A Review of Minority Stress as a Risk Factor for Cognitive Decline in Lesbian, Gay, Bisexual, and Transgender (LGBT) Elders

Abstract

Lesbian, gay, bisexual, and transgender (LGBT) older adults comprise a unique and growing subset of the aging population. The historical context in which they came of age was imbued with victimization and discrimination. These experiences are subjectively stressful and collectively known as minority stress. Older LGBT adults continue to face stressors related to their gender and sexual identities in their daily lives. Importantly, chronic minority stress (CMS), like other forms of chronic stress, is harmful to health and well-being. CMS contributes to LGBT health disparities, including cardiovascular disease and depression, conditions that in turn increase risk for premature cognitive decline. Furthermore, long-term exposure to stress hormones is associated with accelerated brain aging. Yet, the cognitive functioning of LGBT elders and the influence of CMS on their cognition is all but unexplored. In this review, we examine the influences of CMS in LGBT elders and connect those influences to existing research on stress and cognitive aging. We propose a testable model describing how CMS in LGBT elders heightens risk for premature cognitive aging and how ameliorating factors may help protect from CMS risk. Research is desperately needed to calibrate this model toward improving LGBT quality of life and mental health practices.

Keywords: Cognition; Healthcare Needs; LGBT; disparities.

Figure 1.. Theoretical trajectory of cognitive decline for LGBT older adults.

Cognitive decline is accelerated in LGBT aging (Line B) relative to typical aging (Line A) due to the degree of chronic minority stress, which increases physical and mental health risk factors (de la Torre, 2012; Diniz et al., 2013; Fredriksen-Goldsen, Emlet, et al., 2013; Fredriksen-Goldsen et al., 2016; Ownby et al., 2006; Simard et al., 2009; Sotiropoulos et al., 2008; Stefanidis et al., 2017) and neurotoxic effects of stress hormones on brain structure and function (Lupien et al., 2009). Neuropsychological consequences include learning, memory, and executive functioning. Factors such as discrimination and social inequality accumulate to modify the trajectory (Ferraro & Shippee, 2009) in an additive manner (Minority Stress shaded area). Protective factors (e.g., social support) theoretically promote resilience to cognitive aging (Resilience shaded and stippled area) (Fredriksen-Goldsen, Emlet, et al., 2013; Fredriksen-Goldsen et al., 2015; Meyer, 2015). Protective factors also include those beneficial to typical older adults, including education, socioeconomic status, and physical activity (Alzheimer’s Association, 2016). Genetics can be additive or subtractive but are excluded from the model for simplicity.