Lesbian, Gay, and Bisexual People May Face Higher Dementia Risk Later in Life

Two white gay men walk down a dirt road while holding hands and smiling.
LGB older adults face a higher risk of cognitive decline, a new study finds.


Key Takeaways

  • Sexual minorities are almost twice as likely to experience cognitive impairment or dementia than heterosexual people when sociodemographic factors are adjusted for, a new study says.
  • The findings show how discrimination can have lasting health impacts on LGB adults, and speaks to the importance of eliminating societal homophobia and biphobia.

Lesbian, gay, and bisexual (LGB) people have a higher risk of cognitive impairment as they grow older than heterosexual people, according to a new study.

The findings, published in The Gerontologist, suggest "that health disparities among LGB populations not only appear in early/prime life but extend to late life," says Ning Hsieh, lead author of the study and assistant professor of sociology at Michigan State University.

"It's important for social and elder care programs to be aware of the higher risk of cognitive impairment (and likely earlier cognitive decline) among aging LGB people and offer them timely screening and treatment," Hsieh says.

The Findings

Michigan State researchers were interested in studying the risk of cognitive decline among older LGB people because dementia and cognitive impairment are growing public health concerns in the United States. An estimated 5.8 million Americans over 65 were living with Alzheimer's disease in 2020, and that number is expected to jump to 13.8 million by 2050, according to the Alzheimer's Association. In 2020, Alzheimer's disease and other dementias will cost the U.S. $305 billion.

Minority sexual orientations are also linked to multiple known risk factors for dementia, "including elevated stress, social isolation, and poorer mental and physical health outcomes due to prejudice and discrimination," researchers wrote in the study. But there is little research focused on LGB older adults' risk of cognitive decline compared to heterosexual older adults.

"While the public perception of lesbian, gay, and bisexual people is largely related to young communities, LGB older adults represent an understudied disadvantaged group," says Hui Liu, co-author of the study and professor of sociology at Michigan State University.

After analyzing survey data from 3,567 adults, researchers found that LGB older adults are about twice as likely to have mild cognitive impairment or early dementia than their heterosexual counterparts when sociodemographic factors are adjusted for, Liu explains.

"This difference is partially explained by depression: LGB older people suffer higher levels of depression, likely due to minority stress, than heterosexual older people; and depression is a risk factor for cognitive impairment and dementia," Liu says.

How Stress Affects Older LGB Adults Mental Health

The study did not evaluate why LGB older adults experience more depressive symptoms, but Liu says it's likely due to minority stress, which refers to the additional stress that marginalized groups experience due to discrimination and prejudice they face.

Though LGBTQ+ people now have access to legal marriage and protections against some forms of discrimination, older LGBTQ+ adults didn't have that for most of their lives, says Benjamin Shepherd, a PhD student in clinical psychology at Nova Southeastern University. "They carry with them a lot of financial, social, and emotional disadvantages," he says. "For example, they had to be in hiding, because same-sex sexual activity was illegal until 2003... and a lot of them couldn't even get married."

The historic discrimination they've faced, from society and their families, means they often feel like they have to hide who they are, even into adulthood, which affects their mental health. "Being a sexual and gender minority, it's a concealable stigmatized identity, so people have the choice of disclosing or not," Shepherd says. "That process of having to decide which situations are safe enough to disclose—that's a cognitively taxing process and contributes to an added burden." It can also lead to depression and anxiety, which are risk factors for cognitive decline.

Potential Solutions Across Society And Senior Care Facilities

AARP’s 2018 survey of LGBTQ adults age 45 or older found that 34% of LGBTQ older adults were very or somewhat worried that they would have to hide their identity to access suitable housing. Many also worried about how being LGBTQ+ would impact the care they received through in-home assistance, assisted living, or nursing home care: At least 60% were concerned about neglect, abuse, or verbal or physical harassment and 61% worried about being refused or having limited access to services.

Feeling as though you have to conceal your identity is a risk factor for isolation, which increases risk of dementia, Shepherd says. This means that agencies servicing older adults need to foster safer and more openly welcoming environments. "Senior centers, nursing homes, and other care facilities are important places to start implementing sexual and gender minority affirmative, evidence-based trainings and programming," he says.

In the future, Ning says the accumulation of minority stressors and mental distress over the lifetime is an important factor worth studying. "It's also important for the public to acknowledge that prejudice and discrimination have lasting health impacts on LGB individuals and create burdens on our healthcare system," Ning says. "The only fundamental solution is to eliminate stigma related to minority sexual orientation."

What This Means For You

LGBTQ+ older adults, who often don't have biological family to turn to, need more community and institutional support in order to remain socially connected and comfortable enough to be themselves as they age. Supporting and advocating for LGBTQ+ policies in your community, workplace, state, and at the federal level will help foster an accepting culture for LGBTQ+ people, which affects their health outcomes.

4 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Hsieh N, Liu H, Lai W-H. Elevated risk of cognitive impairment among older sexual minorities: Do health conditions, health behaviors, and social connections matter? Gerontologist. Published online 2020. doi:10.1093/geront/gnaa136

  2. Alzheimer Association. Alzheimer's facts and figures.

  3. Geidner C. The court cases that changed L.g.b.t.q. rights. The New York times.

  4. AARP Research. Maintaining Dignity: Understanding and Responding to Challenges Facing Older LGBT Americans.

By Jo Yurcaba
 Jo Yurcaba is a freelance writer specializing in mental health.