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PSYCHOLOGICAL ADJUSTMENT TO AGING AMONG
GAY MEN OVER AGE FIFTY
By

Scott Berlin

A DISSERTATION
Submitted tO
Michigan State University
in partial fulﬁllment Of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

School Of Social Work

2007

ABSTRACT
PSYCHOLOGICAL ADJUSTMENT TO AGING AMONG
GAY MEN OVER AGE FIFTY
By

Scott Berlin

This study examined psychological adjustment to aging in men who identiﬁed
themselves as gay, bisexual, or men who have sex with men. The study considered the
relationship between ﬁve dependent variables indicative of psychological adjustment to
aging—loneliness, hope, depression, life satisfaction, and self-esteem—and the
independent variables of social support, internalized homophobia, perceived health,
perceived ﬁnancial status, and perceptions Of ageism. Additionally, the study looked at
the relationship between the ﬁve dependent variables and the demographic variables of
race/ethnicity, income, education, work status, relationship status, and living situation. A
speciﬁc focus was placed on HIV status among participants, and both HIV-positive and
HIV-negative individuals participated in the study.

It was unclear whether, in terms of HIV status, there would be differences in the
ﬁve dependent variables between the men who were HIV-positive and those who were
HIV-negative. Additionally it was unclear whether there would be a relationship
between loneliness, hope, depression, life satisfaction, self-esteem, internalized
homophobia, and social support. Finally, it was unclear whether variables such as
perceived health, ﬁnancial status, and life expectancy also would be related to the ﬁve

dependent variables.

The results indicated that HIV status, income, race/ethnicity, living situation,
work status, and relationship status did not have signiﬁcant relationship to the dependent
variables indicative of psychological adjustment to aging. However, perceptions of
health, ﬁnances, and ageism were signiﬁcantly correlated with the dependent variables.
Poor perceived health, ﬁnances, and social support, as well as high levels of perceived
ageism and internalized homophobia, were nonfavorably correlated with the dependent
variables. .

This study illustrates the importance of perceptions, as opposed to objective
measures, of constructs such as health, wealth, and age. Speciﬁcally, the results indicated
that respondents’ perceptions of their reality generally had a stronger relationship to the
variables that measured their psychological adjustment to aging. These ﬁndings inform
services targeting older gay men, in terms of developing interventions that affect

individuals’ perceptions of, rather than just objective indicators of, aging.

Copyright by
SCOTT BERLIN
2007

DEDICATION
This dissertation is dedicated to the loving memory of my dearly departed
nephew, Evan Turner, and dearly departed friend, Thomas Buckingham. I love and miss

you both.

ACKNOWLEDGEMENTS

I wish to thank the following people and organizations. Without their help,
encouragement, and support this project would never have been completed.

Howard Brown Health Center in Chicago and Test Positive Aware Network in
Chicago, Illinois, for allowing me to have access to their resources and facilities.

Michigan State University faculty members Gary Anderson, Kristin Peterson, and
Victor Whiteman, for their technical advice and willingness to serve on my committee.

My parents (Pat and Bob Berlin), siblings (Tim Berlin, Sherry Berlin, Leann
Turner, Vicki Berlin, Carmen Berlin and Shelly Weslock) and nieces and nephew (Jacki
Berlin, Elyse Turner, Jenni Berlin and Matt Berlin) for providing unending support of my
academic endeavors.

My special friends, Rick Leonardo, Joe Vitale, Jeff Lane and Scott Cook, for
being in my life and for their belief in me and my work.

Rena Harold. Her many talents and consistent support in every area imaginable

have been essential to my success. Thanks, Rena! You are my mentor and dearest friend.

vi

TABLE OF CONTENTS

Page

LIST OF TABLES ...................................................................................................... ix

CHAPTER 1. .

INTRODUCTION AND LITERATURE REVIEW ................................................... 1
Background ...................................................................................................... 2
Overview of the Study ..................................................................................... 3
Statement of the Problem ................................................................................. 3
Research Questions .......................................................................................... 3
Deﬁnition of Terms .......................................................................................... 4
Theoretical Framework .................................................................................... 6

Psychological Adjustment to Aging .................................................... 6
Social Construction Theory ................................................................. 7
Homosexual Identity Formation and Development Theory ................ 8
Sociocultural Perspective ................................................................... 10
Activity Theory and Disengagement Theory ..................................... 11
Literature Review ........................................................................................... 13
Historical Research on Older Gay Men ............................................. 13
Psychological Adjustment to Aging .................................................. 15
Contextual Issues ........................................................................................... 20
Study Variables .............................................................................................. 24

CHAPTER 2.

METHODOLOGY .................................................................................................... 33
Research Questions ........................................................................................ 33
Participant Recruitment and Procedures ........................................................ 34

Procedures .......................................................................................... 34
Stratiﬁcation ....................................................................................... 35
Sampling Design ................................................................................ 35
Participant Inclusion Criteria ............................................................. 35
Recruitment ........................................................................................ 36
Consent Procedures ............................................................................ 39
Participant Characteristics ............................................................................. 38
Instrumentation and Variables ....................................................................... 40
Descriptive and Demographic Variables ........................................... 41
Dependent Variables .......................................................................... 42
Independent Variables ....................................................................... 47
Other Independent Variables ............................................................. 49
Risks and Beneﬁts to Participants .................................................................. 49
Data Processing and Analysis ........................................................................ 50
Summary ........................................................................................................ 51

vii

CHAPTER 3

RESULTS ............................................................................................................ 52
Participant Characteristics ............................................................................. 52
HIV Status .......................................................................................... 52
Sexual Orientation ............................................................................. 52
Age ..................................................................................................... 53
Race/Ethnicity ........ ' ............................................................................ 54
Education, Employment, and Income ................................................ 55
Relationship Status and Living Situation ........................................... 57
Addressing of the Research Questions .......................................................... 59
Research Question 2 .......................................................................... 59
Research Question 3 .......................................................................... 59
Research Question 4 .......................................................................... 64
Research Question 5 .......................................................................... 65
Research Question 6 .......................................................................... 67
Research Question 7 .......................................................................... 67
Summary ........................................................................................................ 68
CHAPTER 4.
DISCUSSION ............................................................................................................ 69
Review of the Findings .................................................................................. 70
Demographic and Descriptive Characteristics ................................... 70
Social Supports .................................................................................. 72
Acceptance of Gay Identity ............................................................... 72
Differences Between HIV-Positive and HIV-Negative
Participants ............................................................................. 74
Crisis Competence ............................................................................. 75
Perceived Health, Income, and Finances ........................................... 75
Overall Outcomes of Psychological Adjustment ............................... 76
LGBT Community Ageism ................................................................ 77
Accelerated Aging ............................................................................. 78
Study Strengths .............................................................................................. 79
Study Limitations ........................................................................................... 80
Recommendations for Future Research ......................................................... 81
Recommendations for the Field of Social Work ............................................ 84
Social Services ................................................................................... 84
Health Care ........................................................................................ 85
Housing .............................................................................................. 85
Awareness and Acceptance ................................................................ 86
Conclusion ..................................................................................................... 86
REFERENCES ........................................................................................................ 129

viii

LIST OF TABLES

Page
Table 1. Independent, Dependent, and Descriptive Variables ................................. 41
Table 2. Sexual Orientation by HIV Status ............................................................. 50
Table 3. Age by HIV Status.......... ........................................................................... 51
Table 4. Race/Ethnicity by HIV Status .................................................................... 52
Table 5. Education by HIV Status ........................................................................... 53
Table 6. Employment by HIV Status ....................................................................... 54
Table 7. Income by HIV Status ................................................................................ 55
Table 8. Relationship Status by HIV Status ............................................................. 56
Table 9. Living Situation by HIV Status ................................................................. 57

Table 10. Relationship between Perceived Health and Psychological Adjustment
to Aging ..................................................................................................... 59

Table 11. Relationship between Income and Psychological Adjustment to Aging... 60

Table 12. Relationship between Perceived Financial Status and Psychological

Adjustment to Aging .................................................................................. 61
Table 13. Relationship between Social Support and Psychological Adjustment to

Aging .......................................................................................................... 63
Table 14. Relationship between Internalized Homophobia and Psychological

Adjustment to Aging .................................................................................. 64
Table 15. Correlations between the Variables of Psychological Adjustment to

Aging .......................................................................................................... 65
Table 16. Life Expectancy by HIV Status ................................................................. 66
Table 17. Relationship between Life Expectancy and Psychological Adjustment

to Aging ..................................................................................................... 67
Table 18. Perceptions of Ageism ............................................................................... 68
Table 19. Perceptions of Accelerated Aging ............................................................. 69

ix

APPENDICES

Appendix A:

Consent Form ................................................................................................. 90
Appendix B:

Questionnaire ................................................................................................. 94
Appendix C:

Human Subjects Approval ........................................................................... 127

CHAPTER 1
INTRODUCTION AND LITERATURE REVIEW

It has been estimated that there are over 85 million individuals who are age 50 or
older in the United States (US. Census Bureau, 2003). This accounts for nearly 29% of
the country’s population. With a current median age of 36 that is increasing each year,
there is an ever-increasing focus on older adults. Concerns such as Social Security
solvency, Medicare coverage, and other policy issues, as well as the social support and
care giving needs of this population, are becoming more prominent.

A National Gay and Lesbian Task Force study states that one to three million
Americans over age 65, are lesbian, gay, bisexual or transgender (LGBT; Cahill, South,
& Spade, 2001). The number and proportion of LGBT older adults is expected to grow
signiﬁcantly in the coming years. Based on the immense arrival of the baby-boomers
into older age, it is expected that, within 30 years, twenty percent of Americans will be
over age 65. Approximately four million of these seniors will be LGBT.

LGBT Older adults will face many challenges as they move into older age. Older
LGBT people often do not access health care, housing, or other social services,
sometimes because of institutionalized heterosexism and homophobia (Cahill et al.,
2001). In this context, heterosexism is deﬁned as “a belief or argument that male-female
sexuality is the only natural, normal, or moral mode of sexual behavior, and is also used
to refer to the effects of that cultural ideology” (Corsini, 2001, p. 344). Homophobia is
deﬁned as “the fear Of, aversion to, or discrimination against homosexuality or

homosexuals” (O’Donahue & Casselles, 1993, p. 177). In relationship to this

“institutionalized heterosexism and homophobia”, policies and delivery systems often do
not consider the LGBT community (Cahill et al., 2001).

In addition to baby boomers transitioning into older adulthood, there is increased
visibility of LGBT individuals in our communities and society. Moreover, due to the
Stonewall Riots of 1969 and the beginnings of a large, organized LGBT political effort,
acceptance of LGBT people has become much more common.

Background

In June of 1969, the famous Stonewall Riots took place in New York City at a gay
bar, focusing national attention on the LGBT community. Patrons at the Stonewall Bar
fought back against the police harassment and brutality that was oﬁen directed at them.
Many see these riots as the beginning a “new age” for LGBT advocacy (Herdt & de
Vries, 2004). Possibly as a result of this these events, in 1973, the American Psychiatric
Association (APA) eliminated homosexuality from its listing of mental illnesses, creating
another step toward equal rights and treatment for LGBT people (Berger, 1980).

During the 19703, researchers in the social sciences began to recognize that
LGBT seniors might have distinct characteristics and needs, and thus the research in this
area continued to grow. Berger (1980) and others (Friend, 1980, 1987; F rancher &
Henkin., 1973; Kimmel, 1977, 1979) began to illuminate some of the realities of aging
among these individuals. Although research has grown in this area, there continues to be
an important need for additional research, particularly in regard to continuing social
justice as well as social change and the development of more social services (Berger,

1980; Kimmel, 1977; Kooden, 1997).

This population of individuals who has witnessed epic change, including being
one of the ﬁrst generations to live as openly LGBT people, are now in middle and older
adulthood. As such, research is needed in regard to how this generation of older LGBT
adults negotiates its way into older age.

Overview of the Study

This exploratory study utilized a correlational research design. It speciﬁcally
examined the outcomes associated with psychological adjustment to aging among gay
and bisexual men, as well as men who have sex with men in metropolitan Chicago.
These outcomes were measured by various established quantitative mental health and
attitude measures. Additionally, the study assessed other descriptive and demographic
information. While men who identiﬁed as gay, bisexual, and/or as men who have sex
with men were eligible for this study, the sample will be identiﬁed simply as gay men for
the remainder of this document.

Statement of the Problem

The problem that this study addressed is the lack of research on the ways in which
gay men over 50 years of age cope with the stresses of aging, as well as the possible
inﬂuence that various factors may have on their coping skills.

Research Questions

Based on the statement of the problem, the research questions are:

1. What are the demographic and descriptive characteristics of the sample?

2. Are there differences between HIV-positive and HIV-negative participants in

terms of psychological adjustment to aging measures?

3. DO variables such as perceived health, income, ﬁnances, social supports,
race/ethnicity, education, employment status, and internalized homophobia affect the
psychological adjustment aging measures?

4. Are the variables associated with psychological adjustment to aging (self-
esteem, loneliness, hopelessness, depression, and life satisfaction) correlated with one
another?

5. DO the variables and the psychological aging measures have a relationship
with participants’ life expectancy?

6. Do study participants perceive LGBT community ageism?

7. Do study participants perceive or experience accelerated aging?

Deﬁnition of Terms
It is important to have a clear understanding of the following terms when
considering the research.

Accelerated aging is the notion that gay men consider themselves as old (or at
least past their prime) at a younger age than their heterosexual counterparts (Bennett &
Thompson, 1991).

Ageism is “a prejudice against a certain individual or group because of their age.
This includes any assumption of familiarity or sameness due to one’s age. Age
discrimination can refer to prejudice against any age group solely on the grounds of age”
(Butler, 1968).

Gay refers to people who share affectional and/or sexual attractions to others of

the same sex and to identities and the culture and communities that have developed

among people who share those identities (American Psychological Association [APA],

1998). In terms of this study, gay men, bisexual men, and men who have sex with men
were all considered eligible for the study. In some cases, “gay” is used to refer to the
collective sample throughout this document.

Heterosexism is deﬁned by Herek (1996) as a system of ideology that “devalues
and stigmatizes” non-heterosexual behavior, identity, relationships, and community.

Homophobia is the “irrational fear, hatred and intolerance of gay, lesbian, and
bisexual persons” (Gelberg & Chojnacki, 1995 p. 268).

Internalized homophobia is “a set Of negative attitudes and affects toward
homosexuality in other persons and towards homosexual features in oneself” (Shidlo,
1994,p.178)

Older, for the purpose of this study, refers to individuals 50 years of age or older.
While “older”generally refers to those 65 and older, this study utilizes participants in
midlife and older age, and the participation criteria included being aged 50 years or older.
Bennett and Thompson’s work (1991) discusses that there is a belief among some gay
men, that their old age begins at a younger age.

Psychological adjustment to aging is the measurement or assessment of mental
health, attitudes, personality, affect, and other outcomes among Older adults (Havighurst
& Orr, 1955). For the purpose of this study, psychological adjustment to aging will be
assessed through ﬁve constructs: depression, hopelessness, loneliness, life-satisfaction,

and self-esteem.

Theoretical Framework

Psychological A diustment to Aging

Psychological adjustment to aging is a concept that has been discussed in the
aging literature since the 19503 (Havighurst & Orr, 1955), and various speciﬁc indicators
have been used to measure psychological adjustment to aging. Psychological adjustment
to aging concerns general well being and quality of life in terms of social and
psychological outcomes for individuals during their years of older adulthood.

In the context of this study, psychological adjustment to aging was evaluated
through various scales cited in the research (Berger, 1984; & Kimmel, 1977; Kooden,
1997) and was broken down into the dependent variables of hope, life satisfaction,
loneliness, depression, and self-esteem. Factors that may affect these measures of
psychological adjustment included the descriptive variables of HIV status, income,
education, relationship status, and employment status, as well as various independent
variables such as perceived health, internalized homophobia, perceived ﬁnancial stability,
and social support. HIV status is a key variable in terms of adjustment to aging. The
variables and measures will be described in detail in Chapter 2 (Methods).

