Depression and substance abuse common among LGBTQ elders

The second in a three-part series

“I can’t tell you how many times I have wanted to open a bottle of scotch in the middle of the day and start drinking, but I know I won’t stop.” Julie West, 75, retired three years ago after a 50-year career in social work. “I worked 12 to 15 hour days for decades,” she explained. “I never had enough time. Now time is all I have. It’s a little daunting.”

West, who lives alone in South Philadelphia “with several cats, like a classic lesbian stereotype,” said she finds drinking calms her and that it’s not surprising that seniors hang out in bars.

“When we were young, we went to bars to meet people,” she said. “It’s the same now that we’re old. Why are these older people in bars all the time? They have friends; they feel important; they feel in control; they feel a modicum of what they felt when they were working — daily community.”

For many LGBTQ elders, retirement is not what they expected. According to the National Council on Aging (NCOA), SAGE and other organizations addressing LGBTQ elders, depression and anxiety are increasingly common, as are substance abuse and even thoughts of suicide. Coping with the radical change in their lives is, as West suggests, difficult. But coping mechanisms like alcohol, drugs and casual sex can be even more harmful for older people who may have health problems that can be exacerbated by risky behaviors.

Roberta Hacker was executive director of Women in Transition for 30 years and now works as a consultant on women’s and LGBTQ issues for various agencies in Philadelphia and the suburbs. In her work in mental health and substance abuse, Hacker said she has seen many LGBT elders coping via alcohol and drugs.

“Loneliness and despair can prompt seniors to pick up the bottle,” she said. “It may start as a couple of beers, a glass of wine, maybe some medical marijuana. These all provide a short term respite from the underlying problem.”

But, Hacker explained, “what happens is that it is a desirable place to be — buzzed or in a contented fog — and so they use it more and more.”

Hacker said once that behavior becomes repetitive, substance abuse and addiction entrench, and it becomes hard to extricate. Family and friends may try to intervene, but intervention may be resisted.

“Knowing they are abusing alcohol or drugs just doesn’t phase LGBTQ people in the midst of a substance abuse problem or even crisis,” she says. “Their families can intervene, but it won’t matter. They feel they have nothing else to live for and that substance, whatever their chosen drug is, helps ease that pain. Finding something to supplant that is the crux of the matter — and that is different for elders than it is for younger people.”

Even if they recognize they need help, Hacker points out that LGBTQ elders may delay or be reluctant to seek medical care due to bias, discrimination, stigmatization or experiences of having been refused medical treatment. She noted that the cost of care might also be an issue for LGBTQ elders who are more likely than their heterosexual and cisgender peers to experience poverty.

SAGE, the nation’s largest social service and advocacy group for LGBT elders, offers one study suggesting that LGBT elders may be as much as five times less likely to access needed healthcare and social services. One study found that 75 percent of LGBT seniors interviewed reported not being open about their sexual orientation to healthcare workers.

LGBT baby boomers, the largest population of people 55 to 75, reported concern about discrimination as they age, with less than half saying they had confidence that healthcare professionals will treat them with dignity and respect, according to the study “Out and Aging: The MetLife Study of Lesbian and Gay Baby Boomers.” Fears of discriminatory treatment by healthcare professionals are particularly strong among lesbians, 12 percent of whom said they have no confidence that they would be treated respectfully.

In her practice as a therapist and clinical social worker, Dr. Jennie Goldenberg specializes in trauma. Outside her office door, a sign declares that it is a safe space for LGBTQ clients. “I want everyone to know, without having to ask, that they are welcome and can disclose their sexual orientation and gender identity in this space,” she said.

Goldenberg is acutely aware that such disclosure might not be easy and that LGBTQ people have issues with healthcare professionals that must be overcome. But, she explained, for LGBTQ elders, reaching out for therapy can be essential to survival.

“Social isolation is a major factor of depression in older adults,” she said. “LGBTQ elders have often experienced years of rejection from family members, friends and community — including faith communities. This has caused a pervasive sense of isolation.”

Reaching out is not easy, Goldenberg said. “LGBTQ elders don’t trust mental health professionals to have the cultural competence necessary to understand, nor the ability to empathize with their minority status within the larger culture.”

She added that LGBTQ elders “have experienced the cumulative effect of years of daily microaggressions. Lifetime experiences of discrimination and victimization based on sexual orientation have caused stigma, shame and the internalization of negative societal views of their sexual orientation and gender identity.”

Max Bernstein turns 79 in 2020 “like Bernie Sanders or Joe Biden,” he joked. “I could run for president.” Bernstein said he “never expected to be old. To be honest, I expected to die in the 1980s, like a lot of my friends. AIDS was taking everyone then.”

A handsome man who swims daily and works out at a local gym near his apartment in the Gayborhood, Bernstein, who looks significantly younger than he is, said he “revisited that past” in recent years. “I retired a couple years ago and almost immediately started acting out. I got into being a leather daddy. I was in the bars nearly every night. I have no idea what was going on. It was like someone told me that I didn’t have much time left, so I should do whatever I wanted, f–k the consequences.”

Bernstein said he was fortunate he “woke up, got tested and bought a thousand condoms” one morning after a “particularly risky night.”

“I’m embarrassed to say I was having unprotected sex like it was 40 years ago, and I’d never heard of AIDS,” he says. “I’m lucky for the second time that I didn’t get HIV. I want to tell other men my age to take the condoms along with that blue pill.”

According to the CDC, cases of STIs in adults over the age of 50 have increased significantly. Additionally, older adults may be embarrassed to ask a doctor to be tested for STIs and are less likely to be diagnosed with an STI in its early stages. Many STIs do not have symptoms, so many older adults also do not realize they are infected until serious and possibly permanent damage has occurred, which is commonly the case with HIV/AIDS in older adults. Doctors may also misdiagnose early symptoms of HIV infection — fatigue, weakness and memory changes — as signs of aging or another disease related to aging.

Hacker said the LGBTQ community needs to step up for their elders and make more space for both their concerns and them as people. “While our LGBTQ youth have the highest rates of suicidal ideation,” she explained, “the highest rates of completed suicide are among people 65 and older. Why aren’t we prioritizing that reality in our community? Where is the Trevor Project for LGBTQ elders?”

Hacker said, “We are so deeply youth-focused as a community, we basically ignore our elders, but there are literally thousands of LGBTQ seniors right here in Philadelphia who need just as much help as our youth. We need to do more. Much more.”

Some names were changed to protect the privacy of respondents. Next week: Disability, staying healthy, aging in place, LGBTQ elder activism.

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Victoria A. Brownworth is a Pulitzer Prize-nominated award-winning journalist whose work has appeared in The New York Times, the Los Angeles Times, The Philadelphia Inquirer, Baltimore Sun, DAME, The Advocate, Bay Area Reporter and Curve among other publications. She was among the OUT 100 and is the author and editor of more than 20 books, including the Lambda Award-winning Coming Out of Cancer: Writings from the Lesbian Cancer Epidemic and Ordinary Mayhem: A Novel, and the award-winning From Where They Sit: Black Writers Write Black Youth and Too Queer: Essays from a Radical Life.