Introduction

The aging population continues to grow worldwide, and with it comes the need to better understand the factors that contribute to healthy aging, particularly among diverse populations (Jensen et al., 2020; Nolan et al., 2022). The World Health Organization (WHO) defines older adults as individuals aged between 60 and 80 years old who are experiencing physical changes associated with aging. This definition focuses on a specific age range and highlights the natural physiological transformations that occur during this period.

On the other hand, another perspective on older adults emphasizes the broader experience of aging. This viewpoint defines older adults as individuals who are growing older and facing physical challenges that are not typically present in younger age groups. This definition is more inclusive and focuses on the general experience of aging, rather than a specific age range, recognizing that the aging process can vary significantly among individuals. Research indicates that OMSM often experience higher rates of depression and suicidal tendencies compared to the general population (Chan, 2023). This disparity in psychological well-being among OMSM can be attributed to factors such as discrimination and stigma related to their sexual orientation (Corpuz, 2023). Addressing discrimination and promoting social equality are crucial steps in improving the psychological well-being of OMSM (Chan et al., 2022). 

Both definitions acknowledge the physical challenges associated with aging but approach the classification of older adults differently, either through a specific age range or a broader experiential perspective. Among these populations are older lesbian, gay, bisexual, and transgender (LGBT) adults, who face unique challenges and experiences that can influence their psychological well-being, health, and overall aging process (Yarns et al., 2016; Westwood et al., 2020). Despite recent advances in research on LGBT issues, there remains a need for a more comprehensive understanding of the complex interplay between psychological well-being and health outcomes in this population (Fredriksen et al., 2017). This systematic review aims to explore the impacts of psychological well-being on health and aging among older LGBT adults, shedding light on the specific factors that contribute to their resilience and vulnerability.

Existing research on the aging LGBT population has primarily focused on individual aspects of health, such as mental health, HIV prevention, and chronic diseases (Friedman et al., 2018; Nelson et al., 2023). However, there is a growing recognition that psychological well-being plays a crucial role in shaping health outcomes and aging experiences for older LGBT adults (Baiocco et al., 2022; McKay et al., 2023). Psychological well-being encompasses a range of factors, including self-acceptance, personal growth, purpose in life, positive relations with others, environmental mastery, and autonomy (Matud et al., 2019). By examining the intersection of these factors with the unique experiences of older LGBT individuals, this review seeks to provide a more holistic understanding of the aging process for this population.

By meticulously examining the existing research, we discerned and deliberated the pivotal findings concerning the influence of psychological well-being on health and aging among older LGBT adults. We investigated the connections between psychological well-being and diverse health outcomes, such as mental health, chronic illnesses, and HIV susceptibility, as well as the role of psychological well-being in determining the overall life quality for older LGBT individuals. Moreover, we scrutinized the particular factors that contribute to both resilience and vulnerability within this demographic, encompassing the ramifications of discrimination, trauma, and sexual orientation-related disparities.

Research Question

To address the nuanced challenges faced by a diversely aging global population, this systematic review aims to deeply investigate how psychological well-being influences the health and aging outcomes of older LGBT adults. Given the World Health Organization’s and various gerontological perspectives’ different definitions of “older adults,” this study adopts an expansive approach, considering factors such as self-acceptance, personal growth, purpose in life, positive relations, environmental mastery, and autonomy. This exploration is critical, especially in the face of persistent societal challenges such as discrimination and inadequate healthcare that disproportionately affect older LGBT individuals. By examining the dynamic interactions between these elements of psychological well-being and the specific health vulnerabilities and resiliencies within this group, this review seeks to unearth vital insights that could drive effective policy changes and intervention strategies, ultimately enhancing the overall health and well-being of this often marginalized demographic.