When discussing psychological adjustment to aging, a broad theoretical view can
be utilized to explain the phenomenon. This study is based on ﬁve theories: (1) social
construction theory, (2) homosexual identity theory, (3) sociocultural perspective,

(4) activity theory, and (5) disengagement theory. These theoretical bases will assist in

exploring psychological adjustment to aging and are discussed below.

Social Construction Theory

The central concept of social construction theory is the idea that people and social
groups that interact collectively in a social system, produce, over time, representations of
each other’s actions and that these beliefs eventually become tailored into societal roles
relative to one another. Thus, knowledge and people’s concept of reality becomes
combined into the structure of society. Therefore, “social reality” is thought to be
socially constructed and is a function of a person’s unique reality as well as society’s
vision of what is real (Berger & Luckmann, 1966).

Friend (1987) discussed aging among gay and lesbian people in the context of
social construction theory. He presented the notion that gay people who are dealing with
sexual identity, generally have two types of responses to the social construction of
homosexuality as a negative identity. Some internalize the negativity related to
homosexuality, while others reconstruct its meaning in positive ways. Friend believes
that an individual’s capability to reconstruct his homosexuality in a positive manner is a
signiﬁcant indicator of a positive psychological adjustment to aging. Although Friend
discussed two distinct responses to the construction of homosexuality, he sees them as
two extremes or opposing endpoints of a continuum. He identiﬁed three groups in the
above-mentioned continua that reﬂect three possible styles of identity formation. Each is
discussed below.

Stereotypical older LGBT people. This group consists of those who have
completely internalized their homosexual identity. They are characterized by low or no
associations with other LGBT people, isolation, low sexual intimacy, self-hatred, guilt

anxiety, and low self-esteem.

Passing older LGBT people. This group is characterized by marginal acceptance
of their sexual orientation. Generally, this group takes great pains in hiding their sexual
orientation through activities such as heterosexual marriages and distancing themselves
from other aspects of “stereotypical” LGBT people. Common emotional components
include anxiety, self-consciousness, fear of being exposed, conditioned self-acceptance,
and absence of support during crises. While the construct of a passing older LGBT
person represents a midpoint in the continuum of self-acceptance, it becomes clear that
the idea of passing and continuing to hide one’s self-identity is not a great deal more
desirable than being completely closeted.

Aﬂirmative older LGBT people. The afﬁrmative group is characterized by
reconstructing homosexuality as something positive. The literature states that this is the
largest group (Berger, 1984; Friend, 1987). Vibrancy, activity, and independence
characterize this group. They have maintained a high level of self-acceptance and
healthy adjustment even in non-accepting environments (Friend, 1987).

In terms of this study, variables assessing perceptions of health and illness, as
well as perceptions of ﬁnancial well being, are assessed. These socially constructed
meanings were analyzed in terms of their impact on dependent variables that measure
psychological adjustment to aging.

Homosexual Identity Formation and Development Theory

Cass’s (1979) work presented the ﬁrst theoretical model of homosexual identity
formation and expanded our knowledge of gay and lesbian persons. The six-stage model
that Cass presented has developed into a foundation for the study of homosexual identity

formation (McCarn & Fassinger, 1996).

Friend (1987) and Kooden (1997) utilized Cass’s model and applied it to older
gay men in the 19805 and 19908. Kooden’s (1997) paper builds on Friend’s (1987)
discussion regarding the necessity of dealing with one’s internalized homophobia as a
ﬁrst step to the “successful” psychological adjustment to the aging process. The second
step is the need to address one’s ageism, both internally and externally. Kooden stated
that creating (reconstructing) a positive notion regarding one’s age is as important as
creating an afﬁrmative image of oneself as a gay person. In this regard, he created a list
of developmental tasks for successful aging, based on his work with gay male clients.
They are as follows:

1. Resolving negative attitudes toward homosexuality.

2. Finding a positive gay/lesbian role model.

3. Renegotiating a “new body image” in which one feels attractive and
comfortable with the body.

4. Creating and developing a personalized value system.

5. Developing high self-esteem and empowerment.

6. Developing a positive sense of peership and family of choice in the context of
interpersonal relationships.

7. Finding joy in work and play.

8. Taking charge of one’s life.

9. Taking control of physical health.

10. Positive visualization of the future as an older gay person.

11. Acceptance of mortality and development of spirituality/meaning of life.

12. Positive acceptance of being an older gay person (Kooden, 1997, p. 26).

In terms of this study, the variables measuring internalized homophobia and
perceived ageism were used to address the theoretical perspective of homosexual identity
formation theory. The data were analyzed to assess how these factors affected the
dependent variables of psychological adjustment to aging. Both internalized homophobia
and perceived ageism had a non-favorable relationship with psychological adjustment to
aging measures (Kooden, 1997)

Sociocultural Perspective

The fundamental concept of the sociocultural perspective view of human
development is idea that people develop predominantly through social interaction. The
sociocultural perspective theorizes that behavior and emotions are shaped not only by
previous learning and unconscious inﬂuences, but also essentially through the social and
cultural context. Current sociocultural theory has its foundation in Vygotsky’s (1986)
work as well as other social scientists (Wertsch, 1991; Wertsch, 1998). The sociocultural
perspective has major implications various social science discipline, including education,
psychology, and sociology.

When considering the sociocultural perspective among gay men, it is vital to be
aware of minority status, marginalization, and stigmatization among this group.
Historical events play a key role in inﬂuencing the experiences of LGBT people.

Although the Stonewall Riots and the 1973 decision of the American Psychiatric
Association to remove homosexuality as a mental illness from the Diagnostic and
Statistical Manqu Mental Disorders (DSM) both positively affected the LGBT
community, homophobia still strongly exists in our society. On the interpersonal level,

gay people internalize the homophobia that they experience from individuals,

10

organizations, and the larger society. “To be a sinner in the eyes of God, criminal in the
eyes of the law and sick in the eyes of psychiatrists, leads to low self-esteem and lack of
self worth” (Kochman, 1997, p. 12).

While, historically, the helping professions have not been particularly supportive
of gay/lesbian people, recent self-advocacy and social change has brought social workers
and other social scientists to more progressive views. However, full acceptance and
nurturing are still not prevalent (Kochman, 1997). For the current study, descriptive data
that addressed the sociocultural perspective of gay men over 50 years of age were
collected and analyzed.

Activity Theory and Disengagement Theory

Research on aging has traditionally focused on the older individual’s participation
in life, and aging theories generally include biological, physical, psychological, and
social aspects of the aging process. Two predominant theories, activity theory and
disengagement theory, have been studied by Havighurst (1968). They have been used
widely to explain the psychological well being of older adults.

Activity theory is a notion of aging that holds that, the greater an older adult’s
level of activity, the more likely he or she will do better in terms of psychological well
being. When considering activity theory, the emphasis is placed on the external actions
of the person. Havighurst (1968) stated that activity theory is the foundation for
interventions that most helping professionals use when working with seniors. The
accepted belief is that older adults should attempt to maintain activities and attitudes of
middle age as long as possible. When they cannot continue certain activities, they are

encouraged to ﬁnd alternatives for those activities.

11

An opposing theory to activity theory is disengagement theory. Disengagement
theory posits that disengagement with various social systems is a normal and appropriate
step as an individual moves into older age. This theory regards lessened social activity as
a process characterized by mutual withdrawal of both the individual and society. The
older individual both accepts and desires this lessened activity (Havighurst, 1968).

Cumming and Henry (1961), in their discussion of disengagement theory,
posited that this disengagement can be initiated by the older individual or by other people
in his or her life. The older person may remove themselves, more distinctly from some
people, while continuing to be close to others. Furthermore, systems in society, such as
employers and Social Security may make this withdrawal easy for the older person.
Disengagement theory also posits that, when a person has entered into older age, the
balance that existed in middle age between the person and society is replaced with a new
balanced that often includes a greater distance and a different relationship with one’s
environment.

These two theoretical frameworks provide different views of older age. To
date, research has been inconclusive in support of one theory over the other. It has been
argued, and supported by extensive research (Havens, 1968; Reichard, 1962), that some
aging persons ﬁnd disengagement more satisfying, while others gain greater satisfaction
from higher levels of activity.

In terms of this study, variables that assess the factors of engagement with life
were collected and correlated with variables that measure psychological adjustment to
aging. Examples of variables that help assess engagement with life include work status,

hobbies, relationship status, and socialization activities.

12

Literature Review

Historical Research on Older Gay Men

One of the ﬁrst pieces that discussed the topic of older gay men in the context of
social science research was a passage in a book, The Third Sex (Allen, 1961). In the
19705, a few empirical studies were conducted (Fenwick, 1978; Kelly, 1977; Kimmel,
1977), and in the 19805, while the amount of research increased on older gay men, its
prevalence was still small (Wahler & Gabbay, 1997). During the 19905, there was a
sizable addition of empirical articles on older gay men. Two full issues of the Journal of
Gay and Lesbian Social Services (1997, 2001) were dedicated to the LGBT older adult
population.

Sampling and research model problems. Research has almost always occurred
among middle class, Caucasian, urban-dwelling men who are active in the community
(Wahler, 1997). Additionally, sample sizes usually have been quite small, less than 20
(Francher & Henken, 1973; Friend, I987; Kimmel, 1977, 1979; Minnegrove & Adelman,
1978). These small samples probably occurred due to invisibility of LGBT seniors and
other community members at the time of the research. In addition, much of the research
contained statistically insigniﬁcant ﬁndings; the research simply served as an
informational base, with small samples and anecdotal information (Allen, 1961; Fenwick,
1978; Kimmel, 1977, 1979-1980).

Research design. The knowledge base on aging gay men has been generated
through a combination of both quantitative and qualitative research (Wahler & Gabbay,
1997). Later 19805 articles that assessed psychological adjustment to aging have

embraced a more positivist approach, utilizing depression and anxiety scales to compare

13

gay people to heterosexuals (Berger, 1984; Friend, 1987; Kehoe, 1988). The late 19905
articles concerned needed services and contained qualitative needs assessments and
discussions of services generally developed through practice wisdom (Beeler, Rawls,
Herdt, & Cohler, 1999; Jacobs, Rasmussen, & Hohman, 1999). Such research has been
based on the increased needs for these services (Beeler et al., 1999).

Evolution of the research. The research on older gay men has followed a course
from a essentially pathological and negative emphasis, to a much more functional
discussion and, ﬁnally, to a development of theory about the unique strengths and
competencies of older gay men (Berger, 1980, 1982, 1984; Friend, 1980; Lee, 1987).
More recent research has concentrated on the identiﬁcation of programming and
interventions for Older gay men (Beeler et al., 1999; Jacobs et al., 1999). Additionally,
there has been a change in language used, from a deviance perspective (Francher &
Henkin, 1973; Weinberg, 1970) to one that recognizes and respects LGBT people
(Kimmel, 1977). This parallels the historical changes and increasing acceptance of
LGBT people.

Stereotypes of older gay men. Berger (1980, 1982, 1984) looked at older gay men
through a series of semi-structured interviews. This research helped to dispel many
commonly held stereotypes that older gay men were sad and alone. He noted, with few
exceptions, that gay men were at least as well adjusted to aging as were their heterosexual
counterparts.

Numerous later studies found that gay men may, in fact, adjust more easily to
aging than do their heterosexual counterparts (Kooden, 1997; Whitford, 1997). The

literature, however, is inconsistent. Some research found no signiﬁcant differences in

14

psychological adjustment among gay men, compared to their heterosexual counterparts
(Adelman, 1991; Berger, 1982), while other research found smooth transitions into older
age for gay men, as compared to their heterosexual counterparts (Kooden, 1997;
Whitford, 1997).

Psychological Adjustment to Aging

There is a fair amount Of literature that explores how gay men adjust to the aging
process, including an examination of the social context of aging among gay men from the
standpoint of what is known and how it is known. The issues that will be discussed
below include successful aging, self-acceptance, crisis competency, expectations of aging
“family” relationships, intimate relationships, gender role ﬂexibility, ﬁiendship, and
generativity. These issues were chosen not only to represent the social domain of aging
in general, but also to represent the critical gaps and issues for the 215t century in
research and policy.

Successful aging. Early aging research had historically looked at on aging, using
the constructs of decline and 1055 (Williams & Wirths, 1965). Then, older individuals
began to experience better health and longevity, which created a new area of study. This
area of study grew to include a new focus on healthy older adults (Heckhausen & Schulz,
1996; Rowe & Kahn, 1998). This broadened focus led to comparisons between the two
groups of older adults, the healthy and the ill. In addition, research highlighting the
distinctions among the healthy group of older adults began to be a part of the framework
of aging research (Rowe & Kahn, 1998). This research was intended to learn more about
the two groups of healthy older persons, those without illness, but at risk (the usual

agers), and those without illness and not at risk (the successful agers).

15

The concept of “successful aging” has been broadly studied using constructs of
physical, cognitive, and psychological and social functioning (Herdt & de Vries, 2004).
Some have stated that the use of terms such as successful aging suggests “the capitalist
takeover of aging” (Herdt & de Vries, 2004). The critical evaluation of “successful
aging” is the notion that, when aging is studied in terms of “objective” outcomes, these
outcomes are assessed within a given historical and cultural period and in a given gender
and class context, without proper recognition of the social construction of aging (Herdt &
de Vries, 2004). However, if research looks at aging and successful aging in only
subjective terms, this also would not be appropriate (Herdt & de Vries, 2004).

The previously mentioned concepts produce concerns in terms of how to measure
successful aging. If all the criteria for successful aging was considered, it would be
difﬁcult to assess who is a successful ager and who is not (Baltes & Carstensen, 1996).
Rowe and Kahn (1998) propose one set of possible criteria of successful aging. Their
model includes three constructs: avoidance of disease, maintenance of high cognitive and
physical functioning, and engagement with life. These measures are most commonly
utilized by researchers from various disciplines (Herdt & de Vries, 2004).

Self-acceptance. A central theme in the research reviewed was the notion that a
key determinant of success in aging among gay people is a high level of self-acceptance
a5 a gay person and as an older person. This can be a high expectation because of
continuing widespread non-acceptance of ones gay identity, by American culture coupled
with widespread ageism in the gay community and in the larger society (Friend 1987;

Kooden, 1997).

16

Crisis competency. Berger (1982), Friend (1991), and Kooden (1997) discussed
the concept of crisis competency. This concept is the notion that gay men may have had
a history of addressing crises more often than their heterosexual counterparts and
therefore may have an easier time handling the crises that accompany old age. Dealing
with issues such as coming out, discrimination, isolation, and HIV/AIDS has perhaps
better prepared gay men for the issues of older age, such as death, loss, and loneliness.
Many gay men have already cutoff relationships with family members due to non-
acceptance of their sexual orientation. Still many others have lived through the deaths of
a signiﬁcant proportion of close friends and peers. Many living with HIV/AIDS have
had to make the emotional adjustment of having chronic compromised health. This
“crisis competency” may help gay men in this situation (Kooden, 1997).

Expectations of aging. Berger (1984) stated that expectations of aging may be
different and perhaps more realistic among gay men. Many of their heterosexual
counterparts have perceptions about receiving assistance and care from their children and
spouses. Most gay men studied did not possess this notion and tended to independently
plan for their retirement and Older age. These gay men were more likely to be alone
during older age. Although this may manifest as an isolating factor, this independence
may assist in the facilitation of transition to older age (Friend, 1987).

“Family ” relationships. While gay men report less contact with their families,
they also generally report larger close friendship networks (Kosberg & Kaye, 1997). In
the absence of close family ties, some gay men establish friendship networks that serve as
family equivalents. The research points out that gay/lesbian people generally have a

larger network of friends, as compared to their straight counterparts, who have more

17

family ties. Dorfman (1995) measured the quality and quantity of informal support
among a group of homosexual and heterosexual respondents and found no statistically
signiﬁcant differences in the two groups.

