Karen Fredriksen-Goldsen

University of Washington Seattle | UW · School of Social Work

Social prejudice, family nonacceptance, and lack of marriage or adoption rights often restrict the formation of conventional social ties among LGBT older adults. As a result, they often rely on families of choice constituted by other LGBT/age peers for support. Using a series of regression analyses with a national sample of LGBT older Americans, th...

Background and Objectives This study explores resilience factors among sexual and gender minority (SGM) midlife and older adults, identifying historical/environmental, psychological, social, and behavioral predictors, and examining variations across racial/ethnic subgroups. By adopting a resilience-focused perspective, this research contributes to...

Objectives: Unidimensional measures of sexual and gender identity are most often used in research. Yet, sexuality and gender are defined by complex characteristics. Guided by the Health Equity Promotion Model, we assess multidimensional properties of sexual and gender identity. Methods: This study utilizes 2016 survey data from Aging with Pride: Na...

Despite a proportionally higher likelihood of serving, the role of prior military service in the mental health of transgender individuals is understudied. Research on the impact of military service on mental health tends to be proximal. We examined the distal relationship between prior military service, identity stigma, and mental health among tran...

This article introduces the multidimensional properties of social connectedness among sexual and gender minority (SGM) midlife and older adults and examines the relationship between these properties and general health. Data were analyzed from Aging With Pride: National, Aging, and Sexuality/Gender Study, including 2,450 SGM adults aged 50 and older...

Background Due to our aging population and changing demographics, there are an increasing number of older adults with dementia with no care partner in the U.S., a trend more pronounced among sexual and gender minority (SGM) older adults. To our knowledge there are no extant interventions for SGM older adults with dementia and few dementia intervent...

Background In contrast to their counterparts in the general population, sexual and gender minority (SGM) older adults and their care partners, have distinct susceptibilities that complicate living with dementia, including significant disparities in comorbid chronic conditions, social isolation, and systemic marginalization, such as discrimination a...

Network size and composition are structural aspects and perceived support is a functional aspect of social networks. How these social network characteristics are related to LGBT older adults’ emotional wellbeing is not well understood. We investigated these relationships using data from The Caring and Aging with Pride study, a cross-sectional surve...

The health-related pathways of bisexual individuals are most often compared to those of lesbians and gay men or examine participants of different genders separately. However, little is known regarding how the health-related pathways of bisexual individuals of diverse genders compare to one another, particularly in mid- to later life. This analysis...

Despite some advances in LGBTQ+ rights over the past few decades, many states lack legal protections against discrimination based on sexual orientation or gender identity, and the current political climate raises concerns about future challenges to LGBTQ+ rights. This symposium explores the implications of discriminatory policies on the health, hou...

The population is becoming more diverse in terms of sexual orientation and gender identity across all age groups. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are found to experience health disadvantages over time. However, there is a lack of research on health-related mechanisms, so it is important to understand the unique n...

Cognitive health of sexual and gender minority (SGM) older adults with intersecting racial/ethnic minority identities is an under-researched topic. This research utilizes data from Aging with Pride: National Health Sexuality/Gender study to examine differences in health-promoting and risk factors for cognitive impairment among African American and...

Increasing diversity and rapidly evolving sociopolitical context are changing how sexuality and gender identity are experienced, expressed, and measured in contemporary America. Based on longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study, we examine sexual and gender identity, differentiation from other rela...

Sexual and gender minority (SGM) (i.e., lesbian, gay, bisexual, sexual diverse, and transgender) midlife and older adults face specific health, social, and structural inequities in addition to the late-life challenges experienced by older adults in general. Extant research had largely examined health disparities and related risk and protective fact...

Emerging research shows Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults experience higher prevalence of cognitive impairment when compared to their heterosexual and cisgender peers of a similar age. The same is true for racial and ethnic minority older adults when compared to their White counterparts. Little is known about the c...

As the population of older adults is growing in complexity and diversity, research has established health disparities by sexual and gender identity among older adults. While most research to date has been cross-sectional, this paper utilizes four-wave longitudinal data from Aging with Pride: National Health, Aging and Sexuality/Gender Study (NHAS)...

