The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults
The Cascading Effects of Marginalization and Pathways of Resilience in Attaining Good Health Among LGBT Older Adults
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DOI：
10.1093/geront/gnw170
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发表时间：
2017-02-01
期刊：
影响因子：
5.7
通讯作者：
Emlet, Charles A.
中科院分区：
文献类型：
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作者：
Fredriksen-Goldsen, Karen I.;Kim, Hyun-Jun;Emlet, Charles A.
研究目的：女同性恋、男同性恋、双性恋和变性（LGBT）老年人构成了一个多样化且不断增长的健康差异人群。在本研究中，我们使用健康公平促进模型，研究了LGBT老年人经历弹性、风险和边缘化的途径，以及它们与获得积极健康结果的关系。设计与方法：骄傲地衰老：国家健康、老龄化和性/性别研究（NHAS）是第一个纵向研究项目，旨在检查50岁及以上的LGBT成年人的健康、老龄化和福祉。使用2014年的数据（N = 2415），我们测试了一个结构方程模型，该模型将终身边缘化、身份肯定和管理、社会和心理资源以及健康行为与积极的健康结果联系起来。结果：认同肯定正向预测社会资源和心理健康，社会资源正向预测心理健康。边缘化与开放性身份管理方式的LGBT老年人的社会资源较少、策略性身份隐藏的LGBT老年人的身份肯定度较低、心理健康状况较差有关。心理健康与更好的健康行为有关，这反过来又预示着积极的身体健康结果。结论：尽管LGBT老年人的健康状况不同，但他们的健康状况似乎是通过多种恢复力和风险途径实现的。提供者必须始终了解LGBT老年人生活的历史背景和他们发展的优势，以便了解他们的健康状况，并制定量身定制和有针对性的预防和干预服务。
Purpose of the Study: Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a diverse and growing health disparate population. In the present study, using the Health Equity Promotion Model, we investigated pathways by which LGBT older adults experience resilience, risk, and marginalization and their relationship to attaining positive health outcomes.Design and Methods: Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS) is the first longitudinal research project designed to examine the health, aging, and well-being of LGBT adults aged 50 and older. Using data from 2014 (N = 2,415), we tested a structural equation model linking lifetime marginalization, identity affirmation and management, social and psychological resources, and health behaviors to positive health outcomes.Results: Identity affirmation positively predicted social resources and mental health, and social resources positively predicted mental health. Marginalization was associated with fewer social resources for LGBT older adults with an open identity management style, lower identity affirmation for LGBT older adults who strategically concealed their sexual identity, and poorer mental health. Mental health was associated with better health behaviors, which in turn predicted positive physical health outcomes.Implications: Although a health disparate population, good health among LGBT older adults appears to be attained via multiple resilience and risk pathways. Providers must remain aware of the historical contexts in which LGBT older adults lived and the strengths they developed in order to understand their health and to develop tailored and targeted prevention and intervention services.