Objectives

This systematic review aims to synthesize existing research on the interrelationships between psychological well-being, health, and aging in older LGBT adults. By comprehensively examining how factors such as self-acceptance, personal growth, purpose in life, positive relationships, environmental mastery, and autonomy impact their health outcomes and aging processes, this study seeks to illuminate the unique needs and challenges faced by this population. The insights gained from this analysis will inform researchers, healthcare providers, social service providers, and policymakers, guiding the development of more precise and effective interventions and policies. The ultimate goal is to enhance the health and well-being of older LGBT adults, ensuring that they receive the support and recognition they need as they navigate the complexities of aging in diverse societal contexts.

Methods

Review Questions

  1. 1.

    What are the unique mental health challenges faced by older LGBT adults as a result of discrimination, stigma, and social isolation?

  2. 2.

     How does differential victimization based on sexual identity impact the physical and psychological well-being of older LGBT adults?

  3. 3.

    What targeted interventions and policies can be implemented to address the health disparities and promote the mental health and well-being of older LGBT adults?

Study Design

This systematic review aimed to comprehensively examine the challenges and impacts of psychological well-being among older LGBT adults. Studies focusing on this population were identified, categorized, and critically evaluated to determine the challenges and psychological impacts faced by older LGBT individuals. The primary objective was to establish the current state of psychological well-being among older LGBT adults by reviewing and analyzing the collected information. Additionally, the review explored the health challenges faced by older LGBT adults.

Search Strategy

The study employed a rigorous search methodology that adhered to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines (Cho & Shin, 2022; Muthiah et al., 2024). The electronic databases of MEDLINE, PubMed, Google Scholar, and the Cochrane Library were systematically searched to identify relevant studies investigating the challenges and impacts of psychological well-being among older LGBT adults. To identify additional relevant studies, the reference lists of included studies were also searched. The advanced search feature in the different databases was utilized to conduct a comprehensive exploration of the literature using various keywords and search terms.

The study employed a combination of keywords to search through electronic databases, including sexual orientation/gender terms such as LGBT, lesbian, gay, bisexual, and transgender. Health-related terms such as psychological and well-being were also used, with a focus on mental health. Additionally, the search keywords focused on older LGBT adults and social challenges or support. The use of these keywords aimed to identify relevant studies and publications that explore the health and social challenges faced by older LGBT adults. After the initial search, duplicate titles were removed, and irrelevant studies were excluded based on the abstract and full-text review. All authors cross-checked the final list of included studies to ensure relevance and quality.

Selection Criteria

We chose to start our literature search from the year 2000 to ensure that our review encompasses the significant shifts in societal, legal, and research landscapes regarding LGBT older adults. The early 2000s marked the beginning of notable legal advancements, increased visibility, and dedicated research efforts, which collectively provided a richer and more comprehensive understanding of the experiences and needs of LGBT older adults (Eskridge, 2002; Herdt & Vries, 2004; Fredriksen-Goldsen, 2010). These developments have been crucial in shaping current perspectives and policies, making this an appropriate starting point for our systematic review.

The sample period begins in the year 2000 to align with the burgeoning research and public awareness regarding LGBT issues, crucial for understanding shifts in psychological well-being, health, and aging in older LGBT adults. This starting point facilitates an analysis of evolving social attitudes and their impacts over the past two decades. The inclusion and exclusion criteria for our systematic review, detailed in Table 1, aim to explore the health challenges and psychological well-being of older LGBT adults. We have chosen the age threshold of 50 years based on developmental theories that categorize fifty as the beginning of late middle adulthood, thereby capturing the onset of unique health challenges that can intensify with age. However, we acknowledge that definitions of “older adulthood” vary, with some studies extending this to 60 or even 65 years. This discrepancy is crucial and merits further discussion in the context of our study’s objectives and the specific vulnerabilities faced by the LGBT population as they age.

Table 1 Inclusion and exclusion criteria are employed in searching for studies to include
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Included studies must focus on health challenges specific to LGBT individuals aged 50 and above and be published in English from the year 2000 onwards. We selected the year 2000 as a starting point because it marks a significant era in the visibility and rights of LGBT individuals, influencing health outcomes and societal attitudes significantly. Research predating this period may not accurately reflect the current realities and advancements in understanding gender and sexual diversity, which have evolved considerably.