Families and Work: New Directions in the Twenty-First Century provides an innovative framework for understanding the interface between family care and employment. It offers a detailed analysis of the needs and experiences of employed care-givers and examines the full range of employees' family care responsibilities, including the care of children,...

Background: Sexual and gender minority (SGM) older adults and their care partners, compared to the general population, face unique vulnerabilities that exacerbate living with dementia, including elevated disparities in comorbidities, social isolation, and structural inequities, such as discrimination and lack of access to supports. Methods: This...

Purpose: There is a dearth of research on violence and adverse experiences among LGBT midlife and older adults. The goal of this article was to present tailored measures and investigate the relationship between adverse experiences, health, and age. Methods: Based on the Health Equity Promotion Model, we examined lifetime violence, lifetime discrimi...

Background and Objectives: Research suggests lesbian, gay, bisexual, and transgender (LGBT) populations have unique health care challenges. The purpose of this study was to understand contextual factors, including minority stress and social resources, associated with the health care utilization of LGBT middle-aged and older adults. Research Design...

Background and Objective Care partners of people living with dementia require support to knowledgeably navigate decision making about how and when to use monitoring technologies for care purposes. We conducted a pilot study of a novel self-administered intervention, “Let’s Talk Tech,” for people living with mild dementia and their care partners. Th...

Background: Heightened risks of cognitive impairment, disability, and barriers to care among sexual and gender minority (SGM) older adults are well documented. To date, culturally responsive evidence-based dementia interventions for this population do not exist. Objective: This study describes the design of the first randomized controlled trial...

Objectives: Sexual minority older adults are a health disparate group with disproportionate rates of subjective cognitive impairment (SCI) and psychological distress. This study estimated risks of SCI by sexual orientation and gender, accounting for variations in psychological distress. Methods: We aggregated National Health Interview Survey data (...

Little is known about caregiving outcomes of sexual and gender diverse, including LGBT, caregivers. Informed by the Health Equity Promotion Model (HEPM) and Pearlin's Stress Process Model, we utilized data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS), to examine perceived stress among a sample of 754 sexual and g...

Heightened risk of adverse health behaviors is of major concern among lesbian, gay, bisexual, and transgender (LGBT) older adults. Yet, no previous research has investigated heterogeneity of LGBT older adults on a set of health behaviors in conjunction with healthcare barriers. We aim to identify latent classes of the behavior and barrier patterns...

We investigated health, economic, and social disparities among lesbian, gay, bisexual, and sexually diverse adults, 18 years and older. Analyzing 2011-2019 Washington State Behavioral Risk Factor Surveillance System (N = 109,527), we estimated and compared the prevalence rates of background characteristics, economic and social indicators, health ou...

Despite the growing number of recent studies on the positive role of social resources on health and well-being among SGM older adults, the multi-dimensional construct of social resources has not been examined due to a lack of adequate measures and data. This study describes the rationale behind the measurements of social resources used in the Natio...

Health behaviors are multi‐dimensional and associated with various barriers to healthcare. With no previous research having investigated patterns of health behaviors in conjunction with healthcare barriers among lesbian, gay, bisexual, and transgender (LGBT) older adults, we aim to identify latent classes of the behavior and barrier patterns, to ex...

Existing research has documented higher levels of cognitive impairment among marginalized populations, including among LGBT (lesbian, gay, bisexual, and transgender) older adults. Research has also found LGBT older adults living with cognitive impairment experience a unique and challenging context compared to their heterosexual and cisgender peers....

Sexual and gender minority (SGM) older adults are at greater risk for dementia and social isolation compared to their heterosexual peers. Lack of an available caregiver is of major concern. Yet, most dementia interventions to date have been designed primarily for caregiver-care recipient dyads or solely caregivers. A pilot study evaluated a 9-sessi...

Loneliness has been found to be associated with increased risk for early mortality and dementia, with sexual and gender diverse older adults at elevated risk of both social isolation and loneliness. Based on the Health Equity Promotion Model and Iridescent Life Course, we examine factors associated with increased risk of loneliness over time, utili...

