Loneliness Among Older Sexual and Gender Minority Adults

Abstract

A presentation about the risk factors for loneliness among 2SLGBTQ+ older adults

Full text

March 2024
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This presentation was given at the Living with Pride Benefit at Vancouver’s Westin Bayshore
Hotel on March 1, 2024. www.livingwithpride.ca
The first half of the presentation is about loneliness in general.
The second half is about loneliness among older sexual and gender minority adults.
Some slides have been added or updated since the March presentation.
This document is for personal use only and is not yet final.

Loneliness tells us when our basic human needs are not being met and motivates us to take
corrective action.
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People describe a variety of distressing thoughts and feelings when they are lonely.
Recommended report: The Psychology of Loneliness from Campaign to End Loneliness, 2020.
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We see here evidence for the deep evolutionary roots of loneliness and other forms of social
pain like rejection or grief. There is an overlap in brain regions that process social and physical
pain. Given the importance of social connection for our species’ survival, our brains evolved to
treat social threats or deficits with the same urgency as physical threats.
There is also some evidence that taking acetaminophen can relieve social pain (Dewall et al.,
2020, Psychological Science).
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As I mentioned earlier, loneliness can be related to isolation but is not synonymous with it.
Vulnerable group may be easiest to help: if you can reduce their isolation, you can reduce their
loneliness (provided that they have not fallen into the negative feedback loop that I will
describe shortly).
Lonely but not isolated group: loneliness may be caused/compounded by mental health
problems, stigma, etc. Psychological approaches (e.g., interpersonal therapy, CBT) may be
more helpful for this group.
Isolated but not lonely group may be fairing well now, but may find themselves feeling isolated
when they lose their independence and require support from others.
See Newall & Menec (2017, JSPR); Menec et al. (2020, PLoS One) .
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The late Robin Williams aptly described how loneliness is more than just being alone.
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Important to distinguish type of loneliness because they have different risk factors and may
require different strategies.
Intimate loneliness: perceived absence of a close intimate tie, like a partner or best friend.
Social loneliness: perceived absence of a broader social network of friends, family, etc.
Collective loneliness: perceived absence of belonging to a larger group or cause, like a
religious community or team of some sort.
Existential loneliness: a sense of isolation that results from the realization that no one can fully
comprehend one's deepest thoughts, feelings, and experiences. It is a fundamental sense of
aloneness even in the presence of intimate ties. It can be especially acute at end of life.

