Application of the aging-well model in lesbian and bisexual women

From the Bowen Group, Public Health Sciences Division

By 2060, the population of Americans over the age of 85 is expected to double. Most of what is known about healthcare in older women is from the heterosexual women. The experiences of sexual minority women (SMW), who identify as lesbian or bisexual, have been understudied. SMW is one of the fastest-growing groups with over 2.4 million adults, and it is expected to double by 2030. To understand evidence-based care for SMW, it is important to consider aging and the health needs of older SMW. By living outside the heterosexual social norm, SMW have been exposed to discrimination, prejudice, and social inequality. As a result, SMW have a greater risk of decreased health in comparison to heterosexual adults. A few studies report that SMW have poorer mental and physical health than heterosexual women and an increased risk of chronic diseases. Nonetheless, it has also been reported that supportive communities of older sexual minority adults promote resilience and social support. Dr. Jennifer Jabson Tree, emphasized the importance of studying SMW, “There is a gap in what we know about older lesbian and bisexual women; culturally and scientifically we focus much less on sexual minority women over age 60. In fact, the majority of health surveillance data sources, do not assess sexual orientation after the age of 60.  We believe that sexual orientation matters for a number of important reasons, across the life course, including in life over aged 60.”

Aging-well is a multidimensional concept of aging, accentuates resilience and includes three theoretically grounded constructs: successful aging, focuses on physical, social, and emotional functioning as it pertains to quality of life; effective aging, describes resiliency to health-related challenges and general challenges; and optimal aging combines three subdomains: hedonic well-being, evaluative well-being, and eudaemonic well-being. These three subdomains focus on emotional well-being and positive affect, satisfaction with life, and personal growth. Resilience can be examined as a positive aspect of aging-well models for developing and testing health promotion programs for older adults. The objective of this study by the Bowen Group, from the Division of Public Health Sciences, was to conduct an exploratory investigation into aging-well among SMW over 60 years of age. This study was published in The Journals of Gerontology.

The study population, SMW aged 60-89, came from the Women’s Health Initiative (WHI) Extension Study. Women who answered sexual orientation questions in the baseline survey were included in this study (n=31,502). Various scales were evaluated within the successful, effective, and optimal aging constructs. Various statistical analyses, including linear and logistic regression models, were used to assess the relationships between aging-well constructs and sexual orientation groups.

Graphical Representation of Older woman
Older Woman/Free Stock Image Image from Dr. Jennifer Jabson Tree

Women aged 75 and older, lifetime WSW (women who have sex with women) bisexual were more likely to report living in a nursing home since the age of 45 than heterosexual women (AOR=2.99; 95% CI=1.24-7.20). Lifetime WSW-lesbians were more likely to report good mastery to handle problems aged 60-74 (aOR=1.67, 95% CI=1.12-2.48) and self-control, aged 75+ (aOR=0.45, 95% CI=0.22-0.92) at the age of 45 than heterosexual women, respectively.  Lifetime WSW-lesbians had a higher score in satisfaction in life (B=1.26, 95% CI=0.28-2.24), social support (B=3.05, 95% CI=1.92-4.18); they were also more likely to have enjoyed life than heterosexual women, all after the age of 45 (aOR=1.66; 95% CI=1.10-2.50).  However, WSW-lesbians, aged 75+, were less likely to report being happy at least most of the time than heterosexual women (aOR=0.61; 95% CI=0.39-0.95). 

In conclusion, SMW were aging-well and exhibited resilience, which is the main focus of the aging-well model. The study’s findings indicate that lesbian and bisexual women, at a certain age, may fare and function better than heterosexual women. Dr. Jabson Tree stated, “Our findings contribute to addressing this gap by highlighting that sexual minority women over the age of 60 are active, engaged and doing very well.  Specifically, social supports, self-mastery, and personal growth, are promoting aging-well in lesbian and bisexual women over age 60. Our findings support VanWagenen and colleagues’ (2010) findings that older sexual minority adults were still ‘raring to go!” This research and future research are important for improved healthcare and preventive services in SMW.  Dr. Tree continued, “There continues to be a significant lack of evidence concerning the aging-well experiences among diverse sexual minority women; women who are both a racial/ethnic minority and sexual minority. Understanding the experiences of women holding multiple marginalized and intersecting identities could provide much needed, vital, information about healthcare, and health promotion and wellness programs for diverse sexual minority women over the age of 60”. 

This research was unfunded.

Fred Hutch/UW Cancer Consortium member Deborah Bowen participated in this study.

Jabson Tree, JM, Patterson, JG, Beavers, DP, & Bowen, DJ. (2020). What is successful aging in lesbian and bisexual women? Application of the aging-well model. The journals of gerontology. Series B, Psychological sciences and social sciences, gbaa130. Advance online publication.