Exclusion criteria include studies involving participants younger than 50, non-LGBT individuals, or topics not directly related to the unique challenges faced by the LGBT community, such as universal socioeconomic issues (e.g., unemployment, famine). We also exclude non-English publications, newspapers, case reports, dissertations, and other systematic reviews to ensure a focus on primary, peer-reviewed studies that provide the most relevant and up-to-date data on our research topic.

The search strategy in this systematic review followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and employed a comprehensive approach to identify published studies on the psychological impacts faced by LGBT individuals. By searching the electronic databases using a combination of keywords and modifying the search terms to suit each database, a total of 1613 studies were identified. Additionally, the references of relevant studies were also searched to find more studies, resulting in a total of 84 examined publications. The abstracts and titles of the different studies were assessed and analyzed for eligibility for inclusion, and the complete information of the studies and articles that met the eligibility inclusion criteria was gathered for evaluation and analysis in this study. Figure 1 illustrates the PRISMA flowchart (PROSPERO ID: 345195) that depicts the search strategy for included and excluded studies, including the explored databases. This search strategy resulted in the selection of 15 studies that met the eligibility inclusion criteria.

Fig. 1
figure 1

The flowchart of the PRISMA process used in this study to identify, screen, and select studies for inclusion. The PRISMA flowchart provides a detailed overview of the search strategy for included and excluded studies

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Data Extraction and Synthesis

Initially, the two primary authors independently screened the titles and abstracts of the identified records. This initial screening was instrumental in determining the relevance of the studies to our review criteria. Studies that did not meet the inclusion criteria based on their titles and abstracts were excluded. The remaining studies underwent a second round of screening where the full texts were reviewed for eligibility. This included a careful assessment of the study’s focus on psychological well-being in older LGBT adults, as well as the quality and relevance of the research.

During this phase, we encountered 113 studies that could not be retrieved for full-text review. The reasons for this included accessibility issues such as paywalls or articles being unavailable online, as well as practical impediments like broken links or withdrawn manuscripts. In some instances, identified records were conference abstracts without corresponding full-text publications. These challenges were systematically documented and factored into the selection process to maintain the integrity and rigor of our review.

All decisions made at each stage of the screening process were recorded in a PRISMA flow diagram, ensuring transparency and replicability of our methodology. Disagreements between the primary authors at any point of the screening were resolved through discussion, and if necessary, a third author was consulted to achieve consensus. Following this comprehensive screening process, the data from the final selection of studies was extracted and synthesized, as detailed in Table 2. The independent reviewer’s role was pivotal in confirming the validity of the extracted data and the final study selection, enhancing the credibility of our systematic review.

Table 2 Summary of the studies included in the analysis of psychological well-being outcomes among older adults who identify as LGBT
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The data extraction process was conducted in a systematic and rigorous manner, adhering to established guidelines and procedures for systematic reviews. The data was extracted and recorded in a consistent and standardized manner to facilitate analysis and synthesis. The first author (A.S.W.C.) conducted the data extraction, identification, categorization, and synthesis, which the other authors reviewed and confirmed or rejected in teams of two. Differences were resolved through discussion or with the third author (J.H.M.C.). The data extraction process was a critical component of the systematic review, and the careful collection and recording of data ensured the reliability and validity of the study findings.

Results

The Challenges Faced by Older LGBT Adults in Psychological Well-Being, Health, and Access to Healthcare

This systematic review included 15 studies out of 1697 records across four electronic databases (Table 2). The current review analyzed fifteen articles that investigated the psychological well-being of LGBT individuals aged 50 years and above. Eight of the articles employed cross-sectional surveys, three utilized interview surveys, two were national surveys, and two used audio computerized self-interviews. This diverse collection of study designs provides a robust framework for understanding the varied aspects of psychological well-being across different populations within the older LGBT community. The studies were conducted in different parts of the world, including the United States, Australia, China, and Hong Kong. The results indicated that a significant proportion of older LGBT individuals experienced poor physical and mental health, depression, and discrimination. Fredriksen-Goldsen et al. (2014) found that 22.0% of the LGBT participants in their study had poor health and 29% experienced depression symptoms. The study also found that lesbian and bisexual women had more disabilities than gay and bisexual men. Similarly, Flatt et al. (2018) reported that 20.0% of LGBT individuals had hypertension, and about 36.0% felt a score in the depression range. In contrast, Hughes (2018) found that 81.0% of the participants were associated with good mental well-being.