Many studies cite the concept of “chosen families” for older gay people. Beeler
et al. (1999) stated that two-thirds Of their sample of middle-aged and older gay men and
lesbians stated that they had created a family of choice. Weinstock (1998) discussed the
notion of friends as family by categorizing three possible groups: (a) friends as substitute
family members; (b) friends as a challenge to the core structure of the family; and (c)
ﬁiends as in-laws. A recent qualitative study of 20 gay men and lesbians over the age of
65 found that all but one considered their ﬁiends to be their family in some manner
(Herdt & de Vries, 2004)

Friendship. Many studies have illustrated several positive impacts of friendship
that are associated with a person’s emotional well being in their later years. Therefore, it
should be even more important in the lives of older gay men and lesbians. Unfortunately,
there have been few studies is addressing the role and meaning of friends in the lives of
LGBT seniors. Most of the studies in this area are anecdotal and inferential and consist
of compilations of personal narratives of lesbian and gay seniors (Adelman, 1990;
Berger, 1982; Vacha, 1985). The few empirical studies that assess friendship among gay
men and lesbians, particularly in later life, include Nardi’s (1999) study of gay men
representing a broad age range, Dorfman et al.’s (1995) exploration of lesbians and gay
men over 60, Quam and Whitford’s (1992) study of gay men and lesbians over 50, and

Beeler et al.’s (1999) study of mid- and later life gay men and lesbians. In all of these

18

studies, the importance of friendship for the health and psychological well being of older
gay men and lesbians has been highlighted.

Gender role ﬂexibility. Gender role ﬂexibility is Often more corrrrnon among gay
and lesbian couples than it is among heterosexuals. Often, in same sex relationships,
particular responsibilities and roles are not clearly deﬁned. For example, if a straight
man’s partner/wife dies, he is probably more likely to have to learn her responsibilities,
such as managing the household. In gay/lesbian relationships, it is more likely that both
partners complete many common tasks (Friend, 1987). This may allow the other to
adjust more easily if a partner dies. The role of “head of household” or “breadwinner” is
less deﬁned among gay couples. This may help to make the transition to living alone and
managing a household less severe among LGBT seniors (Berger, 1980; Lee, 1987)

Generativity. The concept of generativity was coined by Erikson (1978).
Erikson’s generativity versus stagnation stage stresses the notion of “achieving a sense of
commitment and love” and prepares an individual for creating a legacy to leave for later
generations. This notion of commitment and legacy as Erikson viewed it, in terms of
generativity, has often been interpreted by social scientists in terms of having and raising
children. Erikson never limited his conceptualization of generativity to parenthood and
did not believe that parenthood and generativity are one in the same (Herdt & DeVries,
2004)

Generativity can be accomplished through numerous varied life choices, beliefs,
and commitments, ranging from child-bearing and child-rearing to vocation/occupation,
professional activities, volunteer activities, social group memberships, friendships, and

leisure pursuits. These areas of generativity remain unexplored, although some

19

preliminary study in this area has occurred (McAdams, 1993). Having and raising
children continues to be the primary focal point of research with middle-aged and older
heterosexuals, there are many ways of achieving generativity among midlife and older
gay people that have been studied by a few researchers (Cohler, 1998; Cornett & Hudson,
1987; Herdt & DeVries, 2004; lsay, 1996). Generativity for LGBT individuals may be
achieved in many ways, including parenting, mentoring, pet ownership, real estate
preservation, and various career pursuits such as teaching, the arts, and community
service (Herdt & DeVries, 2004).

Contextual Issues

Many contextual issues affect Older gay men and their lives. This section will
present some of these contextual issues.

Historical experiences of discrimination. A large portion of existing social
service research on gay people conﬁrms that gay seniors often mistrust social services
and health care agencies due to life long experiences of marginalization and oppression
within those organizations and within their community. The Older gay people who were
out and seeking services prior to Stonewall, and before homosexuality was removed from
the American Psychological Association’s (APA) list of mental disorders in 1973, are
even more likely to be guarded in terms of social service organizations. Before these
changes, LGBT individuals were disempowered, assumed to be mentally ill, and were
Often sent of these organizations to “ﬁx” their problem of homosexuality (Herdt, et
al.,1997).

The damage from being marginalized and stigmatized from past experiences

reminds older LGBTs that it may be risky to place their trust in individuals and social

20

systems that have historically harmed them. In terms of accessing systems, the historical
experience has had a lasting impact on this group (Herdt, et al.,1997).

Homophobia and heterosexism. Many LGBT seniors have been signiﬁcantly
affected by their past history of accessing social services. Further, poor treatment of
these individuals continues today. Currently, civil rights for LGBT people are not
recognized based on sexual orientation, gay marriage or domestic partnership is not legal
in the majority of states, and many states have enacted bans on gay marriage. LGBT
seniors continue to report homophobia in the community and in helping agencies.
Research among social workers in recent years has cited a signiﬁcant rate of homophobia
and heterosexism that is reﬂected in community settings and among social workers
themselves (Herdt & de Vries, 2004).

When older gay and lesbian people consider that, one day, they may have to rely
on systems such as nursing homes, home care agencies, and senior centers, they are
concerned and anxious. Numerous gay seniors fear being mistreated and may avoid
getting needed services, even when their health and safety may depend on it (Herdt &
DeVries, 2004).

The meaning of aging among LGBT people is not understood well in the United
States. For the ﬁrst time in history, a generation of self-identiﬁed gay people is entering
retirement and still there is minimal information about their physical health, mental
health, and special social service needs. We understand even less about what well being,
successful aging, and psychological adjustment to aging in later life mean among this

group. Additionally, the aging processes among LGBT people who are already in their

21

in.

T1" Var.

retirement years, many of whom are still “closeted,” remain invisible (Herdt & DeVries,
2004)

HIV/AIDS and youth focus of social services. The HIV epidemic has dominated
research efforts in the LGBT community during the past 25 years. Most current and
predominant areas of social science study relate to risk and prevention in the community
(Levine, Gagnon, & Nardi, 1997). Additionally, a focused effort of HIV prevention
among young gay men is the area in which most money and effort is dedicated (Boxer,
1997; Cohler, 1998). Additional social services that assist youth in coming out and in
adjustment, while important, have obscured from view older gay people, many of whom
remain isolated from the community (Herdt, Beeler, & Rawls, 1997).

A geism and age cohorts. It is important to discuss the greater culture when
considering the study of midlife and senior gay men in the US. In a recent report, the
Henry J. Kaiser Foundation found that the experiences of older gay men and lesbians is
vastly different than those of younger lesbians and gay men when it comes to interacting
with their heterosexual peers. As the research presents, a large number of young people
are increasingly open and accepting of LGBT people in their schools, churches, and
workplaces. However, individuals, age 65 and older, are least likely to have accepting
attitudes toward LGBT people. Additionally, young people and seniors, according to the
report, hold very different views about policy. The great majority of young people, aged
18 to 29, support lesbian and gay unions, marriage, and adoptions for LGBT people,
while, for people over 65 , only about 25% support these policies. This is a huge gulf that
defrnes the problems of each cohort as it adapts to society and ﬁnds a foothold in this

new century (Herdt & de Vries, 2004).

22

In addition to vastly different perceptions about LGBT people among age cohorts,
there are also high levels of ageism that are perceived in the gay community, according to
some of the current research. Further, research shows that gay men have more ageist
beliefs than do lesbians, and gay men perceive more ageism in society than do lesbians
(Schope,2005)

Accelerated aging. The term accelerated aging was coined by Bennett and
Thompson (1990). It refers to the notion that gay men consider themselves as old (or at
least past their prime) at a younger age than do their heterosexual counterparts. This
issue has been the subject a few studies during the past few decades. The ﬁndings of
studies looking at accelerated aging among gay men are inconclusive, however (Jones &
Pugh,2005)

Mental health needs and access. In general, gay and lesbian older adults are
considered to be more cautious to use mental health services than are heterosexual older
adults, even though many concerns of the two groups are similar. LGBT seniors often
see a counselor for common reasons such as, relationship difﬁculties, bereavement issues,
work worries, and ﬁnancial stress. Concerns about discrimination, marginalization and
homophobia prevent LGBT seniors from getting help when they need it (Quam, 1997).

Mental health providers and other helping professionals should be cognizant of
internalized homophobia and create a setting responsive to their LGBT clients (Quam,
1997). It is also important that mental health providers do not assume that clients’
presenting problems are automatically related to their sexual orientation. Further, helping
professionals should be aware Of their personal perceptions and assumptions about gay

and lesbian seniors and learn about differences among the group (Quam, 1997).

23

I." r

' ﬁlm.

I”??? Va.

Study Variables

The following section presents the study variables in terms of the literature
available on these constructs. The review will include a discussion of ﬁndings to date on
these measures and how they relate to mental health, aging, and gay identity.

Life satisfaction. Life satisfaction is a construct usually assessed through self-
rating and is looked at in combination with other variables to create an extensive view of
well being (Andrews & Whitney, 1976; Diener et al., 1999). In the literature, life
satisfaction has been associated with variables such as job satisfaction, interpersonal
relationships, socioeconomic status, education, and family background, in addition to
various others. All these associations highlight the idea that life satisfaction is a
multidimensional construct.

Larson (1978) reviewed historical studies and noted that assessments of overall
psychological well being varied widely among research efforts. Larson expressed
concern about these studies based on their dependence on respondents’ self-assessment.
He coined the term, “subjective well-being” to deﬁne social psychological factors
measured by self-reports. Larson stated that several measures should be used to assess
the construct of life satisfaction among seniors. Speciﬁcally, he looked at early measures
of subjective well being or life satisfaction among individuals in areas of adjustment in
various aspects of life including work, health, and religion.

Larson (1978) assessed that health, socioeconomic level, and activity level were
signiﬁcantly related to life satisfaction among the older adults that he studied. Also,
Larson discovered that, among people over 60 years of age, assessments of life

satisfaction declined. However, when other variables were considered, such as poor

24

health, ﬁnancial issues, lower activity, fewer friends, and widowhood, the relationship
between age and life satisfaction was not signiﬁcant.

Loneliness. Townsend’s (1973) work emphasizes the difference between social
isolation and loneliness in later adulthood. Social isolation implies having less contact
with family and community. Loneliness is deﬁned as having an undesirable feeling of
loss of companionship.

There are inconsistent results in terms of assessing whether loneliness increases or
decreases as one ages Several studies that look at age trends in loneliness indicate that
loneliness tends to be highest among adolescents, and then continues to decrease across
the lifespan (Berger, 1999; Kooden, 1997), while some of the literature indicates that
loneliness increases among older adults (Herdt & DeVries, 2004). When discussing the
relationships between age and loneliness, researchers stress the need to take into
consideration background variables such as available social contacts with family, friends,
and partners (Yoakum, I994).

Self-esteem. Rosenberg and associates (1995) postulated that self-esteem is
created and maintained by way of three social processes: “(a) reﬂected appraisals, which
are the evaluations and responses of others toward us; (b) social comparison, which
involves evaluating ourselves in comparison to a reference group or individual; and (c)
self-attribution, which involves observations of our own behaviors and outcomes and
subsequent attributing of characteristics to ourselves”. All three processes contribute to
self-esteem.

Brandstadter and Greve (1994) studied self-esteem among seniors in terms of

their “view of self”. “The self is maintained and enhanced through a continual process of

25

regulation throughout the life cycle, involving psychological processes that aid in the
achievement of and consistency between actual and intended courses of personal
development” (p. 152.). This framework centers heavily on the psychological adjustment
to social circumstances that allows for maintaining self—esteem.

Depression. Research indicates that older adults suffer from depression at a rate
of 17%, as observed in medical setteings and that there is an even higher rate among
those older adults who are hospitalized or in nursing homes (Beekman et al., 1995;
Borson, 1998). Seniors have the highest rate of suicide among all age groups, as well as
other physical issues that are related to their depression. Estimates of the incidence of
depression in later life vary from about 10% for older persons living on their own, to
about 25% among individuals with a chronic illness (Beekman et al., 1995; Blazer, 1989;
Borson, 1998; Callahan, Hendrie, Dittus, Brater, Hui & Tierney, 1994). These results
stress the connection between mental and physical health among seniors.

An intersesting aspect of depression in later years is greater likelihood of
physical illness and suicide. The high suicide rate is predominately accounted for by
Caucasian men. Caucasian males, age 85 and older have suicide rates of up to 67.6
suicides per 100,000, more than ﬁve times the overall national suicide rate of 12 per
100,000 (Advance Report of Final Mortality Statistics, 1992). Depression represents the
most frequent cause of suicide among these individuals (Conwell, et al., 1996). The
relationship between depression and nonsuicidal death among older adults is supported
for heart attack and other illnesses, where depression increases mortality signiﬁcantly

(Erasure-Smith & Lesperance, 1993).

26

Numerous seniors are widowed annually. Bereavement after the death of a
signiﬁcant other is a major risk factor for depression. Approximately 10-20% of widows
and widowers experience depression during the ﬁrst year of bereavement (Zisook &
Schuchter, 1991). Although this research did not address older gay men, the notion of
depression due to loss of a partner should hold true for this group as well. Untreated, this
depression may continue, become chronic, and lead to increased disability and problems
with health (Latham & Prigerson, 2004).

Hopelessness. Although the construct of hopelessness has been somewhat
difﬁcult to deﬁne, historically, hopelessness may be viewed as the level to which a
person has a negative expectancy about events in his or her future and is one of Beck’s
(1967) “cognitive triad of negative condition, which includes the depressed person’s view
of the self, the world and the future. Hopelessness is closely related to depression, and
assessment of hopelessness is often utilized to assess the threat of suicide or of suicidal
ideation. (Beck, Steer & Ranieri, 1988).

HIV/AIDS. HIV/AIDS is an important concern in many populations; however, it
has major importance when discussing communities of both gay men and the elderly.
The Centers for Disease Control and Prevention (CDC) provides various statistics in
regard to HIV/AIDS. As of December 2004, there were 462,792 persons living with
HIV/AIDS in the US. With regard to prevalence, 72% of cases occurred among men
(CDC, 2006). The number of persons in the 55 and older age group living with HIV was
51,602 at the end of 2004 (CDC, 2006).

Moss and Miles (1987) examined HIV infection rates in older adults and found

that 10% of AIDS cases occurred in the age group of 50 years and older, with 25%

27

occurring in the population aged 65 and older and 4% in persons who are 70 years of age
and older. Noting the statistics reported by the CDC as well as Moss and Miles’
statistics, an argument can be made for the need to educate older populations about HIV
transmission and safe-sex/intravenous (IV) drug use tactics. In addition, several
researchers have noted that elderly persons are frequently leﬁ out of the HIV/AIDS
prevention education agenda, based on misconceptions regarding their lack of sexual
activity or drug use (Emlet, 1997).

Such misconceptions regarding the aging population (and speciﬁcally the aging
gay male population) are problematic because the result is that these persons are not
being targeted with HIV prevention education nor are they being tested for HIV/AIDS
when they present themselves in medical settings with symptoms. Emlet (1997)
indicated that men having sex with men (among the population aged 50 and over) still
account for most AIDS cases (Schamhorst, 1992). Gordon and Thompson (1995) also
indicates that 38% of respondents in their study contracted HIV via male to male sex.
This information is important for the medical community, so that persons are targeted for
HIV prevention education or tested for HIV when presenting themselves for medical
attention; for the social services community, who presumably counsel and deal with the
emotional/psychological needs of those affected; and for members of the community at
large—gays, straights, and HIV-positive and HIV-negative individuals.

Kowalewski (1988) stated that gay men are often ambivalent towards persons
living with AIDS, so that, “although they cannot forget or overlook them, they fail to get
involved in any meaningful sense in advocating for those dealing with the disease”.

Mental health issues among HIV-positive persons is an key factor in providing optimal

28

‘1‘!- u..-

HIV care. Mental health information from clients with HIV can be an key source to
supplement the research knowledge base on HIV and mental health. Intake information
can supply a helpful snapshot of signiﬁcant patient concerns in terms of psychosocial
issues associated with HIV/AIDS (Berg, Mimiaga, & Safren, 2004).

