Determinants of physical functioning and health-related quality of life among sexual and gender minority older adults with cognitive impairment

Determinants of physical functioning and health-related quality of life among sexual and gender minority older adults with cognitive impairment (2023)

Hyun-Jun Kim, Karen Fredriksen-Goldsen, & Hailey Jung

Using data from the Goldsen Institute’s Aging with Pride: National Health, Aging and Sexuality/Gender Study, this study is the first to explore how factors such as physical activity, lifetime discrimination, and social connection may contribute to the health and well-being of sexual and gender diverse older adults with cognitive impairment over time.

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Activity, Nutrition, and Sleep

Of our study participants....

53.6% were getting enough sleep (7-9 hours)

71.8% participated in outdoor leisure activities

17.6% received insufficient food intake

Our research found that decline in physical and psychological wellbeing was associated with lower levels of exercise, outdoor activity, quality of sleep, and nutrition.

More than half of our study participants reported difficulty getting enough sleep or nutrition on a day-to-day basis.

The benefit of exercise and physical activity

On the other hand, our work reveals that exercising regularly could help lessen the decline of cognitive functioning over time. In fact, existing programs for individuals with cognitive impairment and their caregivers have been effective in promoting exercise and outdoor activities and increasing health and quality of life.

Discrimination, Victimization, and Identity Stigma

Discrimination, victimization, and identity stigma as risk factors

Decline in quality of life was also associated over time with lifetime discrimination, victimization, and identity stigma related to sexuality or gender, even when controlling for health risk and health-promoting factors.

Chronic conditions, discrimination, and cognitive impairment

However, the degree to which they were associated with decline in quality of life did not remain significant when chronic conditions were factored in. More research is critical to understand how the accumulated stress of lifetime discrimination might contribute to the relationship between discrimination, chronic health conditions, and cognitive impairment.

Social Connection and Caregiving

The benefit of social support and connection

Our work suggests that being in a relationship or having a large social network beyond immediate family may be associated with a higher quality of life. This is important insight, as programs and other interventions that support the social networks of those with cognitive impairment could improve quality of life.

Of our study participants...

37.2% had a partner or spouse

57% were living alone

Social isolation and loneliness

Sexual and gender diverse adults with cognitive impairment may be at higher risk for social isolation and loneliness. It’s well-documented that many sexual and gender diverse adults with cognitive impairment may be without a spouse or partner to support them or may find it difficult to keep ties with their social network as their health declines.

Implications for Healthcare Providers

1 Promoting regular exercise and physical activity

Regular exercise may help alleviate decline in physical functioning over time. Our work underscores the importance for medical health professionals to assess activity engagement and help sexual and gender diverse adults experiencing cognitive impairment understand the benefits of exercise and physical activity and find physical activates they enjoy doing regularly.

Connecting sexual and gender diverse adults with resources of support

Sexual and gender diverse adults with cognitive impairment may not receive support from a partner, spouse, or social network. It’s important for health care providers to identify and connect those adults with resources of support and understand how they may be impacted by changes in their social network.

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3 Responsive care to changing social networks

Current programs and resources for sexual and gender diverse older adults experiencing cognitive impairment may not adequately address their specific needs. Training for healthcare providers to be culturally responsive to changes in support networks may help protect sexual and gender diverse older adults from social isolation and stigma.

The national population of sexual and gender diverse older adults is increasing exponentially. In a national survey, 80% of sexual and gender diverse adults aged 50 and over reported mild difficulties with concentration, memory, problem solving, learning, comprehension, or communication. It is crucial that we better understand and create policy and programs to address the higher risk of cognitive impairment faced by sexual and gender diverse older adults to protect their independence, well-being and quality of life, as well as reduce public health costs associated with caregiving, hospitalization, and institutionalization.

Recommended citation: Kim, H.-J., Fredriksen-Goldsen, K., & Jung, H. H. (2023). Determinants of physical functioning and health-related quality of life among sexual and gender minority older adults with cognitive impairment. Journal of Aging and Health, 35 (1-2). doi:10.1177/08982643221108658

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Cognitive impairment, Alzheimer’s disease, and other dementias in the lives of lesbian, gay, bisexual and transgender (LGBT) older adults and their caregivers: Needs and competencies