LGBTQ adults experience higher rates of dementia and rely more heavily on informal social support to meet care needs compared to cisgender, heterosexual peers. As dementia progresses and they enter new systems of care, LGBTQ adults must make important choices not only about health promoting behaviors and care plans generally, but also about identit...

Aging lesbian, gay, bisexual, and transgender (LGBT) adults are a health disparate population with unique healthcare challenges. Using data from the Aging with Pride: National Health, Aging, Sexuality/Gender Study (NHAS; N = 2,560), we examined contextual factors that influence the healthcare utilization of LGBT middle-aged and older adults. Causal...

While sexual and gender minority (SGM) older adults are found to be at heightened risks of cognitive impairment, they may face unique challenges in health‐related quality of life (HRQOL) due to bias, social isolation, and other SGM‐related risks. This study examined risk and protective factors predicting HRQOL among SGM older adults living with cog...

Background and Objectives: Understanding the influence of social resources on health is crucial in gerontological research. However, access to social resources may differ by one’s particular LGBT identity and the intersection of LGBT identity with other sociodemographic characteristics, including age. Research Design and Methods: Using 2010 data f...

While interest in sexuality\research is growing, in the past it has been largely invisible in gerontology. By exploring the full range and dimensions of sexuality and their interrelationships with multiple factors, this paper presents conceptual, substantive, and methodological advances for the field of sexuality in later life. Based on the Sexual...

The lives of transgender older adults are rarely examined, and little is known about the critical life events and experiences of this population. Informed by the Iridescent Life Course, this study investigates how intersectionality, fluidity, context and power impact the life events and experiences of trans older adults by generation and gender. Ut...

Objectives Utilizing Iridescent Life Course, we examine life events among three generations of lesbian and gay adults: Invisible (born 1920–1934), Silenced (born 1935–1949), and Pride (born 1950–1964) Generations. Methods: We utilized a subsample ( n = 2079) from the 2014 wave of Aging with Pride: National Health, Aging, and Sexuality/Gender Study...

Background and Objectives Prior research has shown informal caregiving among older adults can negatively impact the caregiver’s physical and psychological health. However, little is known about protective and risk factors associated with the health-related quality of life (HRQOL) of lesbian, gay, bisexual, transgender, and queer (LGBTQ) caregivers....

Background Monitoring technologies are used to collect a range of information, such as one’s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer diseas...

Objectives: To examine risk and protective factors predicting physical functioning and physical and psychological health-related quality of life (HRQOL) among sexual and gender minority (SGM) older adults with cognitive impairment. Methods: This study analyzed longitudinal data from Aging with Pride: National Health, Aging, and Sexuality/Gender St...

Dementia, a global health priority, poses a disproportionately high risk to lesbian, gay, bisexual and trans plus (LGBT+)/gender and sexuality diverse people. Despite this, little research has explored the lived experience of LGBT+ people with dementia or their care partners. This scoping review aims to understand what the literature reveals about...

Objective: This study examined older lesbian and gay adults' experiences regarding informal caregiving, including challenges and positive aspects of caregiving. Methods: Interviews were conducted with 16 lesbian women and gay men in Australia, aged 60+, who were engaged in informal caregiving. Analyses involved a qualitative thematic approach....

Objectives Transgender older adults are among the most health disparate populations in the United States; they also face some of the most significant barriers in accessing high quality, affordable, preventive healthcare services. We compare utilization rates of eight recommended preventive health screenings for adults aged 50 and older, by gender i...

We investigated health, economic, and social disparities among transgender adults (transgender women, men, and nonbinary) aged 18 years and older. Using population-based data from Washington State Behavioral Risk Factor Surveillance System (WA-BRFSS), we pooled 2016 through 2019 data (n = 47,894). We estimated weighted distributions and prevalence...

This past year, the lives of vulnerable older adults, including those within the older LGBTQ+ community have been disrupted dramatically, as has the research agendas designed to improve their lives. Older people, including LGBTQ+ older adults with dementia, have been placed at increased risk for social isolation and mental health issues during COVI...

In the Covid-19 context, researchers and policy makers have turned their attention to long-standing disparities in health equity, including by race, ethnicity, poverty, sexuality, and gender. Yet, scholarship to date does not conceptualize age as a critical aspect of difference requiring an equity lens. In this presentation, we utilize an Age Equit...