In recent study, that analyzed intake information from HIV positive men who
have sex with men (MSM), depression was cited as the most common issue (58.1% of
clients), followed by anxiety (38.2%),(Berg, et al., 2004). Depression (96.3%) and low
energy (78.2%) top two symptoms on a self-administered patient checklist, followed by
anxiety (69.2%). HIV-speciﬁc problems was often discussed by patients as a presenting
problem in their lives, and indirectly as HIV impacted their interpersonal relationships
The discussion above emphasizes the mental health issues that are common among HIV-
positive men who have sex with men. Mental health is a key component of overall
quality of life. Helping professionals, who work with gay men, can use this information
to broaden their awareness of mental health issues that impact this population (Berg, et
aI,2004)

Health. To address the needs of LGBT community members, the American
Medical Association (AMA) formally outlines medical provider responsibilities for
assisting individuals in this community (AMA Council on Scientiﬁc Affairs, 1996). For
example, gay men may be at increased risk for health issues such as HIV, Hepatitis,
cancer, and certain sexually transmitted diseases. It is critical that gay men receive
particular treatments, such as a Hepatitis B vaccine and colo-rectal cancer screenings.
Research has shown that physicians often do not ask patients about their sexual

orientation and that patients often do not divulge it. When this lack of communication

29

occurs, the result is inevitably a health care situation in which the needs of a gay/lesbian
person cannot possibly be fully met. In fact, almost one-half of patients in one study did
not tell physicians their sexual orientation. Further, many did not communicate their HIV
status to their health providers (AMA Council on Scientiﬁc Affairs, 1996). This lack of
communication generally enables the physician to assume that the patient is heterosexual
and potentially not investigate, diagnose, or treat ailments that are more likely to affect
the homosexual community. However, “taking a sexual history in a nonjudgmental and
attentive manner with Open ended questions can help the patient feel comfortable and
willing to conﬁde in the physician” (AMA Council on Scientiﬁc Affairs, 1996, p. 188).
This nonjudgmental attitude reminds physicians that it is certain behaviors that put gay
men at risk for particular ailments, rather than sexual orientation, per se.

A major breakthrough relating to the physical health of gay and lesbian persons is
found in the health initiative recently released by the federal government, called Healthy
People 2010 (Gay and Lesbian Medical Association and LGBT Health Experts [GLMA],
2001). This is a national agenda with two main goals: “(a) increase quality and years of
healthy life and (b) eliminate health disparities.” The initiative also addresses ten leading
health indicators and has several areas of focus. Among the leading health indicators are
responsible sexual behavior and access to health care. HIV is included in one of the
focus areas. The Gay and Lesbian Medical Association has also released a document
supporting this report, which speciﬁes health care needs that are speciﬁc to the LGBT
community. This is the ﬁrst time in the history of the federal government that such a
document has been offered in conjunction with the nation’s ten-year health initiative

plans. The document aims to educate the medical community (and the LGBT

30

community) about issues speciﬁcally related to health maintenance of persons in this
community. For example, the document asserts the importance of regular immunizations,
in addition to being immunized for Hepatitis A and B and inﬂuenza (Gay and Lesbian
Medical Association and LGBT Health Experts, 2001).

Internalized homophobia. Disclosure of homosexuality is now generally viewed
in the professional literature as more desirable than secrecy. Disclosure is often seen as
evidence of a healthy gay identity, whereas secrecy has come to be viewed as socially
and psychologically problematic (Cain, 1991).

Social support. Social support is an important component of one’s ability to cope
and function across the life course (Kooden, 1997). The perception that one can obtain
assistance or empathy when needed has been shown to inﬂuence well being, as well as
rates of morbidity and mortality. However, while perceived social support has been
shown to inﬂuence psychological and biopsychosocial adaptation across the life course,
several qualiﬁcations need to be made. The perception of social support may be just one
of several social factors inﬂuencing these processes. As posited by Svenson (1981), the
interaction of the person with the environment is a functionally complex phenomenon.
Thus, she suggests that assessment of social support requires the acknowledgement of
individual differences in conjunction with a wide variety of social factors that may
moderate psychological and biopsychosocial practices. (Friend, 1987)

Financial stability. A key factor of successful aging is found in the interface
among ﬁnancial stability and good health. Disagreement about the direction and
causation of these two variables has been difﬁcult to pin down. It has been shown in the

literature that healthier households are more ﬁnancially stable ones. It is unclear whether

31

higher incomes lead to better health, or poor health limits ones ability to build up assets
There is also a possibility that neither direction of causation is key, and the association
simply reﬂects other factors that make some healthier and wealthier. A great deal of
further research is required to understand the complexities of health, wealth and aging
(Older Americans, 2004).

The preceding paragraphs have outlined the research literature regarding aging
issues among gay men. The Introduction should help to set the stage for this study.
Informed by the research to date, the next chapter will outline the study of psychological

adjustment to aging among a sample of gay men over 50 years of age in Chicago.

32

CHAPTER 2
METHODOLOGY

This study examined psychological adjustment to aging in men who identiﬁed
themselves as gay, bisexual, or men who have sex with men, who are over 50 years of
age and who reside in metropolitan Chicago. This was an exploratory study that utilized
a cross-sectional one-phase research design. Because of its exploratory nature, the study
did not call for formal hypothesis testing. Participants were recruited to complete a 305-
item questionnaire and were paid a stipend of $15 for their participation. There were 75
participants who met the criteria for study and completed the questionnaire.
Questionnaires were collected from May 2005 through September 2006. Human
Subjects Review Board Approval from Michigan State University and Howard Brown
Health Center were obtained (Appendix A).

This chapter presents the methodology used to assess psychological adjustment to
aging outcomes. It begins with a restatement of the research questions, followed by a
discussion of participant recruitment and procedures, participant characteristics,
instrumentation and variables, risks and beneﬁts to participants, institutional review
board (IRB) review and informed consent, and data analysis. The chapter concludes with
a summary.
Research Questions

This study was guided by six research questions, which is an appropriate way to
conduct descriptive social research (Loﬂand & Loﬂand, 1995). The goal was to examine
psychological adjustment to aging, as well as to assess the impact of HIV/AIDS on the

study sample. The research questions pertain to life experiences of gay men as they age

33

and were designed to collect data on the physical, mental, and social attributes of the
respondents. The research questions guiding this study are as follows:

1. What are the demographic and descriptive characteristics of the sample?

2. Are there differences between HIV-positive and HIV-negative participants in
terms of psychological adjustment to aging measures?

3. Do variables such as perceived health, income, ﬁnances, social supports,
race/ethnicity, education, employment, and acceptance of gay identity affect the
psychological adjustment aging measures?

4. Are the variables associated with psychological adjustment to aging (self-
esteem, loneliness, acceptance of gay identity, hopelessness, depression, and life
satisfaction) correlated with one another?

5. Do the variables and the psychological aging measures have a relationship
with participants’ life expectancy?

6. Do study participants perceive LGBT community ageism?

7. DO study participants perceive or experience accelerated aging?

Participant Recruitment and Procedures

Procedure

The procedure involves the administration of the questionnaire, described below,
to 75 men who identiﬁed themselves as gay, bisexual, and/or as a man who has sex with
men (MSM), and who were 50 years of age and older. Participants were recruited for the
study at agency locations (Howard Brown Health Center and Test Positive Aware

Network) and community social venues, as well as through various existing studies at

34

Howard Brown Health Center. All participants resided in metropolitan Chicago during
their participation in the study.

Stratiﬁcation

The sample was stratiﬁed into two groups: those who were HIV-positive and
those who were HIV-negative. If a participant self-reported as HIV-positive, he was
asked to complete additional questions about health and HIV status. These questions
included T-cell counts and viral load assessments, as indicators of HIV/AIDS progression
and health. Other questions included year of diagnosis, whether the participant had been
hospitalized, and whether they had had an HIV-related illness.

Sampling Design

Men who identiﬁed themselves as gay, bisexual, or MSM were recruited for the
study. The reason for including men who have sex with men with gay and bisexual men
is that a signiﬁcant group of men who have sexual activity and relationships with same
sex partners do not identify themselves as gay or bisexual. While sexual identity is
important to the study, inclusion of men who have sex with men but do not identify as
age or bisexual includes a different aspect of the gay community. Because gay men are a
complex, heterogeneous population, obtaining a representative or random sample would
be difﬁcult. Thus, convenience sampling methods were utilized through referrals from
and recruitment in LGBT community venues. These venues included organizations that
offer social services to LGBT people in the metropolitan Chicago LGBT community,
organizations that offer health services to the LGBT community, organizations that offer
HIV/AIDS speciﬁc services to those who are HIV-positive, and bars, businesses, and

community activities that serve LGBT individuals.

35

Participant Inclusion Criteria

As noted above, the researcher recruited men who identiﬁed themselves as gay,
bisexual, or MSM, who were over 50 years of age and who resided in metropolitan
Chicago. More speciﬁcally, individuals were required to identify as a male, but this self-
reporting may or may not have excluded transgender individuals. Individuals were
considered eligible to participate in the study based on the criteria detailed below, which
also appeared on the consent form (Appendix A).

Inclusion criteria were: (a) aged 50 years and older, deﬁned as 50 years, 0
months, 0 days, and older; (b) self-identiﬁcation as a man; and (c) self-identiﬁcation as
gay, bisexual, or a man who has had sex with men. Exclusion criteria were: (a) not
meeting the three criteria above; (b) not willing to sign a consent form; or (c) identiﬁed
by study staff as cognitively impaired such that the individual would not be able to
understand the consent process.

Recruitment

Recruitment began in May 2005, and data collection was completed in September
2006. As noted above, convenience sampling techniques were utilized to recruit
individuals into the study. A broad-based recruitment plan was utilized to Obtain
participants who varied in terms of race/ethnicity, socioeconomic status, and experiences
of aging.

Community-based agency recruitment. The majority Of respondents were
recruited by networking with community-based agencies that offer services for LGBT
individuals and for those who are living with HIV/AIDS. The organizations were

contacted and an appointment was made to discuss the study and present it to potential

36

participants. Participants had the option of ﬁlling out the questionnaire immediately at
the agency or to taking the questionnaire home and returning it via US mail.
Approximately 67 participants completed the questionnaire and mailed it in while
approximately 8 participants ﬁlled the survey out, on site. Stipends in the amount of $15
were given in cash to those participants who ﬁlled out the surveys at the agencies. Those
who mailed in the survey were sent their stipend by return mail. A brief description of
the agencies from which participants were recruited is presented below.

Howard Brown Health Center (HBHC) is a health center and social service
organization that addresses the health care needs of the LGBT community. HBHC’s
multi-site operation includes a main health center in an uptown neighborhood in Chicago,
Triad Health Practice at Illinois Masonic Hospital, and the Broadway Youth Center in the
Lakeview neighborhood of northern Chicago. HBHC offers a large network of programs
and services, provided by a diverse and qualiﬁed staff of licensed doctors, nurses, health
care practitioners, research professionals, and prominent community leaders.

The Multicenter AIDS Cohort Study (MACS) at Howard Brown is a longitudinal
study of the natural and treated histories of HIV/AIDS among gay and bisexual men,
conducted at sites located in Baltimore, Chicago, Pittsburgh, and Los Angeles. A total of
6,973 men have been enrolled during the past 23 years. From April 1984 through March
1985, a total of 4,954 men were enrolled; an additional 668 enrolled from April 1987
through September 1991. A third enrollment of 1,351 men took place between October
2001 and August 2003. This third cohort augments research efforts in regard to the long-

term beneﬁts and adverse effects of medical treatment.

37

Some participants for this study were enrolled through MACS. Permission was
obtained from the lead principal investigator of the MACS to mail survey packets to all
MACS participants living in Chicago, who were 50 years of age and older. Additionally,
all service providers at HBHC were asked to refer their clients who met the criteria for
the study to the researcher for follow-up. Some employees at HBHC who met the criteria
for the study also completed surveys.

Test Positive Aware Network (TPAN) in Chicago is an HIV/AIDS service
organization that empowers people living with HIV through peer-led programming,
support services, information dissemination, and advocacy. The organization also
provides services to the broader community to increase HIV knowledge and sensitivity,
and to reduce the risk of infection.

The researcher attended and recruited participants in TPAN groups that were
designed for and attended by older gay men living with HIV/AIDS. In most cases, group
members completed the questionnaire during group time, although, in some cases, they
took the survey packet home and mailed it back later. Additionally, the researcher asked
group members to take extra survey packets if they knew other gay or bisexual men or
men who have sex with men who would be willing to complete a survey.

Bar/club community recruitment. Recruiting participants at bar/club venues and
other public venues was important to capture those who do not access services in the
community. These venues were identiﬁed based on the age of customers who go to the
venue. For example, there are bars that cater to an older gay male crowd in the Chicago
metropolitan area. The researcher took questionnaires to local gay bars in Chicago.

Eligible individuals who agreed to participate in the study were given a packet that

38

included a cover letter, an informed consent form, a copy of the questionnaire, and a self-
addressed stamped envelope. Participants were given the option to ﬁll out the
questionnaire at the venue or to take the packet home and to return it through US. mail.
Participants who mailed in their surveys were sent a $15 stipend when their questionnaire
and consent form were returned by mail. The participants who ﬁlled out the
questionnaire on site were each given $15 in cash.

Consent Procedures

Prior to participating in the study, individuals were oriented to the activities
involved in participation. The individual was given a consent form to read, review, and
sign if he was interested in participating. Further, participants were told that they could
refrain from answering any question that they wanted to and that they would incur no
penalty should they choose not to answer a question or to discontinue the survey.

Participant Characteristics

A total of 102 surveys were distributed, and 75 were returned either in person or
through US. mail, resulting in a return rate of 73.5%. The majority of those who
commented stated that the questionnaire was interesting and enjoyed ﬁlling it out. The
typical participant in the study was 51 years old, HIV-negative, Caucasian, had earned a
bachelor’s degree or better, was working full-time, earned more than $41,000 per year,
was not in a relationship, and was living alone. However, there was a great deal of
variance among the participants in regard to these attributes. Detailed characteristics of

the sample will be presented in Chapter 3, which contains the results of the study.

39

Instrumentatio_n_ and Vagalﬂ

In developing the questionnaire, the researcher relied heavily on the review of the
literature on social and psychological adjustment to aging among gay men. The literature
suggested utilizing a combination of existing scales that assess various attitudes and
mental health status. Thus, the questionnaire was developed utilizing established
instruments that, historically, have been used to measure aspects of psychological
adjustment to aging, including hope, depression, life satisfaction, social support, and
loneliness. In addition to selecting and combining existing scales that measure attitudes
and mental health, the researcher included items that were relevant to the study of older
gay, bisexual and MSM, such as perceptions of ageism in the LGBT community, the
impact of HIV/AIDS on their lives, parenthood, and life expectancy, among others.

Participants responded to a questionnaire (Appendix B) designed speciﬁcally for
this study to solicit reactions about the experience of aging as a gay male. The questions
were arranged into sections as follows: (a) Hopelessness; (b) Life Satisfaction; (c)
Depression; (d) Loneliness; (e) Perceived Health; (I) HIV Status; (g) Social Support; (h)
Intemalized Homophobia; and (i) Demographics.

Responses to these questions were answered by means of a Likert-type scale,
multiple choice questions, and numerical responses, resulting in quantitative data.
Existing scales were utilized and new questions were constructed to assess the
experiences of the participants and to answer the research questions guiding the study. A
pilot test of the survey instrument was conducted with ﬁve staff members at HBHC, three
of whom were gay men over 50 years of age. Based on their responses, minor changes

were made to the questionnaire.

40

Table 1 presents the variables measured in the questionnaire, broken down by
descriptive and demographic, independent, and dependent. The numbers in parentheses
correspond to the item numbers on the questionnaire. A discussion of each set of
variables follows the table.

