Many transgender and non-binary (TNB) older Americans face challenging social conditions when managing their health. TNB older adults, for example, disproportionately report lower socioeconomic status and higher rates of chronic illness compared to their counterparts. TNB people often face mental health challenges over the life course due to stigma, discrimination, and violence against LGBTQIA+ individuals and communities. TNB populations are at risk for experiencing poor mental and physical health outcomes, discrimination, and multiple health risk behaviors such as suicide ideation and attempt. Consequently, TNB older adults continue to experience health inequities in older adulthood. Overall, TNB older adults constitute a medically-vulnerable population with substantial health and healthcare disparities.

The COVID-19 pandemic also poses substantial social and health challenges for TNB older Americans. According to the Centers for Disease Control and Prevention, older adults (65 years or over) have a heightened risk of COVID-19-related severe illness, hospitalization, and death among older Americans compared to their younger counterparts. The Centers for Disease Control and Prevention also found that about 1 in 4 older Americans had at least one potential long-COVID health problem up to a year after an initial COVID-19 infection. While prior research has notably examined TNB health and healthcare disparities during COVID-19, less is known about how TNB people manage such conditions in older adulthood. Examining such disparities in the context of the COVID-19 pandemic is important since COVID-19 has heightened the social and health instabilities of many TNB older communities across the globe.

At the same time, these conditions make it difficult for TNB older Americans to receive adequate social support and resources in protecting their health. For example, family caregiving of older TNB adults can assist with TNB health and healthcare management. However, researchers have demonstrated the social and health challenges LGBTQIA+ caregivers face when caring for a loved one. LGBTQIA+ family care partners, for example, frequently perform more healthcare management tasks than their counterparts. Additionally, LGBTQIA+ caregivers often report increased employment and income insecurity due to their informal caregiving responsibilities and commitments. Researchers have also established connections between chronic illness management among TNB couples and families. Most importantly, many TNB older adults do not have access to informal and formal caregiver support systems in US society. Prior scholarship is limited in addressing effective support and resource provision strategies for TNB older adults and their family care partners during the COVID-19 pandemic.

Present Study

Using qualitative data from 47 in-depth interviews, my primary project examines how TNB adults 65 years or over – as a medically and socially vulnerable population – navigate healthcare, advance care planning, and health inequities in US society. Recently published in Gerontology and Geriatric Medicine, I investigate how TNB older adults manage and maintain their health during the COVID-19 pandemic. Such findings offer potential ways to improve health services and resources for TNB older Americans in protecting and maintaining their health during the COVID-19 pandemic.

Findings

Overall, interview respondents’ narratives revealed that the COVID-19 pandemic was an unanticipated life course disturbance that drastically impacted their health management attitudes and experiences. For example, regardless of interview respondents’ demographic and social backgrounds (e.g., political and religious affiliation), most reported socially distancing themselves from others outside of their household during the early stages of the COVID-19 pandemic. However, interview respondents had various reasons why they chose to physically distance themselves from others outside of their household, aside from the US government stay-at-home orders (e.g., spending more time with family). The primary explanation for why respondents physically distanced from others was due to the fear of being exposed to and managing COVID-19 infection. This fear shaped TNB respondents’ decisions in managing their physical and mental health during the COVID-19 pandemic.

Nearly all TNB older adults from my research sample described their health management decisions and experiences during the COVID-19 pandemic through four, primary themes: (1) exacerbated mental health challenges, (2) disrupted social relationships and support, (3) adopting cost-effective health management strategies, and (4) incorporating family care partners in health management. In addition to worsening pandemic conditions, interview respondents’ health management decisions and experiences were heavily influenced by their privileged and marginalized social locations, such as financial security (or lack thereof), informal and/or formal care partnerships, and reliable access to technology. These broader patterns of inequity affect how TNB older Americans manage their health during the COVID-19 pandemic.

Overall, I investigate how pervasive social inequity and injustice (e.g., lack of familial caregiver support) harm TNB older adults’ ability to maintain their health and well-being in later life, while pinpointing how these processes are shaped by worsening pandemic conditions and interview respondents’ privileged and marginalized social locations in US society. I further describe how trans and non-binary older adults protect (e.g., incorporating family care partnerships) and struggle with (e.g., exacerbated mental health challenges) their health management during the COVID-19 pandemic.

Implications

This study magnifies how understanding TNB people’s health management in older adulthood as a dynamic process — influenced by social inequities, privileges, and sociopolitical contexts — is a critical step toward reducing health and healthcare disparities among TNB older Americans. Integrating research findings and clinical competencies of TNB older patient populations into medical education, training, and practice is essential to fully meet the health and healthcare needs of TNB older Americans during the COVID-19 pandemic. Currently, there is limited research addressing health management that pays particular attention to TNB older adults and how they respond to the challenges imposed by the COVID-19 pandemic while working to maintain, protect, or better their health independently and with family care partners. This research begins to fill that gap by revealing the structural barriers (e.g., disrupted social relationships and support) to achieving TNB older adults’ health management goals during COVID-19.

Nik M. Lampe, Ph.D. is a postdoctoral scholar in the Department of Medicine, Health, and Society and the Vanderbilt LGBTQ+ Policy Lab at Vanderbilt University. You can follow them on Twitter: @nik_lampe