said, “I felt like every time someone new came in the room, it meant I had to come out all over again — it was really exhausting having to explain my life — and that it was okay to be gay — to all these strangers.”

Studies suggest that LGBT older adults have higher rates of chronic conditions and other health problems, such as obesity, high blood pressure, high cholesterol, arthritis, cardiovascular disease, diabetes and more. Because many LGBT older adults have faced discrimination in health care, they may delay doctor’s visits or necessary tests that would help them address these conditions.

NCOA also makes “a special note for people in the transgender community: It is unclear if the use of hormones can also put you at greater risk of a stroke or heart attack. Some studies suggest that cardiovascular risk is unchanged among transgender men using testosterone. However, evidence in transgender women is less clear. The long-term effects of hormone treatment are also uncertain. Along with all the regular steps to take charge of your heart health, make sure to ask your doctor if there are signs or symptoms you should watch for as you age.”

Mental health issues are especially critical for elder patients, who have the highest suicide rates, according to the Centers for Disease Control (CDC). SAGE notes that depression for LGBT elders is common and often untreated.

NCOA notes, 59 percent of LGBT older adults report that they lack companionship, and 53 percent feel isolated. NCOA states that “loneliness can impact your physical health and cognitive


According to SAGE, more than 50 percent of individuals in a national health study on LGBT elders had been diagnosed with depression by a health care provider, and 39 percent reported having had seriously considered suicide.

Dr. Jennie Goldenberg sees many LGBTQ people in her trauma practice, including elders. She said, “Many older LGBTQ folks are understandably wary of accessing mental health services, due to their history of negative experiences within these systems.”

She said that there are concomitant issues for LGBTQ elders that their straight peers don’t face. “They don’t trust mental health professionals to have the cultural competence necessary to understand, nor the ability to empathize with their minority status within the larger culture,” she said.

Other health issues often go unaddressed in LGBT elders until they are at more critical stages.

According to a 2011 national study on LGBT older adults, 19 percent reported having had at least one type of cancer. Lesbians are at higher risk for breast and gynecological cancers than their heterosexual peers. Gay and bisexual men are at higher risk of human papillomavirus (HPV), and while often under-estimated, HPV is serious, often leading to cervical and anal cancer.

Larry Benjamin, Communications Director for Mazzoni Center, said LGBTQ elders are welcome at Mazzoni, but, “we don’t provide specific services for seniors though we, of course, see seniors in our health center and other service areas such as the food bank.”

Benjamin said he is aware that the need for such services for LGBTQ elders is great, and Mazzoni has been in discussion about the issue.

“We are, however, looking to launch a program where we have one of our doctors and or nurse practitioner visit John C. Anderson apartments regularly to perform medicine check-ins, blood pressure checks, having discussions about pre- and post-hospital stays and what to do and expect,” Benjamin said. “everything from cold and flu symptoms and worries about other health concerns to more serious health issues and referrals.”

Goldenberg says the entire community can work to ease the impact of aging on LGBTQ elders and help smooth the transition into old age for those in their family and friend circles.

She said, “Aging in place is difficult enough — fraught with fears regarding financial insecurity and social isolation. Add to that the daily micro-aggressions of living as an LGBTQ minority in a heterosexual world, and it becomes clear that it is incumbent upon all of us in the ‘straight, privileged’ world to reach out to our LGBTQ family, friends, and neighbors and offer support — in whatever form we can offer — in order to make their world a little easier to navigate and bear.” 

*Some names have been changed to protect privacy.

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