LGBTQ+ Elders at Higher Risk for Cognitive Decline Due to Minority Stress

A recent article, published in the Journal of Gay & Lesbian Mental Health, reviewed the risk factors for cognitive decline with lesbian, gay, bisexual, and transgender (LGBTQ+) elders. The researchers go on to propose a model to guide future research and clinical practice.

“Geriatric health care and mental health care cannot be comprehensively informed without greater knowledge of minority groups and subgroups, including LGBTQ+ elders,” the researchers, Anthony Correro II and Kristy A Nielson write.

SAGE Advocacy & Services for LGBTQ+ Elders

Past research has repeatedly found that stress resulting from discrimination, termed “minority stress,” contributes to an increased risk for mental health issues in LGBTQ+ individuals.  However, until this point, little research has been done on the risk factors for cognitive aging in this population.

LGBTQ+ elders are prone to health disparities, facing challenges from heterosexism and ageism under the minority stress model framework. It is believed that long-term exposure to stress can damage the structures and functions of bodily systems.

Previous studies found that LGBTQ+ elders are at a higher risk for developing cardiovascular diseases, chronic inflammation vulnerability to pathogenic infection, and metabolic disorders due to exposure to identity-related stressors. Increased chronic health conditions such as arthritis, diabetes, hypertension, and heart attack are also found in LGBTQ+ elders. LGBTQ+ elders’ mental health is also compromised due to direct discrimination. For example, internalized homophobia has been found to increase symptoms of anxiety and depression.

In general, higher levels of stress hormones are associated with accelerated brain aging and cognitive decline. Also, chronic stress increases the risk for dementia and elevated cortisol levels, leading to Alzheimer’s disease. This study investigated the specific impact of minority stress on cognition for LGBTQ+ individuals.

“Environmental and social systems shape aging trajectories, and these systems are imbued with advantages and disadvantages based on one’s position within society,” the authors note. “Minority stress will continue to impact their (LGBTQ+ elders) mental health and healthcare utilization, which may alter their aging trajectory.”

The article proposed an introductory conceptual model of minority stress-related cognitive decline in LGBTQ+ elders. In the model, LGBTQ+ elders’ cognitive trajectory is theoretically modifiable by minority stress. The authors believed that the neurotoxic effects of stress hormones and metabolic disruptions are the mechanisms for accelerated decline.

The researchers recommend that healthcare providers consider sexual and gender identities in cognitive evaluations and provide targeted and affordable LGBTQ+-affirmative services. Social support, LGBTQ+ community engagement, and identity disclosure are identified as protective factors that slow down the cognitive decline in LGBTQ+ elders.

“Given their (LGBTQ+ elders) particularly high risk for exposure to stress, the pathological aging risk might be exacerbated in LGBTQ+ elders,” they conclude. “Understanding of their risks for cognitive decline and dementia and potential avenues to prevent their particular risks is critically needed.

This article was originally published in the Mad in America on November 24, 2020.