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Usually, loneliness is time-limited as it serves its purpose of motivating social reconnection.
But for some, it can become persistent, in part due to a negative feedback loop.
When feeling isolated from others, we are motivated to reconnect, but cautiously. We
withdraw a little bit in order to re-assess the situation. We also become a little more sensitive
to further social threats (e.g., rejection).
But some people become hyper-vigilant for social threats and withdraw excessively. They
focus too much on the negative aspects of social interactions and start to misinterpret neutral
or ambiguous social cues as threatening. This is common for people who are chronically
isolated or who have experienced a lot of stigma and rejection in the past.
These perceptions may cause them to unwittingly push others away.
This, in turn, leads to negative reactions from others, reinforcing the lonely person’s negative
beliefs about people. This leads to further withdrawal and loneliness.
Notably, this cycle causes chronic stress and, eventually, various health problems.
See Qualter et al. (2015, Perspectives on Psychological Science).
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Anger and aggression: especially in men; may even be the only sign that they are lonely.
Relationships likely bidirectional. For example, loneliness can cause depression, but
depression can also cause loneliness (due to its negative impact on social cognition).
There is also an intense shame surrounding loneliness because people perceive it as a
personal failure—like the problem is exclusively caused by the individual, rather than being an
understandable reaction to social stress, including real and perceived isolation due to social
stigma and discrimination.
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As loneliness is stressful, it puts an extra load on our brain’s executive functions, leading to
lack of control over our emotions.
This can impact self-care.
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The chronic stress of loneliness, plus its impact on health behaviour, likely explains why it is a
risk factor for many physical ailments.
Insufficient sleep: sleeping with one eye open, unconsciously monitoring for social threats.
Poor sleep also causes many of these health issues, including immune dysfunction and
inflammation, which is a known risk factor for many health problems.
Notably, poor sleep can also cause/exacerbate loneliness due to its impact on mood, social
cognition, and social behaviour (see Simon & Walker, 2018, Nature Communications).
Due to all of these health outcomes, loneliness is a known risk for accelerated aging and
earlier mortality.
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This diagram is based on research suggesting that threats to social connection (e.g.,
loneliness, isolation, rejection, bereavement, social evaluation, and social conflict) can produce
pro-inflammatory cytokines that increase our sensitivity to further social threats.
See also Matthews et al. (2024, Brain, Behavior, and Immunity).
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Viewers rated sleep-deprived people as more lonely.
They also felt more lonely themselves! Feeling and looking lonely induces it in others.
Further evidence for the contagion effect of loneliness.
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Loneliness can spread within social networks by affecting how we perceive and treat one
another. Those on the periphery of social networks are the most affected
(Cacioppo, Fowler, & Christakis, 2009, Journal of Personality & Social Psychology).
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Loneliness is such a strong risk for health and social problems that the WHO has declared it a
global public health concern.
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Some cities have declared loneliness a public health emergency.
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The UK government was one of the first to take this problem seriously and even appointed a
“Minister of Loneliness” in 2018.
See “The Loneliness Bureau” (New Statesman, January 2024).
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Despite the previous image showing an elderly person, we should remember that loneliness
can happen to anyone, with the highest rates among younger people and the oldest-old.
In fact, younger people today are lonelier than previous generations of younger people.
Recent studies have found a more nuanced relationship between age and loneliness, but there
still appears to be a u-shaped curve.
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Evidence for the relationship between loneliness and SES comes mostly from other countries.
Canada does not yet have much data on this, at least for older sexual and gender minorities.
Some sexual orientation groups tend to have lower SES (e.g., lesbians; bisexuals).
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Some may live alone to reduce exposure to stigma.
Living with a partner may provide a more intimate, secure, and stable relationship.
Those living with a partner also have more opportunities to do things together and not experience the
stress of hiding their sexual orientation or relationship.
Quality of support received from living with others, like friends or family, may not be as strong as that
received from a live-in partner.
Easier to cope with stigma when you have the support of a live-in partner.
For more info on loneliness and living arrangement, see Kim & Fredriksen-Goldsen (2016, The
Gerontologist).
Housing discrimination: co-ops and stratas may not be very welcoming. Many residents have chosen
non-kin family members they would like to live with, but they are not legally recognized. So the
residents may be accused of overcrowding.
Due to lower SES, some may be forced to leave neighbourhoods where they have developed lifelong
relationships.
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Invisibility in care is another big issue, which featured prominently in the documentary Gen
Silent (highly recommend watching).
I have worked with organizations that have been resistant to my suggestion to ask about
sexual orientation in surveys about residents’ well-being. Their reasoning is that the question
would offend residents or make them suspicious. My response was that LGBTQ residents
might be offended that nobody cared to know about their experiences, or even cared to know
about their presence in the facility.
In some facilities, staff might make no attempt to monitor cliques, which seem to be
everywhere and at all ages!
Benign neglect: thinking that you are doing the right thing and being respectful by minding
your own business not paying attention to the unique experiences and challenges of sexual
and gender minority residents.
This can be profoundly isolating and invalidating and make a person feel like they are
unimportant and do not exist.
In some cases, LGBTQ residents might also be afraid of being harassed or abused by staff or
other residents.
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I think there is a prevailing attitude that older people, including those in the LGBTQ
community, lack sexual desire or should not express it because it is ‘inappropriate’.
This invalidates their experiences and deprives them of a fundamental source of social
connection and happiness.
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We should reduce barriers to partnered living arrangements.
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Minority stress is another risk factor for loneliness in older sexual and gender minority adults.