Table 1: Independent, Dependent, and Descriptive Variables

Descriptive and Independent Variables
Demographic Variables

HIV Status (No. 18) Social Support (Nos. 82-93) Loneliness (Nos. 19-38)

Dependent Variables

Income (N o. 8) Intemalrzed Homophobia Depressron (Nos. 193-212)

(Nos. 39-61)
Race/Ethnicity (N o. 3) 532261;? ll)irnancral Status Hopelessness (Nos. 62-81)
. Perceived Health Life Satisfaction
Educatlo” 0"“ 4) (Nos. 185-187) (Nos. 213-232)
Perce tions of A eism Self-esteem
Employment Status (NO' 5) (Nos.p244-246) g (Nos. 161-184)
Living Arrangement Life Expectancy (N O. 251)

(No. 12)

Relationship Status (No. 13) Perception of Gay Old Age

(No. 240)
Descriptive and Demographic Variables
The questionnaire contained a section designed to obtain demographic data from
the participants, including age, race/ethnicity, sexual orientation, living situation,
relationship status, income and ﬁnancial status, educational attainment, employment
status, HIV status, and health status, among other items. Participants’ date of birth was
collected to verify age. Race/ethnicity was determined with one multiple choice question
with seven options, one of which was “other.” Participants could identify their sexual
Orientation as gay, bisexual, heterosexual, or other. Income was determined by one
multiple choice question that presented different ranges of annual income, while ﬁnancial

Status was collected with three questions that asked participants to judge their ability to

41

If.

meet present and future ﬁnancial needs. Relationship status and living situation were
determined through one multiple question each, as were education and employment level.

Dependent Variables

Hope: Beck Hopelessness Scale (BHS). Hopelessness was measured by the Beck
Hopelessness Scale (Beck et al., 1974). This self-report instrument “assesses the degree
to which an individual holds negative expectations towards his or her future. Each
statement is scored on a 4-point Likert-type scale (1 = deﬁnitely false, 2 = mostly false, 3
= mostly true, 4 = deﬁnitely true)” (Beck et al., 1974) The primary notion is that
hopelessness can be objectively measured by characterizing it as a system of constructs
with a common set of negative expectations (Beck et al., 1974). BHS has been utilized
extensively with older adults and in studies of gay men. Below are three sample items
contained from the Beck Hopelessness Scale (see Appendix B for the entire scale).

I look forward to the future.

I can’t imagine what life will be like 10 years.

All I can see ahead of me is unpleasantness rather than pleasantness

Reliability and Validity for the Beck Hopelessness Scale (BHS)

When discussing reliability of the BHS, the scale has been shown to be a reliable
measure of hopelessness reﬂecting a negative expectation of future outcomes. Beck et al.
(1974) examined the reliability of the BHS in a population of 294 hospitalized patients
who had attempted suicide, and Hill et al (1988) tested the scale on depressed elderly
persons and acceptable coefﬁcient alphas were Obtained (.76 and .84). An alpha was also

Completed on the sample in this study and it was reported to be .940.

42

In terms of validity of the scale, the BHS has a strong association with suicidal
intent and actual suicide completion (Beck et al., 1985). Further the scale was found to
have a moderately high correlation with Beck Depression Inventory which addresses
issues of content validity.

Life satisfaction: Life Satisfaction Index-A (LSIA). Life satisfaction was measured
using the Life Satisfaction Index A, which assesses well being using a subjective
evaluation of one’s own present and/or past life (Fischer & Corcoran, 2000). “Life
Satisfaction Index-A measures ﬁve components of well being: (a) zest versus apathy; (b)
resolution and fortitude; (c) congruence between desired and achieved goals; (d) self-
concept; and (e) positive mood tone” (Fischer & Corcoran, 2000, p. 223). The index
generally is used to measure happiness among respondents (Neugarten et al., 1961).
Each statement is scored on a 4-point Likert-type scale (1 = deﬁnitely false, 2 = mostly
false, 3 = mostly true, 4 = deﬁnitely true). Three sample items are presented below:

As I look back on my life, I am fairly well satisﬁed.

When I think back over my life, I didn’t get most of the important things I
wanted.

Most of the things I do are boring and monotonous.

Reliability and Validity for Life Satisfaction Index-A (LSIA)

In terms of reliability for the Life Satisfaction Index-A (LSIA) There have been
numerous studies testing the reliability of items (Rao & Rao, 1983). Acceptable
coefﬁcient alphas of .76 and above have been reported on studies utilizing the scale. An
alpha was run for the scale items with this sample and the alpha was .899. When

discussing validity of the LSIA, the scale showed a relationship to other scale measuring

43

 

life satisfaction and happiness demonstrating concurrent validity (Fischer & Corcoran,
2000)

Self-esteem: Index of Self Esteem (ISE). The Index of Self-Esteem is intended to
measure the “degree, severity, or magnitude” of a client’s issues with self-esteem. Self-
esteem is regarded as the evaluative measure of self-concept. The ISE is written in
straightforward language and easily administered and scored. Each statement is scored on
a 7-point Likert-type scale (1 = none of the time, 2 = very rarely, 3 = a little of the time, 4
= some of the time, 5 = a good part of the time, 6 = most of the time, 7 = all of the time).
Oftentimes, issues with self-esteem are central to social and psychological problems.
Therefore the instrument has a wide range of uses for a number of clinical problems
(Fischer & Corcoran, 2000).

The index was established through testing Of 1,745 respondents, including single
and married individuals, clinical and nonclinical populations, and college students and
non-students. Respondents included Caucasians, Japanese and Chinese Americans, and a
smaller number Of members of other ethnic groups. Below are three sample items.

I feel that I am likely to fail at things I do.

I feel that people have a good time when they are with me.

I wish that I were someone else.

Reliability and Validity for Index of Self Esteem (ISE)

When discussing validity, the ISE has good known-groups validity, signiﬁcantly

distinguishing between clients judged by clinicians as having self-esteem issues

compared to those judged as having no problems. In terms of construct validity the ISE

44

has been shown to correlate highly with measures that it should be related to such as
depression, happiness and sense of identity scales (Fischer & Corcoran, 1994).

Loneliness: Revised UCLA Loneliness Scale (R ULS). Loneliness was measured
utilizing the Revised UCLA Loneliness Scale, which, based on research citations, has
become the most commonly used measure of loneliness. Items on the RULS are scored
on a 4—point Likert-type scale (1 = never, 2 = rarely, 3 = sometimes, 4 = often). The
revised scale was developed to correct for “issues of bias, socially desirable responses,
and distinctiveness from related constructs.” The scale has been utilized to assess a
varied range of mental and physical health outcomes among diverse populations (Berger,
1984). Loneliness is related to a variety of other problems, including personality
disorders, substance abuse, suicide, and physical ailments. The Revised UCLA
Loneliness Scale has several uses for practice in identifying lonely clients, whose
loneliness is a problem in and of itself, or is connected to other problems (Fischer &
Corcoran, 2000).

Three sample items are presented below:

I lack companionship.

There are people I can talk to

I can ﬁnd companionship when I want it.
Reliability and Validity for Revised UCLA Loneliness Scale (R ULS)

In terms of reliability the RULS has an established internal consistency that is
excellent, with an alpha of .94 (Fischer & Corcoran, 2000). An alpha was run for the

study sample and it was respectively .902.

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When considering validity, the RULS offers good concurrent validity, correlating
with several emotional and personality measures, such as depression and social support
(Fischer & Corcoran, 2000).

Depression: Beck Depression Inventory (BDI). The Beck Depression Inventory
(Beck, 1974) is a 21-question multiple choice self-report inventory that is one of the most
widely utilized instruments for measuring depression. Items of the BDI are self-rated by
the respondent on a 4-point Likert-type scale (1 = often, 2 = sometimes, 3 = rarely, 4 =
never). The BDI is intended for adults, ages 17 to 80, and consists of items that relate to
depressive symptoms such as, irritability, hopelessness, guilt or feelings of being
punished, as well as physical symptoms such as fatigue, weight loss, and lack of interest
in sex. The BDI is commonly utilized as an assessment tool by a variety of helping
professionals and researchers in various venues.

The Beck Depression Inventory experiences the similar issues as other self-report
scales, in that scores can be overstated or understated by the respondent. Similar to other
inventories, the way in which the test is administered can impact the ﬁnal score. For
example, if a respondent is asked to complete the scale in the presence of others in a
clinical environment, social pressure might elicit a different response, compared to a
survey that is mailed (Beck, 1988). Presented below are three sample items:

During the past week, I felt like I could not shake off the blues even with the help
from family and friends.

During the past week, I was happy.

During the past week, I did not feel like eating; my appetite was poor.

46

 

 

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Reliability and Validity for the Beck Depression Inventory (BDI)

In terms of reliability for the BDI, Beck, et a1. examined reliability of the scale
through a meta-analysis Of 25 studies. The samples represented a diverse sampling of
many different groups such as substance abusers, college students and older adults. The
internal consistency of the scale was high regardless of the group. Alphas ranged from
.73 to .95. An alpha was run on this sample and it was .945.

As far as validity with the scale, the scale shows strenghth in content, concurrent
and discriminant validity (Maruish, 1998).

Independent Variables
Social support: Multidimensional Scale of Perceived Social Support (MSPSS).

The Multidimensional Scale of Perceived Social Supports was created in 1988
and piloted on young adults. It is an scale designed to assess social support in three
construct areas: family, friends, and signiﬁcant other (Fischer & Corcoran, 2000). Each
statement of the MSPSS is scored on a 7-point Likert-type scale (1 = very strongly
disagree, 2 = strongly disagree, 3 = mildly disagree, 4 = neutral, 5 = mildly agree, 6 =
strongly agree, 7 = very strongly agree). The scale, which was determined to be a
reliable measure, assesses the extent to which respondents receive support form each of
these sources. Sample items are presented below:

There is a special person with whom I can share my joys and sorrows.

My family really tries to help me.

I can talk about my problems with my friends.

47

 

F anti '4,

Reliability and Validity for the Multidimensional Scale of Perceived Social Support
(MSPSS).

The MSPSS has excellent internal consistency, with alphas of .91 for the total
scale and .90 to .95 for the subscales. The entire scale was utilized for this study. An
alpha was run on this sample and it was .945. In terms of validity the MSPSS has good
concurrent validity correlating with depression and loneliness (Fischer and Corcoran,
2000)

Intemalized homophobia: Intemalized Homophobia Scale (IHS). The
Intemalized Homophobia Scale is intended to assess internalized homophobia, which is
thought to be an important construct in the symptoms and treatment of gay men and
lesbians. The scale was initially piloted on 184 men who directly or indirectly identiﬁed
as being gay (Fischer & Corcoran, 2000).

Intemalized homophobia can be viewed as a reaction to the stigma associated
with being gay or lesbian. Many psychological characteristics are linked to internalized
homophobia, such as “low self-acceptance, low ability to self-disclose, low self-esteem,
self-hatred, self-doubt, belief in one’s inferiority, and acceptance of popular myths about
homosexuality” (Fischer & Corcoran, 2000). This measure is extremely useful in
assisting providers in identifying internalized homophobia among clients and identifying
areas for intervention. Each statement of the IHS is scored on a 7-point Likert-type scale
(1 = strongly agree, 2 = moderately agree, 3 = Slightly agree, 4 = neither agree nor
disagree, 5 = mildly disagree, 6 = moderately disagree, 7 = strongly disagree). Below
are three sample items:

Most of my friends are gay.

48

 

It is important to me to control who knows about my being gay.

Even if I could change my sexual orientation, I wouldn’t.
Reliability and Validity for Intemalized Homophobia Scale (IHS)

There was little information on reliability and validity for the HIS. However to
tested reliability an alpha was run on the study sample and it was .789.

Other Independent Variables

Additional independent variables were analyzed for their relationship to the
dependent variables that assess psychological adjustment to aging. They included:
perceived ﬁnancial status, perceived health, perceptions of ageism, life expectancy, and
perception of gay old age. Perceived ﬁnancial status was measured by three questions in
which participants were asked to assess their subjective current and future ﬁnancial
situation, and perceived health was measured by asking participants to rate their current
health and their health compared to one year ago. Perceptions of ageism were assessed
by four questions in which participants were asked to comment on their perceptions of
the prevalence of ageism in the gay community. Life expectancy was measured by
simply asking participants the age to which they thought they would live. Perception of
gay old age was measured by asking participants, “At what age is a gay man old?” as
compared to “At what age is a person old?” These questions were generated by the
researcher.
_R_i§ks and Beneﬁts to Participants

Risks of participating in the study were thought to be minimal, but may have
included increased anxiety or depression as a result of discussing difﬁcult experiences in

participants’ lives, as well as anxiety about disclosure and discussion of HIV status.

49

 

Beneﬁts of participating in the study may have included acquiring a level of support in
regard to sharing feelings about their life experiences. Another potential beneﬁt may
have included resource referrals, available to individuals seeking other social service
support. The study’s researcher is a social worker and has expertise and knowledge in
regard to resource referrals. Finally, it was anticipated that some participants may have
felt good about participating in that their information and stories would be helpful for
others who may have had similar experiences. Upon completion of the survey,
participants were compensated with $15 in cash, which may have provided a small
incentive to participate, or an acknowledgement of the time people took to participate in
the study.
Institutional Review Board (IRB) Review and Informed Consent

This protocol, the informed consent documents, and any subsequent modiﬁcations
were reviewed and approved by the IRB at Howard Brown Health Center and at
Michigan State University. The informed consent described the purpose of the study, the
procedures to be followed, and the risks and beneﬁts of participation. A copy of the
consent form was given to each participant. A sample informed consent form is included
in the supporting documents section (See Appendix A)
Data Processing and Analysis

The informed consent forms and questionnaires for individual participants were
ﬁled separately in locked ﬁles in the researcher’s ofﬁce. Data from source documents
were entered on Statistical Package for the Social Sciences 14.0 (SPSS, 2005) software,
with secured access ﬁelds. Names and any other identifying information were not

entered on SPSS ﬁles or on the questionnaires. Unique conﬁdential numbers were

50

assigned to each participant. Participant numbers and identifying information are being
kept under double locks, separate from all other study ﬁles and accessible only to the
researcher.

Data were derived from the 75 completed surveys. As noted above, the surveys
were coded with a number and entered into SPSS for data analysis. Demographic data
were reported in terms of frequencies and percentages. Cross-tabulation tables were
generated as a means to determine possible associations, and correlations were
determined.

Summm

This chapter described the methodology utilized in collecting the data. The
primary source for data collection was the Multicenter AIDS Cohort Study at Howard
Brown Health Center, followed by the clients of Test Positive Aware Network and the
individuals contacted in community venues, including social organizations, churches, and
local bars.

The next chapter presents the results of the data analysis. The results are used to
address each research question and to provide a better understanding of the aging gay

male experience.

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CHAPTER 3
RESULTS

This chapter presents the results of the data analysis from this exploratory study
of 75 gay men over 50 years of age, in metropolitan Chicago. The chapter begins by
addressing the ﬁrst research question, using descriptive data from the study participants,
to describe the sample. The descriptive variables are organized by HIV status group, i.e.,
positive or negative. Following the descriptive data, the results of the data analysis are
presented, with a focus on signiﬁcant relationships and group differences. The rest of the
results are organized in terms of the remaining six research questions. The chapter
concludes with a summary.
Participant Characteristics

HIV Status

For HIV Status, 32 participants (42.7%) reported being HIV positive, 41 (54.7%)
reported being HIV negative, and two (2.7%) did not answer the question. Of the HIV-
positive participants, 28 participants (83.9%) reported being HIV positive for greater than
ten years (1994 or before). Of the 32 participants who reported being HIV positive, only
two (2.7%) reported having an HIV-related illness in the past six months (lymphoma and
wasting syndrome) and one participant reported a hospitalization in the past six months.

This section creates a descriptive picture of the study sample both in terms of
demographic characteristics and HIV Status.

Sexual Orientation

As noted above, this study consisted of 75 participants. All participants signed

the consent form stating that they were gay, bisexual, or a man who has sex with men

52

 

 

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(MSM). In terms of sexual orientation, 66 participants identiﬁed as gay, four identiﬁed
as bisexual, and two identiﬁed as “other,” while three did not report sexual orientation.
Due to the participants’ signing of the consent form, it was assumed that the two
respondents who identiﬁed as “other” and the three who did not report their sexual
orientation still ﬁt the criteria of the study. It can possibly be assumed that some of these
participants are men who have sex with men but do not identify as gay or bisexual. Table
2 provides information on sexual orientation by the men’s reported HIV status. .

