Health disparities among LGBTQ+ older adults: Challenges and resources. A systematic review

Introduction: Literature reports how LGBTQ elders often encounter perceived homophobia in healthcare settings due to professionals' lack of awareness or discomfort with their specific needs, highlighting the necessity for a contemporary systematic review to address barriers, discuss issues, and propose evidence-based solutions, given the outdated nature of existing literature from the early 2000s amidst significant social and political shifts. This systematic review aims to investigate this issue with specific objectives: (1) identify physical and cognitive health conditions, disparities, risk, and protective factors; (2) discuss existing healthcare and aging-related services; (3) identify and critically evaluate changes and interventions. Methods: A literature search was conducted in May 2023 on four databases (PsycInfo, PubMed, MedLine, and Elsevier – Scopus). Papers were included, if published after 2006, had a focus on American aging LGBTQ over the age of 60 and had a focus on physical and/or cognitive health. Only peer-reviewed papers written in English were included. After papers were selected to be included in the review according to the inclusion and exclusion criteria, deductive thematic analysis was used to code papers’ contents. Results: 110 papers were included in the review. Results highlighted how LGBTQ older adults still experience health disparities and face many obstacles in accessing the healthcare system. Health services and policies addressing the unique needs of this specific population are still insufficient. Barriers such as cultural blindness, stigma, and discrimination within the medical community, along with a lack of health services tailored to their needs, significantly impact the LGBTQ elderly population, particularly those with dementia. The prevalence of heterosexual norms in medical settings and the absence of LGBTQ-friendly health programs lead to inadequate health screenings, perpetuating health disparities. This situation is worsened by the tendency to view LGBTQ elders as a monolithic group, neglecting the unique needs of its sub-groups and resulting in insufficient or inappropriate care. Discussion: These variables have a deep effect on the cognitive health of our target population. Innovative strategies, together with a holistic and intersectional approach, are needed to provide LGBTQ elders and their caregivers with adequate tailored services, support, and resources to counteract poor aging and physical, cognitive, and mental health outcomes.