Rejection sensitivity: tendency to anxiously expect, readily perceive, and intensely react to
social rejection, even if it is not present.
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Despite being a more progressive country, Canada has a long history of LGBTQ discrimination.
Many SGM older adults came of age when same-sex behaviour was highly stigmatized and
criminalized, as we saw with the raids of gay establishments from the late 60s until as recently
as 2004.
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Up until 1969, LGBT Canadians could be imprisoned for the crime of ‘gross indecency’, which
was vaguely defined.
Most prominent example: George Everett Klippert. In 1966, he was declared a dangerous
sexual offender after admitting to consensual sex with several men. He was given an
indeterminate sentence on the grounds he was likely to have sex with men if released. The
conviction was upheld by the Supreme Court.
He was released in 1971 after the government decriminalized homosexual acts between
consenting adults.
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There were also the Gay Purges from the 1950s to 90s, when people suspected of
homosexuality were expelled from the Canadian Armed Forces, RCMP, and civil service under
the pretext of national security concerns.
They government saw homosexuality as a ‘character defect’ and believed that LGBT people
could be targets for blackmail by the Soviets.
Investigations were intensive and involved extreme questioning tactics. People were often
forced to confess, spy on their co-workers, and identify others who might be ‘security threats’
based on their sexual orientation.
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The government even commissioned the so-called ‘Fruit Machine’ to try to identify and expel
LGBT people.
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Many suffered great stigma and shame from friends and family after being publicly outed and
dismissed. Some were assaulted, even sexually, by former colleagues. Many became
depressed, developed PTSD, turned to drugs and alcohol, and even died by suicide.
Those who survived carry this stigma with them today, which has various implications for their
relationships.
Excellent documentary about this: The Fruit Machine by TVOntario.
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In the 1980s and 90s, we also witnessed the devastating AIDS epidemic, which killed countless
people and also increased stigma, especially against gay men.
Some also felt let down by the government, which they felt did not act fast enough to contain
the epidemic (arguably, this was more of an issue in the US than Canada).
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Some people have yet to fully recover from the profound grief of losing numerous partners
and friends at a young age, contributing to a deep sense of loneliness in their later years.
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The stigma and discrimination I have described can lead to reactions that negatively impact
the formation and maintenance of satisfying relationships.
Some people come out later in life and feel uncomfortable interacting with other older SGM.
This can feel very isolating.
Relationship conflict can occur when one person in a couple does not want to do things in
public for fear of being identified or stigmatized.
Unrealistic standards and expectations for self and others can be an over-compensation for
perceived inferiority.
IH can lead to cynicism about same-sex relationships, impacting commitment (e.g., giving up
too easily when there is relationship conflict).
Due to internalized ageism, some may retreat from social activities, fearing they will be
perceived as ‘old and pitiable’.
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In a recent study with nearly 8,000 from 85 countries, I found that minority stress is associated
with loneliness, and part of this association is through the impact of social anxiety and social
inhibition.
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In another study (under review), I found that this model is valid across 4 age groups, from emerging to
older adults.
Of course, the relationships likely work the other way, too, considering how loneliness can alter social
cognition. So loneliness likely contributes to anxiety, inhibition, internalized negativity, concealment,
stigma preoccupation, and perhaps even greater perceptions of stigma and discrimination.
Minority stress can also cause depression, which in turn causes loneliness through social withdrawal
and negative perceptions of others.
Notably, I also found that LGBTQ community involvement is associated with greater marginalization,
and that this relationship is stronger for younger people (perhaps due to their participation in more
public activities).
Despite this risk, community involvement appears to be protective against IH, concealment, and
stigma preoccupation. Moreover, for those more involved in the community, several of the relations in
the model are weaker.
There is also a negative relationship between community involvement and loneliness, but not too
strong. This makes sense because the important thing is not whether you are involved in the LGBTQ
community per se, but whether you feel supported and accepted by the community.
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For a deeper and more meaningful insight into loneliness and aging, I strongly suggest
watching All of Us Strangers, which is in theatres now. This film delves into the nuances of
loneliness, including its connections to aging, parental acceptance, bullying, unresolved grief,
and its impact on our current relationships.
Warning: don’t watch if in a sad mood!
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The Guardian had a great interview with the film’s director. I think this quote speaks to the kind
of loneliness that many middle-aged and older queer people feel today.
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Addressing maladaptive social cognition: cognitive-behavioural interventions are most
effective here.
Rekindling old relationships may be easier than starting from scratch. When people do an
inventory, they are often surprised by the number of relationships they have allowed to go
dormant.
Creating opportunities for new connections: following Cacioppo’s E.A.S.E. approach may be
helpful here (i.e., gradually easing back into social life, starting with non-threatening social
encounters). Others can help by providing motivation and support in the initials stages (e.g.,
accompanying someone to a seniors centre so they do not feel self-conscious).
Unfortunately, not all loneliness can be alleviated, so enhancing personal coping skills can be
helpful (e.g., distraction, mindfulness, ‘flow’ activities, parasocial relationships). See Emotional
Fisrt Aid by Dr. Guy Winch.
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It is vital to safeguard our safe spaces, which are disappearing due to gentrification and over-
reliance on technology to meet people.
Many older adults miss the sense of solidarity and camaraderie they felt as they banded
together during the LGBTQ rights movements in the past.
Having safe spaces is critical now more than ever, as there has been a resurgence of negative
sentiment against the community.
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Preserving existing social spaces and building new ones is vital because our need for
community does not fade as we age.
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