LGBTQ Caregiver

By Dr. Marcy Adelman–

Jan is a 71-year-old lesbian and a diabetic. She lives alone and prides herself on her independence. She is quick to tell you she is a happily retired jack of all trades and now an aspiring photographer. Pre-pandemic she enjoyed doing portraits but COVID-19 and shelter in place (CSIP) put the portraits on hold. She is concerned that diabetes and her compromised immune system put her at greater risk for COVID-19.

From March to May, Jan rarely left her apartment. By mid-May she found herself feeling stressed and out of sorts. She told me for the San Francisco Bay Times, “It was like I was anxious all the time but I didn’t know about what. I was tired no matter how much I slept. I just didn’t feel right.”

In early June she decided she needed to do something new. “I thought, if I don’t get the hell out of this apartment, I am going to go crazy,” she explained. Now, most days Jan can be found on long solitary hikes in the surrounding San Francisco Bay Area countryside taking photographs of birds, redwoods, reservoirs and flowers. I asked Jan how that was working out for her and she replied, “For the most part, that tiredness and anxiety and feeling out of sorts has gone. I can get that way from time to time, but it isn’t an everyday thing anymore.”

Jan isn’t alone in feeling stressed and anxious. The impact on the mental health of older adults living in the time of COVID-19 and shelter in place has been well documented. In a recent Kaiser study, one in four adults age 65+ reported anxiety or depression during the early months of the pandemic compared to one in 10 older adults in a pre-COVID study. Sometimes a simple intervention can help people feel better and less stressed, such as in Jan’s situation, but for many others who are experiencing more severe emotional distress, telehealth counseling with a licensed therapist may be the treatment of choice.

These are stressful times, what with the social and physical limitations imposed on our daily lives, the isolation of sheltering in place, the threat of ourselves or our loved ones being infected and killed by the deadly virus, the loss of jobs or fear of losing our jobs or our homes, and, finally, the heartbreaking loss of family and friends to the virus. Pandemic mental health research tells us that CSIP stress is a common experience regardless of age, race, ethnicity, or gender. But studies also have reported elevated levels of emotional distress in certain populations and communities, especially those communities disproportionately affected by the pandemic, such as older adult women; people with a previous history of anxiety, depression, or post-traumatic stress disorder (PTSD); and Black, Indigenous, Latinx and people of color (BILPOC).

There are currently no studies on the impact of CSIP on the mental health of LGBTQ+ older adults. But in a previous “Aging in Community” column
(https://tinyurl.com/9vdj493a), San Francisco LGBTQ+ senior service providers vividly described the initial distressing impact of the pandemic on the communities they serve—communities that lived through decades of oppression and trauma and now lack the mental health services to assist them through this difficult time.

During CSIP, women have reported higher rates of depression then men. Older adult women are more likely than older adult men to have poor health and to live in poverty. These two factors, poor health and economic insecurity, are related to increased levels of emotional distress. The pandemic has further exacerbated these gender differences.

Studies have reported that people with previous histories of psychological distress, in particular low- and moderate-income older adults, were vulnerable to being triggered during the initial stage of the pandemic. At first little was known about the virus—how long the emergency would last, how long we would be asked to socially isolate ourselves and wear a mask, and which experts to listen to. Our lives were disrupted and delayed through no fault of our own, and every day, more and more people were dying. It is a measure of resiliency that given the chaos, uncertainty, and danger, more people weren’t pushed beyond their limits. Older adults with economic, housing, and/or food insecurities and a previous history of anxiety, depression, or PTSD are more vulnerable to CSIP stress.

CDC data reports that BILPOC communities have been disproportionately affected by CSIP. Black, Indigenous and Latinx communities have experienced the highest rates of infections, hospitalizations, and deaths. These communities are at greater risk for severity of illness than white communities due to longstanding health disparities. BILPOC communities have higher rates of diabetes, cardiovascular disease, and other chronic illnesses than white communities. Historically, these communities have been underserved and underfunded due to systemic racism and economic injustice.

The loss of beloved family members and friends and the increased risk of infection has weighed heavily on the BILPOC communities. Understandably, surveys have reported significantly elevated rates of emotional distress, such as grief, loss, anxiety, depression, and trauma.

We can do something about this mental health crisis. We need to see more accessible, affordable, and culturally informed mental health services for all older adults, but especially women, low to moderate income older adults, and underserved communities, such as the BILPOC and LGBTQ+ communities. State and local governments and philanthropic organizations need to fund senior-centric, coordinated mental health programs and services to those most impacted by CSIP: low- and moderate-income women, and BILPOC and LGBTQ+ communities.