LGBTQ+ older adults face significant health disparities with higher rates of cognitive impairment and social isolation. Yet, the cognitive health needs of LGBTQ+ adults and caregivers have not been adequately addressed in clinical trials and services. In this presentation, we will share findings from Aging with Pride: IDEA (Innovations in Dementia...

LGBTQ adults disproportionately experience dementia and are more likely to rely on informal social support to meet care needs in the community compared to cisgender, heterosexual peers. Culturally responsive interventions will accommodate the unique strengths and independence of this population and support self-determination as they navigate reduce...

Cognitive impairment can lead to significant decline in health-related quality of life (HRQOL) in later life especially among those who are socially marginalized. While Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are documented to be at heightened risks of cognitive impairment, they may face unique challenges due to discrimi...

Background: Heightened risks of cognitive impairment are a critical health concern for lesbian, gay, bisexual, and transgender (LGBT) older adults. The physical and functional declines associated with cognitive impairment are known to increase risks of injury and decrease independent mobility. Method: Guided by the Health Equity Promotion Model,...

Background: The cognitive health needs of LGBT older adults have not been adequately addressed in mainstream clinical trials. Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action), is the first intervention worldwide designed to improve physical functioning and quality of life of LGBT adults living with dementia and caregivers....

Background: In this presentation we discuss the findings of the first national population-based study to examine disparities in subjective cognitive impairment among sexual minority adults. Method: Using the U.S. National Health Interview Survey (2013-2018), we estimated weighted prevalence of subjective cognitive impairment by sexual orientatio...

Background: Caregivers experience chronic stress that can negatively affect their health, resulting in lower quality of life. This study aims to understand the physical and mental health of caregivers by examining modifiable risk and protective factors. Life experiences of LGBT older adults are considered. Method: In the longitudinal study, Agin...

Objectives More than 60% of people with dementia live at home, where assistance is usually provided by informal caregivers. Research on the experiences of the Lesbian, Gay, Bisexual and Transgender (LGBT) caregivers is limited. This scoping review of the literature synthesizes international evidence on support provision for the population of LGBT c...

This study sought to understand the social and individual factors that predict loneliness among older lesbian and gay people in Australia. A sample of 508 gay men and 241 lesbian women, aged 60 and over, completed a survey including measures of loneliness, internalized homonegativity, sexual orientation discrimination, and connectedness to lesbian...

Objectives: This is the first national population-based study to examine cognitive impairment disparities among sexual minority mid-life and older adults. Methods: Using the National Health Interview Survey (2013–2018), we compared weighted prevalence of subjective cognitive impairment by sexual orientation and gender, among those aged 45 plus, app...

Introduction In Australia, there is a unique cohort of older (aged 60 and over) lesbian women and gay men who reached adolescence from as early as the 1940s up until the 1970s. Many have witnessed numerous social changes regarding the acceptance of lesbian and gay people in general society. Given the uniqueness of this cohort, it is important to ha...

Objective Relatively little research has examined ageism among older lesbian and gay adults. In this study, we investigated how ageism, as well as sexuality-related stigma, relate to mental health and well-being in these groups. Method Six hundred and thirteen lesbian women and gay men aged 60+ in Australia completed a nationwide survey. We invest...

Lesbian women and gay men are at greater risk of post-traumatic stress disorder (PTSD) than heterosexual people, however few studies have examined PTSD in older lesbian women and gay men. This study examined predictors of having ever been diagnosed with PTSD, as well as relationships to current quality of life, among 756 lesbian women and gay men a...

In this paper we explore methodological considerations for recruiting stigmatised populations online. Advertising for research participants via social networking sites (SNS) has increasingly become a tool of choice for both quantitative and qualitative researchers. However, such recruitment practices pose a range of challenges for researchers, espe...

Sleep problems may increase the risk for, and result from, other health problems and negatively impact quality of life. Lesbian, gay, and bisexual older adults report more sleep problems compared to their straight counterparts when such problems are measured in the aggregate (e.g. “one or more of four specific sleep problems”). However, scant natio...

