%0 Journal Article %J Gerontologist %D 2014 %T Physical and mental health of transgender older adults: an at-risk and underserved population. %A Fredriksen-Goldsen, Karen I %A Cook-Daniels, Loree %A Kim, Hyun-Jun %A Erosheva, Elena A %A Emlet, Charles A %A Hoy-Ellis, Charles P %A Goldsen, Jayn %A Muraco, Anna %K Data Collection %K Health Status %K Humans %K Mental Health %K Middle Aged %K Risk Factors %K Transgender Persons %K Vulnerable Populations %X

PURPOSE: This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population.

DESIGN AND METHODS: Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework.

RESULTS: Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes.

IMPLICATIONS: The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.

%B Gerontologist %V 54 %P 488-500 %8 2014 Jun %G eng %N 3 %R 10.1093/geront/gnt021 %0 Journal Article %J Gerontologist %D 2013 %T The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors. %A Fredriksen-Goldsen, Karen I %A Emlet, Charles A %A Kim, Hyun-Jun %A Muraco, Anna %A Erosheva, Elena A %A Goldsen, Jayn %A Hoy-Ellis, Charles P %K Aged %K Aged, 80 and over %K Bisexuality %K Cross-Sectional Studies %K Depression %K Female %K Health Behavior %K Health Services Accessibility %K Health Status %K Health Status Indicators %K Homosexuality, Female %K Homosexuality, Male %K Humans %K Logistic Models %K Male %K Mental Health %K Middle Aged %K Minority Health %K Quality of Life %K Resilience, Psychological %K Risk Factors %K Social Stigma %K Social Support %K Socioeconomic Factors %X

PURPOSE: Based on resilience theory, this paper investigates the influence of key health indicators and risk and protective factors on health outcomes (including general health, disability, and depression) among lesbian, gay male, and bisexual (LGB) older adults.

DESIGN AND METHODS: A cross-sectional survey was conducted with LGB older adults, aged 50 and older (N = 2,439). Logistic regressions were conducted to examine the contributions of key health indicators (access to health care and health behaviors), risk factors (lifetime victimization, internalized stigma, and sexual identity concealment), and protective factors (social support and social network size) to health outcomes, when controlling for background characteristics.

RESULTS: The findings revealed that lifetime victimization, financial barriers to health care, obesity, and limited physical activity independently and significantly accounted for poor general health, disability, and depression among LGB older adults. Internalized stigma was also a significant predictor of disability and depression. Social support and social network size served as protective factors, decreasing the odds of poor general health, disability, and depression. Some distinct differences by gender and sexual orientation were also observed.

IMPLICATIONS: High levels of poor general health, disability, and depression among LGB older adults are of major concern. These findings highlight the important role of key risk and protective factors, which significantly influences health outcomes among LGB older adults. Tailored interventions must be developed to address the distinct health issues facing this historically disadvantaged population.

%B Gerontologist %V 53 %P 664-75 %8 2013 Aug %G eng %N 4 %R 10.1093/geront/gns123 %0 Journal Article %J AIDS Behav %D 2011 %T A preliminary randomized controlled trial of a nurse-delivered medication adherence intervention among HIV-positive outpatients initiating antiretroviral therapy in Beijing, China. %A Simoni, Jane M %A Chen, Wei-Ti %A Huh, David %A Fredriksen-Goldsen, Karen I %A Pearson, Cynthia %A Zhao, Hongxin %A Shiu, Cheng-Shi %A Wang, Xin %A Zhang, Fujie %K Adult %K Anti-HIV Agents %K CD4 Lymphocyte Count %K China %K Counseling %K Cross-Sectional Studies %K Drug Monitoring %K Electronics, Medical %K Female %K HIV Infections %K HIV-1 %K Humans %K Male %K Medication Adherence %K Middle Aged %K Nurses %K Outpatients %K RNA, Viral %K Treatment Outcome %K Viral Load %K Young Adult %X

We evaluated a nurse-delivered adherence intervention in a preliminary randomized controlled trial among 70 HIV-positive outpatients initiating antiretroviral therapy (ART) in Beijing, China. In both arms, participants received a 30-min educational session, a pillbox, and a referral to a peer support group. In the enhanced arm, participants could choose an electronic reminder device, three sessions of counseling either alone or with a treatment adherence partner, or both reminder and counseling. Survey assessments and blood draws occurred at baseline, post-intervention (13 weeks), and follow-up (25 weeks). Primary outcomes were 7-day and 30-day adherence assessed by self-report and electronic drug monitoring (EDM), and secondary outcomes were HIV-1 RNA viral load and CD4 count. The intervention was feasible and well received. It led to some improvement in self-reported and EDM-assessed adherence but not the biological outcomes. Providing counseling and facilitating the use of electronic reminders to patients initiating ART merits further investigation as a culturally viable means of promoting adherence in China.

%B AIDS Behav %V 15 %P 919-29 %8 2011 Jul %G eng %N 5 %R 10.1007/s10461-010-9828-3