Note for Tables 2-19). When total N is less than 75, this indicates that some participants
did not respond to a given question.

Table 2: Sexual Orientation by HIV Status

 

 

 

 

HIV Positive HIV Negﬂe
Sexual Orientation N Percentage N Percentage
Gay 28 40.0 36 51.4
Bisexual 1 1 .4 3 4.3
Other 2 2.9 0 0
Total 30 43.4 39 55.7

 

Agg

Of the 75 participants, 66 reported their age. The mean age of participants was
56.39, with a median of 55.5 and a mode of 51. As can be seen, the age distribution was
skewed toward the early 505. Compared to other studies on aging and psychological
adjustment to aging, the sample is somewhat younger. Additionally, the HIV positive

participants were slightly younger, but not signiﬁcantly so (Table 3).

53

Table 3: Age by HIV Status

 

 

 

HIV Status N Mean Median 3:223:31 Minimum Maximum

HIV Positive 30 55.47 54.00 4.73 51 73

HIV Negative 34 57.56 58.00 5.69 50 73

Total 64 56.58 56.00 5.32 50 73
Race/Ethnicity

 

The sample was largely Caucasian (N = 62, 82.7%). However there was sizeable
representation of African American participants (N = 11, 14.7%), one participant
identiﬁed as Hispanic and one as Native American. Compared to the US population, in
this sample, Caucasians are over-represented (82.7% vs. 69.1%). African Americans are
also slightly over represented (14.7% vs. 12.3%). Native Americans represent 1% of the
population and had a representation of one participant in this study. Persons of Hispanic
or Latino origin were notably underrepresented, with one participant (1.4%) as compared
to 12.5% of the national population, and Asian American and others were not
represented, as compared to 3.6% Of the population (United States Census Bureau, 2001).
Table 4 presents the results for race/ethnicity by HIV status.

Table 4: Race/Ethnicity by HIV Status

 

 

 

 

HIV Positive HIV Negative
Race/Ethnicity N Percentage N Percentage
White/Caucasian 24 32.9 36 49.2
Aﬁican American 8 11.0 3 4.1
Hispanic/Latino 0 0 l 1 .4
Native American 0 0 1 1.4
Total 32 43.9 41 56.1

 

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Education, Employment, and Income

All Of the 75 participants reported completing high school. Further, 97.2% had
completed some college, compared to 58.5% of the general population of those 50-54
years of age, 77.3% had an associates degree or greater, and 73.3% had completed a
bachelor’s degree or greater, compared to 29% of the general population of those 50-54
years of age. Of the participants, 42% reported having earned an advanced degree
(master’s or doctorate), compared to 12.7% of the general population of those 50-54
years Of age). Overall, the sample reported a much higher level of education than did the
general population of the same ages (United States Census Bureau, 2000). Table 5
presents the results for education by HIV status.

Table 5: Education by HIV Status

 

 

 

HIV Positive HIV Negative

Education N Percentage N Percentage
High School 0 0 2 2.7
Some College I 1 15.1 4 5.5
Associate’s Degree 3 4.1 0 0
Bachelor’s Degree 3 4.1 19 26.0
Master’s Degree 12 16.4 15 20.5
Doctoral Degree 3 4. 1 I 1.4
Total 32 43.8 41 56.2

 

In terms of employment status, 46.4% of participants worked full-time, 24.6%
had retired, 15.9% were disabled, 7.2% worked part time, and 5.8% were unemployed.
Overall, this group reports lower participation in the labor force than do the general
population their age. The general population reports 76.3% employment for those aged

45-54 and 64.7% for those aged 55-59, compared to 53.6% employment among the study

55

 

 

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participants. Additionally, employment disability status is higher among this group, at
15.9%, as compared to 11.9% of the general population (United States Census Bureau,
2000). Both lower work force participation and greater prevalence of employment

disability can be explained by the impact of HIV/AIDS on this group. Table 6 presents

the results for employment by HIV status.

Table 6: Employment by HIV Status

 

 

 

 

HIV Positive HIV Negative
Employment N Percentage N Percentage
F ull-time 1 1 16.4 19 28.4
Part-time 2 3.0 3 4.5
Unemployed 3 4.5 1 1 .5
Retired 5 7.5 12 I79
Disabled 8 1 1.9 3 4.5
Total 29 43.3 38 56.7

 

As seen in Table 7, in regard to income, 38% of the sample reported having
incomes of over $61,000 annually, 26.8% reported incomes of less than $20,000, while
28.3% fell in the middle three categories, representing $31,000 to $50,999, which is the
range in which most US citizens report their earnings (United States Census Bureau,
2000). It is difﬁcult to assess how this sample compares to national incomes, except to
say that higher than average incomes and lower than average incomes are
disproportionately represented among this group. The lower than average incomes
among the sample could be accounted for by the disproportionate retirement and
disability status among the group. Further, the higher than average incomes could be

accounted for by the disproportionately high education levels among participants.

56

 

 

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Table 7: Income by HIV Status

 

 

 

 

HIV Positive HIV Negative
Income (in dollars) N Percentage N Percentage
< 11,000 5 7.2 4 5.8
11,000-20,999 7 _ 10.1 3 4.3
21,000-30,999 4 5.8 2 2.9
31,000-40,999 3 4.3 4 5.8
41,000-50,999 4 5.8 3 4.3
51,000-60,999 l 1.4 4 5.8
61 ,000-70,999 4 5 . 8 5 7.2
>7l,000 4 5.8 12 17.4
Total 32 46.4 37 53.6

 

Relationship Status and Living Situation

As seen in Table 8, for relationship status, 58.9% of the sample reported not being
in a relationship, separated, or widowed from a same sex relationship, 41.1% reported
being in a relationship with a man, and no respondents reported being in, separated from,
or widowed from an opposite sex relationship. The sample reported a disproportionate
percentage of single individuals, although the statistics are difﬁcult to interpret. The
major reason for this is the statutes that ban or do not allow gay people to marry in most
states. Currently, in the US, 51% of the general population is unmarried (USA Today,
2006). This only accounts for legally married and coupled, so for the general population
in the US, it can be assumed that the percentage of persons in a relationship is somewhat
higher than 51%. This would create an even greater disparity of individuals not in a
relationship compared to the general population. The HIV positive participants were

signiﬁcantly less likely to be in a relationship (Pearson Chi Square Value: 11.77; p<.001)

57

 

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Table 8: Relationship Status by HIV Status

 

 

 

 

HIV Positive HIV Negative
Relationship Status N Percentage N Percentage
Relationship with male 6 8.5 23 32.4
Not in a relationship 20 28.2 13 18.3
Separated from male 1 1.4 2 2.9
Widowed from male 5 7.0 1 1.4
Total 32 45.1 39 54.9

 

As seen in Table 9, in terms of living situation, 58.3% of the group reported living
alone, while 41.7% reported living with someone, of whom, 31.9% reported living with a
partner. The number of individuals living alone is signiﬁcantly different from the general
population, for whom 9.7% live alone (United States Census Bureau, 2000). Further,
signiﬁcantly more of the HIV positive participants were living alone compared to their
HIV negative counterparts. (Pearson Chi Square Value: 10.32; p value< .035)

Table 9: Living Situation by HIV Status

 

 

 

 

HIV Positive HIV Negative

Living Situation N Percentage N Percentage
Lives with partner 5 7.1 17 24.3
Lives alone 22 31.4 19 27.1
Lives with roommate 1 1.4 2 2.9
Lives with friend(s) 0 0 l 1.4
Lives with relatives 3 3 0 0
Total 31 44.3 39 55.7

 

58

 

Addressing of the Research Questions I

Research Question 1 (What are the demographic and descriptive characteristics of
the sample?) was addressed above. The results presented in this section are organized in
terms of each of the remaining research, questions.

Research Question 2

Are there differences between HIV-positive and HIV-negative participants in
terms of psychological adjustment to aging measures?

When analyzing HIV status and its relationship to psychological adjustment to
aging, the results indicated that there were no signiﬁcant differences between the groups.
Perhaps surprisingly, when using ANOVA to look at the dependent variables of
loneliness, hopelessness, self-esteem, depression, and life satisfaction, there were no
signiﬁcant differences between the HIV-positive and HIV-negative groups.

Research Question 3

Do variables such as perceived health, income, ﬁnances, social supports,
race/ethnicity, education, employment, and internalized homophobia affect the
psychological adjustment aging measures?

The following section contains a presentation of the ﬁndings for each independent
variable (perceived health status, income, perceived ﬁnancial status, race/ethnicity,
education, employment, social supports, and internalized homophobia) and its
relationship with the dependent variables related to psychological adjustment to aging.

Perceived health. As discussed above, HIV status did not signiﬁcantly affect any
of the dependent variables. Participants were asked to report their current health status

(excellent, very good, good, fair, poor). Interestingly, even among the HIV-positive

59

group, there were no participants who rated their current health as “poor.” The analysis
(Spearman’s rho) showed signiﬁcant correlations between health status and hopelessness,
-.421 (p = .000); self-esteem, .454 (p = .000); depression, -.409 (p = .000); and life
satisfaction, .458 (p = .000). Participants who reported higher current health ratings also
reported better psychological adjustment to aging. The correlational analysis
(Spearman’s Rho) also showed no signiﬁcant relationships between perceived current

health ratings and the dependent variable of loneliness (Table 10).

Table 10: Relationship between Perceived Health and Psychological Adﬂtment to Aging

 

Variable Rho Signiﬁcance N
Hopelessness -.421 .000 73
Self-Esteem .454 .000 72
Depression -.409 .000 74
Life Satisfaction .483 .000 75
Loneliness -.095 .4l9 75

 

Income and perceived financial status. In regard to the relationship between
income and psychological adjustment to aging, there were no signiﬁcant correlations
Table 11 shows the statistics regarding income and psychological adjustment to aging.

In addition to income, the survey collected data on perceived ﬁnancial status, as
well as perceived adequacy of current ﬁnances and future ﬁnances through three
questions;

Question 9: How would you characterize your current ﬁnancial status? (excellent,

good, average , below average, poor).

Question 10: DO you believe you have adequate ﬁnances to meet your current

needs? (yes, no, maybe , don’t know).

60

 

Question 11: Do you believe you have adequate ﬁnances to see you through the I
rest of your life? (yes, no, maybe , don’t know)
When rating the of adequacy of ﬁnances to cover current and future needs,

participants who answered more positively showed signiﬁcantly more favorable scores

on the variables used to assess psychological adjustment to aging, followed by those who

answered “maybe,” “don’t know,” or “no.” The results for the three categories are

presented in Table 12.

Table 11: Relationship between Income and Psychological Adjustment to Aging

 

Variable F df Signiﬁcance
Hopelessness 1 .66 68 .136
Self-Esteem 0.95 60 .478
Depression I .21 69 .31 1
Life Satisfaction I94 70 .078
Loneliness l .61 70 .140

 

Table 12: Relationship between Perceived Financial Status and Psychological

 

 

 

 

 

Adjustment to Aging
919 Current Fin. QIOAdeq.-Current OI IAdeq.-Future
Variable Rho Sig. N Rho Sig. N Rho Sig. N
Hopelessness -.335 .004 72 -.3 l 3 .008 72 -.374 .001 73
Self-Esteem .290 .014 7I .299 .01 1 71 .393 .001 72
Depression -.363 .002 73 -.305 .009 73 -.394 .001 74
Life Satisfaction .453 .000 74 .423 .000 74 .494 .000 75
Loneliness -.268 .021 74 -.296 .01 l 74 -.462 .000 75

 

Race/ethnicity. In regard to the relationship between race/ethnicity and
psychological adjustment to aging, the results indicated that there were no signiﬁcant
ﬁndings, either in terms of the differences between groups or for the various dependent

variables.

61

Education. The analysis of the relationship between education and psychological
adjustment to aging also yielded no signiﬁcant differences between the groups or for the
variables.

Employment status. In regard to the relationship between education and
psychological adjustment to aging, there were no signiﬁcant ﬁndings in regard to the
differences between groups or for the variables.

Relationship status. The analysis for the relationship between relationship status
and psychological adjustment to aging yielded no signiﬁcant ﬁndings.

Living situation. In regard to living situation (living with someone versus living
alone), the results indicated that life satisfaction was signiﬁcantly higher (Anova .4311 ;
p <.042) among participants who were living with someone. Otherwise, the results
showed that there were no signiﬁcant differences between the groups or for the other
psychological variables, based on living situation.

Social support. The results demonstrated a statistically signiﬁcant relationship
between social support and all the variables indicative of psychological adjustment to
aging. Hopelessness, self-esteem, life satisfaction, and loneliness were all correlated with
social support at the p = .01 level (2-tailed), while depression had a correlation to social
support that at the p = .05 level (2-tailed). This means that social support was related to
all measures of psychological adjustment to aging among study participants.

Self-esteem and life satisfaction are both positive measures of emotional
outcomes and were positively correlated with social support, meaning that higher social
support was related to higher scores for self-esteem and life satisfaction. Hopelessness,

depression, and loneliness are all negative measures of emotional outcomes (higher

62

scores mean more negative outcomes). The correlations with social support among the
dependent variables are as follows: hopelessness, -.381(p = .001, 2-tailed); self-esteem,
.330 (p = .005, 2-tailed); depression, -.278 (p = .017, 2-tailed); life satisfaction, .494 (p =
.000, 2-tailed); and loneliness, -.328 (p : .004, 2-tailed). The strongest correlation was
between social support and life satisfaction (Table 13).

Table 13: Relationship between Social Support and Psychological Adjustment to Aging

 

Variable Pearson r Signiﬁcance N
Hopelessness -.3 81 .001 72
Self-Esteem .330 .005 71
Depression -.278 .017 73
Life Satisfaction .494 .000 74
Loneliness -.328 .004 74

 

Intemalized homophobia. The data showed a statistically signiﬁcant relationship
between internalized homophobia and all the dependent variables that measure
psychological adjustment to aging. Each variable, hopelessness, self-esteem, depression,
life satisfaction, and loneliness, showed a correlation with social support that was
signiﬁcant at the p =.01 level (2-tailed). Self-esteem and life satisfaction are both
positive measures of emotional outcomes and were negatively correlated with
internalized homophobia, meaning that, as internalized homophobia increased, scores
rating self-esteem and life satisfaction declined. Hopelessness, depression, and loneliness
are all negative measures of emotion outcomes (higher scores mean more negative
outcomes). These items were positively correlated with internalized homophobia,
meaning that, as internalized homophobia increased, scores rating hopelessness,

depression, and loneliness increased. The correlations with internalized homophobia

63

 

 

among the variables are presented in Table 14. The strongest correlation was between I.
internalized homophobia and loneliness (Table 14).

Table 14: Relationship between Intemalized Homophobia and
Psychological Adjustment to Aging

 

Variable Pearson r , Signiﬁcance N
Hopelessness .392 .001 73
Self-Esteem -.3 84 .001 72
Depression .385 .001 74
Life Satisfaction -.447 .000 74
Loneliness .534 .000 74

 

Research Question 4

Are the variables associated with psychological adjustment to aging (self-esteem,
loneliness, acceptance of gay identity, hopelessness, depression, and life satisfaction)
correlated with one another?