Shifting historical, political, and social times have impacted transgender older adults in experiences and development. Examining how gender identities interact with life events within a historical context elucidates differences by generations and gender. Using a transgender subsample (n=205) from the National Health, Aging, and Sexuality/Gender St...

LGBTQ older adults are at significantly increased risk for poor mental and physical health, likely consequential to lifelong bias. Allostatic load (AL), the net effect of “wear and tear” on the body resulting from repeated, chronic over-activation of the psychophysiological stress response system. Utilizing the Health Equity Promotion Model, the ai...

Increasing diversity and rapidly evolving sociopolitical context is changing the face of bias experiences in contemporary America. Accordingly, literature has evolved into four unique ways of describing bias, namely lifetime discrimination and victimization, everyday discrimination, and microaggressions. However, there is less conceptual clarity on...

We do not live in a stagnant world, politically, historically or socially - neither are the life experiences of lesbian, gay, bisexual, and transgender (LGBTQ) older adults. Their physical, psychological and social lives are impacted by their present and past historical contexts and generational identity, as well as the sociopolitical environment,...

Pain is not only a result of other health problems but an independent condition that can negatively impact quality of life. Lesbian, gay, and bisexual older adults report more pain compared to their straight counterparts when pain is measured in the aggregate (e.g. “one or more of the following types of pain”). However, scant national research has...

Objectives: Volunteering is associated with positive well-being among older people, providing opportunities to stay active and socially connected. This may be especially relevant for older lesbian and gay people, who are less likely than heterosexual people to have a partner, children or support from their family of origin. Methods: Patterns of vol...

Purpose Little is known about the life course of bisexual older adults. This study examines life events and experiences of bisexuals by generation: Pride Generation, born 1950–1964; Silenced Generation, born 1935–1949; and Invisible Generation, born 1934 or earlier, as well as by gender among women, men, and gender diverse older adults. Methods Ag...

Older lesbian and gay people can face considerable marginalisation, which may affect their perceptions and experiences of accessing health and aged care services. To inform strategies promoting accessibility, this study aimed to investigate perceived barriers and facilitators to health and aged care service access among older lesbian and gay adults...

Many older people in trans communities in Australia and elsewhere have experienced long histories of violence and discrimination in the health and social care sectors, making some of them fearful of interacting with contemporary health and social care providers. This study explored older trans women’s perceptions of these services. It involved a qu...

Being comfortable in disclosing one’s sexual orientation to health and aged care providers is important for older lesbian and gay adults, given that nondisclosure is associated with poorer health and well-being outcomes. In a sample of 752 lesbian and gay adults aged 60 years and older living in Australia, we found only 51% of lesbian women and 64%...

Objective: Research suggests that lesbian and gay people’s disclosure of their sexual orientation to parents is associated with better mental health and identity adjustment. However, adolescents and younger adults have been the main focus with little known about the experiences of older people. The following study focused on older lesbian and gay a...

Older lesbian and gay people are increasingly open about their sexuality but have also experienced a lifetime of discrimination. These groups have experienced a long history of changes to lesbian and gay rights, and many were also at the forefront of activist movements during the latter half of the 20th century. A deeper knowledge is needed of the...

We assessed the associations of prenatal diethylstilbestrol (DES) exposure, a potent estrogen, with sexual orientation and gender identity in 3306 women and 1848 men who participated in a study of prenatal DES exposure. Odds ratios (OR) and 95% confidence intervals (CI) were derived from logistic regression models adjusted for birth year, study coh...

Caregivers experience chronic stress that can negatively affect their health, resulting in lower quality of life. This study aims to understand the physical and mental health of caregivers by examining modifiable risk and protective factors. Life experiences of LGBT older adults are considered. In the longitudinal study, Aging with Pride: National...

LGBT (lesbian, gay, bisexual, and transgender) older adults have been found to have elevated risks of cognitive impairment. Maintaining quality of life is a challenge for those experiencing cognitive decline and their caregivers. Whereas support networks are essential for quality of life, LGBT older adults with dementia may face unique risks, such...