Discrimination, Isolation, and Lack of Support Experienced by Older LGBT Adults

Studies also reported that LGBT individuals experienced discrimination, isolation, and lack of support. Coleman (2017) found that participants in focus groups felt ignored by HIV prevention initiatives and generally excluded from societal aspects. Czaja et al. (2016) reported that 25% of the participants experienced difficulties in accessing required services, and they lacked social or family support, financial security, caregivers, and healthcare discrimination. In addition, Lyons et al. (2021) found that 61.50% of women and 54.70% of men often faced discrimination, which was associated with lowering positive mental health by 4.97% in women and 5.13% in men.

Moreover, studies investigated the impact of HIV on LGBT individuals’ health and well-being. Emlet et al. (2013) found that 9% of the participants were HIV positive, and 66.74% were identified with poor physical health. Frost et al. (2022) reported that older LGBT individuals reported lower relationship satisfaction associated with internalized, felt stigma.

The Impact of HIV on the Health and Well-Being of Older LGBT Adults

Furthermore, the reviewed studies showed that older LGBT individuals faced several challenges that impacted their psychological well-being. These included poor physical and mental health, depression, discrimination, and lack of support. Studies emphasized the need for interventions and support services to address the unique needs of older LGBT individuals.

Challenges That Impact the Psychological Well-Being of Older LGBT Adults and the Need for Interventions and Support Services to Address Their Unique Needs

The selected studies demonstrate that older LGBT adults encounter multiple challenges that affect their psychological well-being, health, and access to healthcare. Among these challenges are depression, poor self-rated health, disabilities, and discrimination in healthcare settings. Accessing healthcare services can be difficult, with financial barriers and discrimination preventing some individuals from accessing necessary services. Health disparities such as smoking and alcohol abuse were also prevalent among this population. The studies also reveal that older LGBT adults face unique challenges associated with their sexual orientation and gender identity, including higher rates of HIV infection, victimization, and discrimination.

In addition, social isolation and a lack of support were prevalent among older LGBT adults, with many feeling ignored by HIV activists and healthcare professionals. This population also faced discrimination in various societal aspects. The findings emphasize the need for healthcare providers to address the specific challenges that older LGBT adults face and provide appropriate care and support. The results also underscore the importance of reducing discrimination and improving access to healthcare services for this population. More research is needed to identify effective interventions to improve the psychological well-being and health of older LGBT adults.

Quality Assessment

In evaluating the quality of the individual studies, we employed the effective public health practice project (EPHPP) quality assessment tool, which involves a comprehensive examination of various aspects. The tool utilizes a rating system across multiple domains, providing a nuanced understanding of the strengths and weaknesses of each study (Table 3).

Table 3 Effective public health practice project (EPHPP) quality assessment ratings for individual studies
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In a comprehensive review of studies examining diverse facets of LGBTQ + health and well-being, several recurring themes emerge in the evaluation of methodological rigor. Significantly, numerous studies demonstrate notable strength in their study design, characterized by robust methodologies and a solid foundation. Emlet et al. (2013), Flatt et al. (2018), and Fredriksen-Goldsen et al. (2013) consistently exhibit robust study designs that effectively minimize potential biases.

Regarding selection bias, the majority of studies, including those by Fredriksen-Goldsen et al. (2014), Chan (2021), and Hughes (2018), exhibit low susceptibility to bias, indicating a meticulous consideration of participant selection. However, a subset of studies, notably Coleman (2017), Alba et al. (2022), and Gonzales and Henning-Smith (2015), reveals a moderate level of selection bias, warranting cautious interpretation.