As seen in Table 15, the dependent variables of hopelessness, self-esteem,
depression, life satisfaction, and loneliness were all correlated with each other.
Hopelessness, depression, and loneliness, which indicate negative emotional outcomes,
were all correlated positively with each other at the p = .01 level (2-tailed). Self-esteem
and life satisfaction, variables that measure positive emotional outcomes also correlated
positively with each other at the p =.01 level (2-tailed). Further, the variables that
indicate negative emotional outcomes (hopelessness, depression, and loneliness) were

negatively correlated with the variables that measured positive emotional outcomes at the

p :01 level (2-tailed)

64

 

Table 15: Correlations between the Variables of Psychological Adjustment to Aging

 

 

Hopeless

Self-

Depressio

 

-ness Esteem 11 Life Satis. Loneliness
Hopelessness Pearson 1 -.774 .753 -.769 .638
Sig. .000 .000 .000 .000
N 73 71 73 73 73
Self-Esteem Pearson l -.790 .731 -.632
Sig. .000 .000 .000
N 72 72 72 72
Depression Pearson 1 -.740 .646
Sig. .000 .000
N 74 74 74
Life Satis. Pearson 1 -.585
Sig. .000
N 75 75
Loneliness Pearson 1
Sig.
N 75

 

! ‘ LI -i‘~ _-

Research Question 5

DO the variables and the psychological aging measures have a relationship with
participants’ life expectancy?

Life expectancy was determined with one survey question that asked participants
to estimate until what age they would live. For the 65 participants who responded to this
question, life expectancy ranged from 58 to 106 years, with a mean of 80.98 and a
median and mode of 80.

The results for the relationship of the independent variables with life expectancy

showed a signiﬁcant relationship between life expectancy and HIV status, perceived

65

 

 

current health status, social support, and internalized homophobia. As presented in Table Ii
16, HIV-positive participants had signiﬁcantly lower mean life expectancy, at 77.28, than
did HIV-negative participants, with a mean of 83.58 (p = .018, 2-tailed).

Table 16: Life Expectancy by HIV Status

 

 

HIV Status N Mean 3:11:23: Minimum Maximum
HIV Positive 25 77.28 11.40 58 97
HIV Negative 38 83.58 9.16 70 106
Total 63 81.08 10.49 58 106

 

Current Health, Liﬁe Expectancy and Psychological Adjustment to Aging. There
were no signiﬁcant differences between the two groups (HIV positive and HIV negative)
for current health rating (excellent, very good, good, and fair). However current health
rating had a signiﬁcant relationship to life expectancy (.265, p = .033, 2-tai1ed), while
other variables, including income, ﬁnances, race/ethnicity, education, employment, social
support, and internalized homophobia, had no relationship. There was also a signiﬁcant
relationship (p < .05, 2-tailed) between life expectancy and hopelessness, self-esteem,
depression, and life satisfaction, but no relationship between life expectancy and
loneliness (Table 17).

Table I7: Relationship between Life Expectancy& Psychological Adjustment to Aging

 

Variable Pearson r Signiﬁcance N
Hopelessness -.410 .001 64
Self-Esteem .297 .019 62
Depression -.302 .015 64
Life Satisfaction .307 .013 65
Loneliness -.190 .131 65

 

66

 

Research Question 6

Do study participants perceive LGBT community ageism?

For perceived ageism, there was one item on the questionnaire, “There is a lot of
ageism in the gay community,” to which participants indicated their degree of agreement
(or disagreement). As presented in Table 18, 80% of respondents stated that they either
strongly agreed or agreed.

Table 18: Perceptions of A geism

 

Response Frequency Percentage
Strongly Agree 24 32.0
Agree 36 48.0
Disagree 9 12.0
Strongly Disagree 4 5.3
Missing 2 2.7
Total 75 100.0

 

Research Question 7:

Do study participants perceive or experience accelerated aging?

The idea of accelerated aging is the notion that individuals feel that they reach
older age more quickly than does the general population. To assess a perception of
accelerated again, participants were asked: “At what age do you consider a person old?”
and “At what age do you consider a gay man old?” The results, as presented in Table 19,
indicated a signiﬁcant difference in the answers to the two questions. The mean old age
rating for people in general was 71.7, compared to a mean old age for gay men of 64.33.
This difference was signiﬁcant at the p = .00 level (2 tailed) t-test = .5478. Further,

those participants reporting a lower gay old age scored less favorably on all the

67

 

dependent variables that measure psychological adjustment to aging. This means that
those who reported a lower age of when they consider a gay man old, also scored
signiﬁcant worse on all measures of psychological adjustment to aging. Hopelessness,
self-esteem, depression, and life satisfaction were all signiﬁcant at the p = .01 level (2-
tailed) and loneliness was signiﬁcant at the p = .05 level (2-tailed).

Table 19: Perceptions of Accelerated A ging
Standard Std. Error

 

 

Question N Mean Deviation of the Mean
At what age do you consider a person old? 73 71.78 13.03 1.53

At what age do you consider a gay man old? 73 64.33 12.81 1.50
Summary

This section included a comprehensive discussion of the study results, answering
all seven research questions. It was observed that HIV/AIDS status, income, relationship
status, living situation and employment status, had no signiﬁcant relationship to
psychological adjustment to aging measures. However subjective views of health and
ﬁnances had signiﬁcant associations with participants’ psychological adjustment to
aging. Additionally, it was observed that participants who scored unfavorably in the area
of internalized homophobia and social supports were also more likely to score
unfavorably on measures of psychological adjustment to aging. The following chapter
will relate these ﬁndings to the research to date as well as suggesting future directions for

research.

68

 

CHAPTER 4 I:
DISCUSSION

This exploratory research, utilizing a survey questionnaire, was designed to
investigate differences in psychological adjustment to aging among a sample of 75 self-
identiﬁed gay men over 50 years old. The study considered the relationship between ﬁve
dependent variables indicative of psychological adjustment to aging: hopelessness, self-
esteem, depression, life satisfaction, and loneliness. These constructs have been
historically utilized in past studies to assess psychological adjustment to aging and
successful aging (Berger, I984; Kooden, 1997; Quam & Whitford, 1992). The
independent variables assessed in this study included social support, internalized
homophobia, perceived health, perceived ﬁnancial status, and perceptions of ageism.
These constructs have been assessed in other studies, and relationships have been found
among them, with psychological adjustment and mental health (Kooden, 1997; Kimmel,
I979; Kaplan & Camacho, 1983; Calahan et al., 1994; Umberson, Wortman & Kessler,
1992). Additionally, the study looked at the relationship between the ﬁve dependent
variables and the demographic and descriptive variables of race/ethnicity, income,
education, work status, relationship status, and living situation. HIV status was also
considered as a factor possibly associated with psychological adjustment to aging.

The study was conducted in metropolitan Chicago. Generally speaking,
participants were professional and educated, as well as having perceptions of a favorable
psychological adjustment to aging and were in good physical health. These
characteristics are not surprising, as the research documents the fact that a select group of

people is typically included in studies such as this (Berger & Kelly, 1996).

69

 

Unfortunately, a representative group of older gay men is not available for study in most
cases. Those who are closeted, isolated or not accessing the LGBT community are
increasingly hard to ﬁnd and even more difﬁcult to recruit into a study. Additionally,
there is less access to gay communities of color. There are not as many venues in
Chicago where older gay men of color can be found. The researcher is a Caucasian gay
man, so accessing gay white men was easier than other groups. The literature discusses
these difﬁculties in obtaining diverse and representative samples among LGBT people
(Meyer, 1999; Sell & Petrulio, 1996; Harry, 1986)

This chapter begins with a review of the ﬁndings, followed by a discussion of the
study’s strengths and limitations, as well as recommendations for future research and for
the ﬁeld of social work. The chapter ends with the conclusion and other
recommendations for the ﬁeld of social work in serving older gay men.

Review of the Findings

Demographic and Descriptive Characteristics

As stated above, in general, the sample was educated, professional, and fairly
afﬂuent. Other demographic components included higher singlehood status, greater
likelihood to be retired or disabled, and greater likelihood of living alone. Although the
research of Berger (1984) and others (Friend, 1987; Kimmel, 1977, 1979; Quam, 1997)
dispelled stereotypes about older gay men being sad and alone, this study highlighted a
higher likelihood of their living alone and being single in older age. This did not,
however, equate to being unhappy or lonely. The sample of single or living alone
respondents reported no signiﬁcant differences in psychological adjustment measures

from their counterparts in the study and most reported strong social support networks.

70

 

 

These ﬁndings have important implications for services and interventions for this
population. When serving this group, it is important to be aware that many may be living
on their own and services should be designed to meet those needs, in addition to meeting
the needs of couples and families. Services such as meals, chore services and day to day
living support will become much more important for someone who is single and living
alone. Isolation may increase among individuals who are living alone if they become ill
and homebound. Programs such as “Friendly Visitors”, originally offered to LGBT
seniors by Senior Action in a Gay Environment (SAGE) in New York City is a practical
way to provide additional support for those seniors who are living alone. Further, support
services including groups and individual counseling could assist single gay seniors in
nurturing their experiences and identities as singles. Social workers should be creative in
development of innovative programs that target speciﬁc needs of the group they serve
whether single or coupled.

In terms of singlehood, living alone and disability status, HIV positive
participants were signiﬁcantly more likely to be single, to live alone and to be on
disability. These ﬁndings have not been highlighted in other studies, with the exception
of higher likelihood of disability status among HIV positive people (Cruz, 2003).
However, these ﬁndings highlight important issues that may be impacting HIV positive,
gay clients in older age. If, in fact, HIV positive older gay men are more likely to be
living alone and single in older age, social workers and other service providers may need
to factor this into care giving and other services as HIV positive individuals face

compromised health.

71

 

Social Supports

The study ﬁnds that social support impacts positively on the dependent variables
that measure psychological adjustment to aging. This ﬁnding supports various other
studies in the literature stating that social supports result in positive impacts on
individuals’ experiences with and perceptions of older age (Berger, 1984; Kooden, 1997;
Friend, 1987).

Social workers and other service providers can continue to offer and create
interventions that allow older gay men to ﬁnd, access and create stronger and larger
support networks. This can be done by increasing services speciﬁcally designed for older
gay men such as social outings, friendship groups, dating resources, theatre ﬁeld trips and
group travel. Also, services can be designed to encourage group participation such as
social events, support groups, performing arts, group vacations and group living. The
possibilities for creating strong and large support networks, are endless.

Intemalized Homophobia

Several authors have noted the manner in which one can accomplish a
“successful” aging process. As discussed in chapter one, for example, Friend (1987)
asserted the need for one to accept his or her homosexuality as part of the successful
aging process. Friend’s work not only highlighted and discussed the concept of
successful aging, but also elaborated on the concept of homosexual identity formation
theory. In combining and discussing these two concepts, he developed a conceptual
model whereby gay people ﬁt into one of three identities: stereotypical Older gay person,
passing older gay person, or afﬁrming older gay person. He believed that, regardless of

which of these three identities one assumes, one’s self-acceptance is important. He did

72

 

 

however encourage clients to move toward an afﬁrming identity. This idea was illustrated
with the internalized homophobia scale. Those with higher scores (less favorable) in the
construct of internalized homophobia also scored less favorably on scales measuring
adjustment to aging including hopelessness, self-esteem, depression, life satisfaction, and
loneliness. Further, the ﬁndings in this study support earlier ﬁndings on self-acceptance
and successful aging (Berger, 1984; Kimmel, 1979; Kooden, 1997)

These ﬁndings create some interesting notions about programming that will better
help Older gay men as well as others in the community to accept their sexual orientation
and identity. When proposing interventions to address internalized homophobia, micro,
mezzo and macro interventions must all be considered.

On the micro level, interventions with older gay men take many possible forms.
Innovative programs that include education, counseling and role modeling can assist
individuals to move along Friends’ suggested continuum toward being an afﬁrming older
gay person. In addition to psycho-social support programs for LGBT seniors, macro
efforts in the area of public policy could have great impacts on internalized homophobia.
Legalizing gay marriage, including sexual orientation as a protected class from
discrimination, allowing LGBT people to be “out” as they serve in the military,
mandating domestic partner beneﬁts in the workplace and community, are all areas where
policies would validate and empower LGBT people in their identity. On the mezzo level
Of intervention many existing programs developed for the mainstream Older adult
population could be revised to provide services in a LGBT-inclusive manner. When
assessing community programs for seniors, there were almost no programs that had

specialized programs for older LGBT individuals. It is necessary for social workers to

73

 

 

advocate for their older LGBT clients, and to create interventions to address internalized (
homophobia, at all systems levels.

Differences Between HIV-Positive and HIV-Negative Participants

The ﬁndings of this study create a narrative of a changing environment for those
individuals who are HIV infected. Numerous studies cite a relationship between chronic
illness and mental health issues, especially depression (Katon & Sullivan, 1990; Katon &
Schulberg, 1992). This study found no relationship between chronic illness (HIV/AIDS)
and poorer mental health outcomes. Speciﬁcally, there were no signiﬁcant differences
between the HIV-positive and HIV-negative participants. This ﬁnding may be related to
the technological advances in the treatment of HIV/AIDS. At the beginning of the
disease (19805 and early 19905), ineffective and toxic treatments were utilized with AIDS
patients. After the mid-19905, there were dramatic advances and survival and quality of
life increased. Today, although still a major health issue, HIV/AIDS, in many cases, can
be managed through a medication regimen. If this study had been conducted prior to
these technological advances, the relationship between HIV and mental health would
likely have been dramatically different.

This ﬁnding creates an interesting discussion about how to better provide services
to HIV positive individuals. Quite possibly, efforts could be redirected for HIV positive
older gay men. Instead of concentrating on mental health issues, perhaps service
programs can be diversiﬁed that are more comprehensive and include reintegration

services such as getting people back to work, health and educational programs and others.

74

 

Crisis competency

As previously discussed in chapter one, Berger (1982), Friend (1991), and
Kooden (1997) discussed the concept of crisis competency. This concept is the notion
that gay men may have had a history of addressing crises more often than their
heterosexual counterparts and therefore may have an easier time handling the crises that
accompany old age. Dealing with issues such as coming out, discrimination, isolation,
and HIV/AIDS has perhaps better prepared gay men for the issues of older age, such as
death, loss, and loneliness. Many living with HIV/AIDS have had to make the emotional
adjustment of having chronic compromised health. This “crisis competency” may, in
fact, help gay men in this situation (Kooden, 1997).

This consideration of crisis competency may help explain the results discussed
above regarding no signiﬁcant differences between the HIV positive participants and the
HIV negative participants in terms of measures of psychological adjustment to aging.
While the literature highlights a relationship between chronic illness and worse mental
health outcomes such as depression (Katon & Sullivan, 1990; Katon & Schulberg, 1992),
this study did not have similar ﬁndings. The idea that HIV positive men in the study may
have developed a high level of resilience or crisis competency and thus reduced any
psychological impacts of living with HIV/AIDS to a negligible level.

Perceived Health, Income, and Finances

In terms of perceived health, participants who reported worse perceived health
also signiﬁcantly reported poorer mental health outcomes. Although HIV status was not
related to worse mental health outcomes, participants’ personal evaluation of their health

was an important variable. These ﬁndings support earlier ﬁndings that relate health

75

 

 

perceptions to mental health outcomes (Kaplan & Camacho, 1994; Calahan et al., 1994).
The ﬁndings also support the theoretical framework or “social construction theory,” that
individuals create their own reality and that perceived reality is more powerful than
objectively measured outcomes.

In this study, social construction theory also was relevant to income and ﬁnancial
status. Although participants showed no signiﬁcant differences in mental
health/adjustment to aging scores in terms of objective income differences, they did
report differences when they were asked about whether they had adequate ﬁnances for
current and future needs. This ﬁnding supports past studies of perceived ﬁnancial status
and its impact on mental health (Umberson, et al., 1992).

Overall Outcomes of Psychological Adjustment

The ﬁndings of this study also support the ﬁndings of others in regard to the
majority of participants reporting favorable outcomes on scales measuring psychological
adjustment to aging, including hopelessness, self-esteem, depression, life satisfaction, and
loneliness (Berger, 1980, 1982, 1984; Friend, 1991; Kelly, I974, 1977, 1980; Kimmel,
1979; Weinberg, 1970). As found in these studies, the present study found that there
were no signiﬁcant differences in measures of psychological adjustment to aging among
those who were coupled versus those who were not. Further race/ethnicity, income,
education, living situation, and relationship status also had no impact on psychological
adjustment to aging.

Additionally the study found a relationship among all of the dependent variables:
hopelessness, depression, self-esteem, loneliness and life satisfaction. This ﬁnding

speaks to concurrent validity. In other words the scales hung together as they were

76

 

 

expected to (See Table 15). This should help to add on to the discussion and IL-
development of a scale that comprehensively measures psychological adjustment to
aging.