The cognitive health needs of LGBT older adults have not been adequately addressed in mainstream clinical trials. Aging with Pride: IDEA (Innovations in Dementia Empowerment and Action), is an intervention designed to improve physical functioning and quality of life of LGBT adults with dementia and caregivers. We evaluate the processes and effectiv...

Heightened risks of cognitive impairment are a critical health concern for lesbian, gay, bisexual, and transgender (LGBT) older adults. The physical and functional declines associated with cognitive impairment are known to increase risks of injury and decrease independent mobility. Guided by the Health Equity Promotion Model, this study analyzed lo...

Resulting from social, economic, and environmental disadvantage in vulnerable communities, health inequities have systematically created greater obstacles to aging. Despite the adversity of their lives, or perhaps because of it, older adults from vulnerable populations embody an Iridescent Life Course, displaying remarkable resilience and resistanc...

This study examines the potential health-related impact of recent versus lifetime experiences of sexual orientation discrimination among older Australian lesbian women and gay men. In a nationwide survey, a sample of 243 lesbian women and 513 gay men aged 60 years and over reported on their experiences of sexual orientation discrimination and their...

Many older people in trans communities in Australia and elsewhere have experienced long histories of violence and discrimination in the health and social care sectors, making some of them fearful of interacting with contemporary health and social care providers. This study explored older trans women's perceptions of these services. It involved a qu...

Informal care‐givers play an important role in society, and many of the people who provide this care are lesbian women and gay men. Being a care‐giver is known to be associated with poorer health and well‐being, and lesbian and gay care‐givers report experiences of stigma and discrimination in the care‐giving context. This study involved a survey o...

Objective: This study examines whether disparities exist in poor health and depressive symptomatology among older gay/bisexual men (50+) with ( n = 371) and without ( n = 973) HIV. If so, what risk/promoting factors account for those disparities? Method: These cross-sectional analyses used 2014 data from the Aging With Pride: National Health, Ag...

According to Joint United Nations Programme on HIV/AIDS (UNAIDS) data, 36.9 million people are living with HIV worldwide. Older adults, those aged 50 years and older, with HIV are increasing worldwide; however, the prevalence and incidence differ substantially across regions. The purpose of this article is to provide an overview of how HIV is impac...

Lesbian, gay, bisexual, and transgender (LGBT) aging research is growing around the globe. Yet, few studies have examined the interconnectedness of different populations and cultures. This study examines whether LGBT foreign-born older adults experience greater health disparities than their U.S.-born counterparts. We conducted a cross-sectional ana...

The needs of older lesbian and gay people regarding access and use of aged‐care services remain underresearched. This paper reports the findings of 33 qualitative interviews with older lesbian women and gay men about their perceptions and experiences of residential aged‐care and home‐based aged‐care services in Australia. The focus of this paper is...

This study examined housing security among 679 lesbian women and gay men aged 60 years and older living in Australia. We examined a range of potential demographic and psychosocial predictors of whether participants felt that their housing situation was secure. Overall, most participants (89%) felt that their housing situation was secure. We found t...

Aging with Pride: National Health, Aging, and Sexuality/Gender Study is the first federally funded study addressing aging among LGBTQ older adults throughout the United States. This article examines the evolution of this landmark study and explores the well-being of LGBTQ adults aged 80 years and older (n = 200), the most underrepresented group in...

In this article, we explore the lives of lesbian, gay, bisexual, and transgender (LGBT) older adults in mainland China, with an emphasis on the shifting nature of the cultural context. Based on a culturally informed perspective, the intersection of LGBT stigma with cultural values (familial responsibility, filial piety, and loss of face) and larger...

Background: LGBTQ* (lesbian, gay, bisexual, trans, and queer) older adults are demographically diverse and growing populations. In an earlier 25-year review of the literature on sexual orientation and aging, we identified four waves of research that addressed dispelling negative stereotypes, psychosocial adjustment to aging, identity development,...

Social research in lesbian, gay, bisexual, transgender, and queer (LGBTQ) aging is a rapidly growing field, but an examination of the use of theory has not yet been conducted for its impact on the field’s direction. We conducted a systematic review of empirical articles published in LGBTQ aging in the years 2009–2017 (N = 102). Using a typology of...