Confounding factors are addressed with varying degrees of control across the studies, maintaining a consistent trend of moderate control. Works such as Fredriksen-Goldsen et al. (2014), D’Augelli et al. (2001), and Hughes (2018) showcase a balanced approach to confounding, minimizing potential distortions in their findings.

Data collection methods are generally executed with a moderate level of rigor in most studies, exemplified by Flatt et al. (2018), Frost et al. (2022), and Lyons et al. (2021). While consistently robust, some studies, like Coleman (2017), Alba et al. (2022), and Gonzales and Henning-Smith (2015), indicate a comparatively weaker control over potential biases introduced during this phase.

The management of withdrawals and dropouts aligns across the studies, with most demonstrating a low level of participant attrition. This commitment to data completeness is evident in studies by Fredriksen-Goldsen et al. (2014), Emlet et al. (2013), and Frost et al. (2022). Data analysis and results interpretation emerge as particular strengths across the board. Studies such as Chan (2021), D’Augelli et al. (2001), and Fields et al. (2013), consistently display robust analytical approaches and interpretations, enhancing the credibility of their findings. Synthesizing these assessments underscores the overall methodological robustness of LGBTQ + health studies. The emphasis on strong study designs, meticulous participant selection, and rigorous data analysis positions these studies as valuable contributions to the understanding of LGBTQ + health and well-being. Researchers should be mindful of variations in the control of confounding factors, data collection methods, and withdrawals when applying these findings in broader contexts. These findings highlight the methodological strengths and weaknesses of each study, providing insights into the overall quality of the research. Researchers should consider these assessments when interpreting and generalizing the results of the respective studies.

Discussion

The challenges faced by older LGBT adults in psychological well-being, health, and access to healthcare are significant and multifaceted. The current systematic review of 15 studies across four electronic databases demonstrated that a significant proportion of older LGBT individuals experience poor physical and mental health, depression, and discrimination. These challenges impact the overall psychological well-being of this population and highlight the need for interventions and support services to address their unique needs.

The studies included in this review also reported that older LGBT individuals experienced discrimination, isolation, and a lack of support. This was particularly evident in healthcare settings, where financial barriers and discrimination prevented some individuals from accessing necessary services. Health disparities, such as smoking and alcohol abuse, were also prevalent among this population. Additionally, older LGBT adults face unique challenges associated with their sexual orientation and gender identity, including higher rates of HIV infection, victimization, and discrimination.

Social isolation and a lack of support were also prevalent among older LGBT adults, with many feeling ignored by HIV activists and healthcare professionals (Conway et al., 2021). This population also faced discrimination in various societal aspects. The results emphasize the need for healthcare providers to address the specific challenges that older LGBT adults face and provide appropriate care and support. Improving access to healthcare services and reducing discrimination are crucial in improving the overall psychological well-being and health of this population (Oexle et al., 2017). The reviewed studies highlight the need for continued research to identify effective interventions that can improve the psychological well-being and health of older LGBT adults. The challenges they face are complex and require a multi-pronged approach, including the provision of appropriate healthcare services, reducing discrimination, and providing social support (Stepanikova et al., 2017; Drydakis et al., 2022). The findings from this systematic review underscore the importance of addressing the unique needs of older LGBT adults to ensure they receive the care and support they need to maintain their overall health and well-being.

In conducting this systematic review, we have included studies from various cultural and political contexts, specifically Australia, China, Hong Kong, and the United States. This diverse sample frame is not merely for representation but is crucial to understanding the nuanced effects of different sociopolitical climates on the psychological well-being, health, and aging of older LGBT adults.

These regions were selected to provide a broad spectrum of socio-political landscapes and levels of acceptance toward LGBT communities. For instance, the inclusion of studies from the United States and Australia offers insights into the experiences of older LGBT adults in countries with relatively progressive policies toward LGBT rights. On the other hand, studies from China and Hong Kong contribute perspectives from settings where LGBT rights and social acceptance might lag, thereby affecting the psychological and physical health outcomes differently compared to their Western counterparts.

