When growing up in New York City, Rochelle Towers says she knew she was “different” from the kids around her. And she also knew she shouldn’t talk about her feelings. As teens are wont to do, she fell in love at age 18, but couldn’t share her joy and giddiness with anyone else. When she later went through a devastating break-up, she confided in another person at last — a straight woman she thought was her friend; that “friend” completely shunned her from that moment on. She later consulted a psychiatrist, who attempted to “cure her” by prescribing birth control pills.

It took time and introspection and a changed and changing cultural awareness, but nearly a half-century later, Towers works as a human rights activist, presenting trainings on “LGBT Humility” to ever-growing crowds of service and care providers. And she’s also involved in a newer personal struggle: “I’m 69 now — and I feel more and more like I’m becoming part of the wallpaper,” she says.

Unique Concerns of Gay Seniors

That wallpaper feeling becomes a familiar one to many people as they age. But it often has an especially severe sting to the many seniors who identify as lesbian, gay, bisexual or transsexual. Many came of age during times when homophobia, biphobia, and transphobia were especially pointed and mean-spirited. In fact, it wasn’t until 1973 that the American Psychological Association removed “homosexuality” from its list of mental disorders. Many navigated through their earlier years the best they could by “passing” in a heterosexist world — marrying a person of the other gender or withdrawing and isolating themselves from all but a precious few other people who could be trusted with their “secrets.”

And the dynamics that still exist paint a disturbing picture of health disparities and isolation.

The LGBT Dementia Care Project recently collected some harrowing statistics related to unique status of LGBT seniors:

• Nearly 33{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} are in poor general health
• About 42{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} have one or more physical disabilities
• A total of 50{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} of people living with HIV are 50 or older
• Only 15{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} have children — and of these, only 9{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} have children who are available to help them with health problems and other needs
• Nearly 15{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} could not identify a person to contact in case of emergency, and
• Approximately 15{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} of LGBT seniors reported they had seriously considered taking their own lives in the past 12 months.

LGBT seniors are also five times less likely to access health and social services due to fear of discrimination or inadequate treatment — and are significantly more likely to live in poverty than those who identify as heterosexual.

And the beleaguered population is growing. In 2010, there were an estimated 2.4 million gay seniors in the U.S. — a total projected to soar to 7 million by 2030, the year frequently cited as the first crest of the “senior tsunami.”

For all these reasons, there is an emerging focus on sensitizing and training friends, family members, and care providers in “cultural humility”: listening to and practicing self-reflection when interacting with individuals they perceive as different than they are.

Coming to Terms With Terms and Assumptions

The terms lesbian, gay, bisexual, and transgender are most often conflated into the acronym LGBT; some people and groups include “Q” for either “queer” or “questioning”: LBGTQ.

The terms are crucial — though many well-intentioned people avoid using them because they “don’t want to make anyone uncomfortable.” In fact, that avoidance often has the effect of quieting LGBT voices and ignoring their realities. It feels like yet another form of discrimination.

For many people, mastering these terms and understanding their meanings is an essential first step in being able to communicate openly and effectively. If the words and acronymns don’t roll easily off the tongue, diversity trainers encourage repeating them — out loud — until they do.

A review of definitions may help, too.

• Lesbians: Women whose primary physical, romantic or emotional attraction is to women. Younger lesbians also tend to use the terms “dyke” or “queer,” but they are offensive to some older people.
• Gays: The term usually applies to men, but in general means people whose primary physical, romantic or emotional attraction is to others of the same sex.
• Bisexuals: People of either gender who are attracted to both men and women.
• Transgenders: People whose gender identity or expression differs from the sex they were assigned at birth — described as “male to female” or “female or male.” Some transgender people alter their bodies with hormones or hormones or surgery or both; it is always inappropriate to ask about this unless the information is volunteered.
• Cisgenders: People whose experiences of their own gender agree with the gender they were assigned at birth. (Example: a woman in a female body, a man born in a male body). This term is less widely used and often confused and confusing when it is used.
• Sexual orientation: The inherent or enduring emotional, romantic, or sexual attraction to other people.
• Gender identity: The innermost concept of self as male, female, a blend of both or neither — how individuals perceive themselves and what they call themselves.
• Gender expression: The external appearance of a person’s gender identity, usually expressed through behavior, clothing, haircut or voice, and typically associated with being either masculine or feminine.

Communicating with and caring for LGBT seniors effectively also requires some people to shed some common assumptions they hold.

For example, many people, including care providers, assume that any LGBT older adult can be easily identified. In fact, no one can tell by looking at an individual or their families, or how they dress or speak. Ignoring a person’s sexual orientation or gender identity can risk creating a “don’t ask/don’t tell” atmosphere in the room.

Another assumption is that older adults do not want to disclose their sexual orientations. This wrongheaded expectation even extends to medical providers treating patients, where the lack of information may be life-threatening. A new study of both patients and providers highlighted this disconnect. It found that nearly 80{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} of providers surveyed believed that patients would refuse to disclose their sexual orientations. By contrast, however, only 10{d0e74b8a3596e4326b45924d39792f257a1f9983beed4201831d386befd3d18e} of patients from a randomized, national sample of lesbian, gay, bisexual, and heterosexual subjects said they would refuse to do so.

Rather than muddle through or offend by using the wrong pronouns or terminology with a LBGT senior, it is usually better to respectfully ask what an individual prefers. And in many cases, it can be the start of a rewarding breakthrough for all.

A third common assumption is that discussing sex and sexuality with older adults is inappropriate, since they aren’t sexually active, anyway. Being LGBT is more about identity than sex. But experts say there is also damage in not talking about sex with those who need and want to discuss it. A University of Chicago study found that people ages 57 to 85 think of sexuality as an important part of their lives.

Resources for Help and Support

Resources for LGBT seniors and those who care for or interact or live with them have been slow to materialize, but that is beginning to change. The following services and groups are among those providing information and support:

• Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders (SAGE) runs an LGBT Elder Hotline offering peer counseling, information, and local resources to older adults and their allies: 1-888-234-7243
• SAGE’s National Resource Center on LGBT Aging operates the country’s only technical assistance resource center, offering education in creating safe and inclusive environments for the older LGBT adult population
• The National Resource Center on LGBT Aging offers a free, 30-minute video online: Understanding and Supporting LGBT Older Adults, and
• The LGBT+ National Aging Research Center offers resources and studies pertaining to LGBT seniors on topics including health, aging, and caregiving.