By examining these varied contexts, our review highlights the complex interplay between regional cultural norms and the mental health outcomes of older LGBT adults. For example, the data from the US and Australian studies often show a higher prevalence of supportive structures and healthcare access, which correlate with better health outcomes compared to findings from China and Hong Kong. Such differences underscore the potential impact of cultural acceptance and legal recognition on the well-being of older adults in the LGBT community.

Aging within the LGBTQ + community presents unique challenges and opportunities, with a growing population of LGBTQ + seniors requiring specialized care and support. By 2030, it is estimated that there will be a significant increase in the number of LGBTQ + individuals over 65 in the United States, highlighting the importance of addressing their specific needs (Singh, 2022). LGBTQ + older adults often face isolation, discrimination, and economic disparities, with factors such as strained family connections and poverty affecting their well-being (Salerno et al., 2020). Research indicates that many LGBTQ + older adults in long-term care facilities do not feel comfortable being open about their sexual orientation or gender identity, leading to increased risks of mental health issues and abuse (Poteat et al., 2011).

Efforts are being made to advocate for LGBTQ + seniors, such as the passing of legislation like California’s SB 219, which aims to protect LGBTQ + older adults in long-term care from mistreatment (Macapagal et al., 2016). The establishment of LGBTQ + -specific retirement communities also signifies progress in providing safer spaces for LGBTQ + older adults (Cech & Waidzunas, 2021). Activism plays a crucial role in advocating for systemic changes, including pushing for comprehensive nondiscrimination protections in employment and housing to benefit LGBTQ + older adults and the broader community (Poteat et al., 2012).

While systemic reforms are essential, personal connections and community support are equally vital in improving the quality of life for LGBTQ + older adults. Engaging with LGBTQ + older adults, ensuring they feel included and valued, and checking on their well-being are simple yet impactful actions that can enhance their overall well-being (Newcomb et al., 2019). As we move forward, a combination of systemic changes, personal initiatives, and continued advocacy efforts will be crucial in addressing the unique challenges faced by older LGBTQ + individuals.

Limitations

This review is limited by its focus on English-language articles published between January 1, 2000, and June 30, 2022, which excluded relevant studies that were not published in English. The inclusion of only survey studies may also limit the generalizability of the findings, as participants may have been biased or provided unreliable information. Additionally, the review may be subject to publication bias, as non-significant results may not have been included in the selected articles. These unpublished findings may contain important information that could have influenced our understanding of older LGBT individuals’ psychological well-being. Furthermore, the decision to define older LGBT individuals as those aged 50 and above due to the limited availability of material for those aged 65 and above may have impacted the generalizability of the findings. Finally, the varying sample sizes across studies may also limit the ability to draw definitive conclusions about the impact of psychological well-being on older LGBT adults. The methodological consideration revolves around potential variations in laws, policies, and national health contexts that may influence the well-being of LGBT older adults differently in countries such as China compared to the United States, Australia, or Hong Kong. Although the inclusion of global data is crucial for reflecting a comprehensive picture of LGBT experiences, the study may encounter limitations in directly comparing these diverse contexts. This review primarily focused on studies specifically addressing the challenges faced by older LGBT adults in psychological well-being, health, and healthcare access. While recognizing the significance of the concept of “successful aging,” we acknowledge that this aspect was not explicitly explored in our review. In future research and discussions, we will consider incorporating insights related to successful aging in the context of older LGBT adults, recognizing its relevance to a comprehensive understanding of their well-being.

Conclusion

Understanding and promoting psychological well-being among older LGBT adults is vital in order to effectively address their unique health challenges and aging experiences. Factors such as discrimination, trauma, and sexual orientation-related disparities are critical to consider when designing interventions for this population. While preventing the spread of HIV remains important, a broader focus on fostering psychological well-being can help reduce distress and enhance overall health. As the population of aging LGBT adults continues to grow, it is crucial for gerontologists, healthcare providers, social service providers, and policymakers to collaborate and develop comprehensive support systems tailored to their needs. By prioritizing interdisciplinary collaboration, we can ensure that aging LGBT adults receive the care and support they need to thrive in later life.