LGBT Community A geism

Ageism and invisibility have been cited in many articles as an ongoing and
serious issues among older gay men as well as other members of the LGBT community
(Harrison, 2002; Brotman, Ryan, & Corrnier, 2003; Cahill et. al, 2000). In terms of
LGBT organizational priorities, programs focusing on younger LGBT people have often
been on the top of the list of agency funding and operation. This creates few programs
designed for LGBT seniors that are housed at LGBT community organizations. In
Chicago, there are three organizations that offer programs speciﬁc to older LGBT
individuals. This lack of services will become increasingly evident as LGBT baby
boomers move into retirement. In addition to this invisibility in social service provision,
older gay men cite ageism and invisibility in social venues such as bars, health clubs and
social events (Harrison, 2002). This issue is related to societal and community norms
about aging in American culture and speciﬁc norms about age and attractiveness in gay
culture.

When questioned about ageism in the gay community, the sample reported high
levels of perceived ageism in the community. Seventy percent of the sample agreed or
strongly agreed that there is a lot of ageism in the gay community. This ﬁnding supports
previous literature (Kaufman & Phua, 2003; Gamets & D'Augelli, 1994). Such results
suggest that work needs to be done among gay men to reduce both ageism and

perceptions of ageism in the community. These efforts must take place on many levels.

77

 

First, LGBT organizations must factor in programs into the array of programs developed .
and offered to community members. This can be done by including Older LGBT people
in planning groups, on board positions and in leadership positions at community
agencies. Additionally efforts to reframe gay culture to ﬁnd value and desirability in
older LGBT people should be a priority. This can be accomplished through
intergenerational programs that facilitate cooperation, mentorship and exposure of all age
groups to each other in the community. There are a few intergenerational groups in
major US. cities that are facilitating this exposure of the generations to one another.
Work with both young and old must be a part of changing attitudes about age.

Accelerated Aging

As discussed in previous chapters, the idea of accelerated aging is the notion that
individuals feel that they reach Older age more quickly than the general population does.
To assess a perception of accelerated again, participants were asked: “At what age do you
consider a person old?” and “At what age do you consider a gay man old?” There have
been just a few studies that look at accelerated aging among gay men (Bennett &
Thompson, 1990; Adelman, 1991; Schope, 2005; Friend, I991). In Bennett and
Thompson’s work (1990), accelerated aging or the onset of middle and old age was
perceived to be earlier for gay men compared to their heterosexual counterparts. Also, in
Schope’s work (2005), both younger and older gay men perceived accelerated aging in
their personal community experiences. Schope’s study contrasted gay men and lesbians
and found that gay men in his study were signiﬁcantly more ageist and experienced

accelerated aging, than lesbians.

78

There were a relatively high number of participants who reported accelerated
aging in this study. This is in comparison to the existing research on “accelerated aging”
These ﬁndings reﬂect most studies’ ﬁndings of accelerated aging (Bennett & Thompson,
1990; Adelman, 1991; Schope, 2005; Friend, 1991). In terms of interventions,
accelerated aging can be addressed and reframed much in the same way that ageism
issues can be dealt with. These two concepts are interrelated. When gay culture can
successfully address ageism, accelerated aging will dissipate.

Study Strengths

The study possessed at least four strengths. First, the study incorporated
established measures that have been utilized for many years on different populations,
including gay people, older adults and, in some cases, older LGBT adults (Berger, 1984;
Friend, 1987; Cruz, 2003). These established and frequently used scales enabled the
questionnaire to have a high level of reliability and validity.

Second, this study was one of the ﬁrst of its kind to analyze and discuss
differences that exist as a result of HIV status. Information about how HIV/AIDS may
affect individuals socially, psychologically, and interpersonally is important information.
In this study, a lack of difference in measures based on HIV/AIDS status was interesting
and important with implications for changing attitudes and programs.

Third, this study had a good sample size. Although, in some ways, 75 participants
represent a small, limited sample, a sample of 75 gay men over 50 years of age represents
a fairly sizable sample, compared to the majority of studies with this population (Friend,

1987; Kimmel, 1979, Berger 1984). While a bigger, more diverse sample would have

79

 

been ideal, this study represents a move in the direction of greater access to this
population that was perhaps not as possible or likely before.

Fourth, this study included more persons of color, especially African Americans,
than have similar studies (Berger, 1984; Herdt, et al., 1997; Weinberg, 1970). The study
sample included 11 African American participants (14.7%). While Caucasians were still
over-represented in the sample, African Americans had reasonably good representation.
Study Limitations

There were at least four limitations to this study. The ﬁrst and most important is
the sampling methods. Participants were recruited via two social services organizations
serving the LGBT community, as well as through local gay bars in metropolitan Chicago.
This convenience sampling did not allow for random sampling and, consequently, the
persons in this study were not representative of aging gay men, in general. Additionally,
this method restricted the recruitment of persons to those who were connected to the
LGBT community in one way or another and also biased the sample toward middle class,
educated, and professional participants. Sampling issues were the greatest threat to
external validity in this study.

The second is that participants were largely well educated, largely Caucasian men
with high incomes, a typical problem in sampling this community of older gay men
(Quam & Whitford, 1992). This is a problem as a sample of well educated, Caucasian
men with higher socioeconomic status may have differential access to the physical and
mental health care systems than do than less educated, poorer men and possibly those of
minority status, thus more positive results, i.e. positive adjustment to aging, may be

indicative of this sample.

80

 

 

r?-

The third is that, although the study recruited gay man over 50 years old, the
sample was skewed toward individuals 55 years and under. This group accounted for
approximately 50% of the sample. While this lack of diversity in age was a weakness, it
did allow the research to target those gay men that were hardest hit by the HIV/AIDS
epidemic, providing greater access to a cohort that experienced the greatest health
impacts and loss of loved ones to the disease.

A fourth area in which the study was limited was in its cross-sectional survey
design. The study involved primarily quantitative research, collected at one time period.
Although this method allowed the researcher to collect data from 75 respondents,
representing a good sample size, and an interesting “snapshot” of their circumstances,
other studies (Berger, 1984; Kimmel, 1977; Cruz, 2003) used a mixed method approach,
which, if used in this study, would have provided greater depth to the data. The addition
of qualitative methods, such as interviews, would allow for triangulation of the data and,
as noted above, provide more depth. Further, longitudinal data would also allow for
looking at the participants over time and perhaps exploring some causal relationships
between independent and dependent variables.

Recommendations for Future Research

Studies that draw participants from a wider range of gay men would be useful in
presenting the diversity of experience among gay men in later life. Underrepresented
groups such as ethnic minorities, those who are less educated or less wealthy, and gay
men living rural areas also need be given a voice. Future research efforts should stress
greater priority and creativity in terms of ﬁnding a diverse sample. Researchers must

ﬁnd nontraditional places where diverse gay men gather. For ethnic minorities this may

81

include ethnic neighborhoods, community settings, festivals and business establishments.
Researchers could make contacts with health department representatives to establish
where HIV incidence as well as testing and counseling is done for given ethnic groups.
Community leaders from Latino, Native American and Asian American gay
constituencies could be contacted to better locate and reach out to community members.
More collaboration with groups and community organizations can further broaden the
scope of diverse individuals recruited for studies.

When considering rural gay men and gay men who are not “out”, creative
methods and new technologies could be utilized to access this group. The intemet is a
powerful networking tool in which gay men who are otherwise not connected to large gay
communities could be accessed. Doing outreach through websites, online publications
and chat rooms would open up areas that previously remained untapped.

As people live longer lives, research that contributes to further understanding of
adult development, particularly to development in later life, would enrich our body of
knowledge about adulthood, as well as about Old age. Investigators of human
development should look at the lives of gay people and incorporate their experiences into
traditional models of development, expanding their utility. This notion is important
because often models of development are applied to gay men as well as other
marginalized groups. These models may not be appropriate to apply to individuals with
different history and experiences. Gay men and other marginalized groups must be

included in adult development research.

Another area of future research is in the area of mixed research modalities. This

study was completely quantitative in nature, which provided signiﬁcant contributions to

82

 

the knowledge of gay men and aging. By using qualitative measures with this group a
level of triangulation could occur. Future research could use mixed modalities to provide
an understanding, not only of trends among this group but could further assess meanings
of aging, HIV/AIDS and ageism from a narrative perspective, giving voice to this

population.

This study found no signiﬁcant differences between HIV positive and HIV
negative participants in terms of their adjustment to aging measures. This highlights the
probable strong resilience and crisis competency among the HIV positive respondents.
Further research could explore sources of resilience among HIV positive gay men.
Answering questions about resilience and protective social factors among these
individuals could feasibly inform social work interventions for newly HIV diagnosed

individuals as well as others experiencing difﬁcult adjustment to life events.

Finally, ﬁndings from this study highlight high levels of perceived ageism among
the sample and a high level of accelerated aging. These ﬁndings are interesting and
disturbing because they implicate a high level of prejudice in the gay community as well
as creating perceived stigma about age among older gay men. Future research could look
at meanings of aging and ageism as well as sources of prejudice about age among gay
men of all age groups. Further, testing interventions that attempt to lower levels of

ageism would be a formidable research agenda around this area of interest.

The previous paragraphs discussed a few possible areas for future research. The
area of aging among gay men is a largely untapped area of study. Possibilities for

research remain unexplored.

83

Recommendations for the Field of Social Work

The ﬁndings of this study, as well as the literature reviewed, have implications for
services and programs for older LGBT seniors. In this regard, four areas, social services,
health care, housing, and awareness/acceptance (Herdt et al., 1997), are discussed below.

Social Services

Many of the participants reported not utilizing agencies for LGBT people. In
some cases, they reported using aging organizations of the mainstream society more often
than those designed for older LGBT individuals. This may speak to the provision of
inappropriate services and or a lack of services for older LGBT individuals. As such, it is
ﬁtting to establish more LGBT-speciﬁc senior centers in certain geographic locations.
These centers could house accessible advocacy, referral, and case management services.
Ideally, outreach activities would be provided that would include support programs for
seniors who are homebound, such as friendly visitor programs and telephone support. In
addition to services, the center should Offer social outlets for LGBT seniors that include
social/romantic and intellectual venues for seniors (Quam, 1997).

Based on some of this study’s ﬁndings, social service efforts should include
programs that target ageism. Such programs could include mentorship and reverse
mentorship programs that include all ages of LGBT people. Intergenerational support,
discussion and social groups may also address some of the ageism in the LGBT
community.

This study highlighted the importance of and individual’s perceptions of their
emotional well-being. Programs are needed that help change individuals’ perceptions of

their lives including accelerated aging, perceived health and ﬁnances may facilitate better

84

perceived experiences among LGBT clients. These programs could include Cognitive
Behavioral Therapy (CBT) to help clients reframe their experiences and realities.

Health Care

In terms of health care for LGBT seniors, it has been suggested that training be
provided for healthcare providers and staff to ensure that they are aware of and open to
LGBT issues. These issues include health risks speciﬁc to LGBT patients, senior
sexuality, and recognition of partners and families of choice in terms of medical care and
decision-making. In the area of access, communities should offer access to affordable
LGBT-sensitive health care providers, as well as to preventative health care services
(Herdt et al., 1997). Also, legal paperwork and contracts should be completed to help
protect the rights of partners and other caregivers in healthcare settings. Power of
attorney, guardianship rights and living wills are important documents to include in
assisting LGBT clients.

Him

Housing has been cited as one of the key unmet needs of LGBT seniors. Seniors
need support services that will allow them to remain in their homes for as long as they
can. When remaining in the home is no longer an option, LGBT seniors desire
comfortable, safe, affordable, and LGBT-ﬁiendly retirement housing. Additionally,
support services and resources for caregivers were cited as a desire of these seniors
(Herdt et al., 1997).

Awareness and Acceptance

A major theme present among many LGBT seniors researched is a sense of being

invisible in their communities. This invisibility happens in the LGBT community as well

85

 

 

as in the senior community and society at large (Herdt & DeVries, 2004; Berger, 1984; it
Cruz, 2003). It is, therefore, an important ﬁrst step in providing needed services that we,
as service providers, recognize that LGBT seniors exist. Additionally, service providers
need to accept their experiences and appreciate their histories when providing services
(Herdt et al., 1997). There is a great deal of work to be done at the community level in
both mainstream aging organizations as well as agencies providing LGBT services to
included older LGBT people in their service planning.
Conclusion

As discussed above, recent studies have shown that some aging gay men and
lesbians face unique challenges, including limited access to gay-friendly health care,
feelings of invisibility, confrontations with ageism within gay and lesbian communities,
denial of hospital and nursing home visitation rights for their partners, loneliness and
social isolation, internalized homophobia, and accelerated aging (Quam, 1997; Cruz,
2003). Nevertheless, some research suggests that gay men and lesbians age with the
advantage of crisis competence and mastery of stigma, having weathered the trials of
coming out and having developed positive self-identities within a homophobic society
(Herdt & DeVries, 2004).

Unprecedented demographic changes in the United States associated with the
“elder boom” are placing enormous demands on private and governmental social service
agencies and health care providers. These demands are particularly acute for those
attempting to address the special needs of LGBT elders, and additional research to guide

their efforts is sorely needed. Agencies and policymakers are currently scrambling to

86

meet these special needs. The time is ripe for the development of a research agenda to
address the needs of this population in the 215t century (Herdt & DeVries, 2004).

Many of the needs of older LGBT people have little to do with their sexual
orientation and a great deal to do with. their age. It is important not to assume that
problems are necessarily tied to one’s sexual orientation. LGBT clients face many of the
same issues that their heterosexual counterparts do in terms of isolation and loneliness.
Heterosexual seniors at least have the option to rely on the local senior center for support.
LGBT older adults often have no such services available that are “gay friendly” or
sensitive to their needs. For those who have not come out, this isolation becomes even
more severe (Kooden, 1997).

Being cared for when ill is often an issue faced by LGBT seniors. It is estimated
that one to three million gay men are parents (Patterson, 1992). No data were found on
the number of gay seniors with children. In this study, 15 percent of the participants
reported having children. LGBT seniors often do not have children or other family
support, upon which their heterosexual counterparts can rely. This lack of an available
network of younger, healthier caregivers offers challenges for aging LGBT people and
their social workers.

Bereavement creates still other issues. Participants in this study reported
disproportionately high levels of loss to HIV/AIDS, of friends and partners, especially
among those HIV positive respondents. While the loss of a partner carries the same
issues for LGBT people as for straight people, both legal and emotional barriers make the
grieving process more difﬁcult for LGBTs (Quam, 1997). Most states do not offer

complete legal protection for partners of LGBT people. In many cases the partner can be

87

 

F—

left out of decision making around hospital care, advanced directives and power of
attorney. Survivor beneﬁts are nonexistent and the federal level and in most states.
There are no legal guarantees around will and inheritance for partners of LGBT people.
Social workers must be aware of the unsure and unpredictable legal landscape and must
help their LGBT clients to document their wishes in a clear and comprehensive manner.

There is a great deal of work that needs to be done for the aging LGBT
population. At the 1995 White House Conference on Aging, the Lesbian and Gay Aging
Interest Network (LGAIN) made the following recommendations to better serve gay and
lesbian elders: (l) ensuring access to aging services; (2) developing health care
prevention and education policies that address particular risk factors of gay and lesbian
elders such as AIDS, breast cancer, and substance abuse; (3) addressing homophobia and
eliminating presumption of heterosexuality among health, mental health, housing, and
social services providers; and (4) eliminating legal and social barriers facing caregivers
and survivors. These issues are still present a decade later. Further, many more goals
must be met to appropriately provide for our LGBT seniors (Kochman, 1997).

This dissertation has continued the discussion of aging among gay men. The
study highlighted that HIV status was not related to psychological adjustment to aging.
This ﬁnding paints a different picture of the social impacts of HIV/AIDS in the US in the
twenty-ﬁrst century. Although still a serious and chronic illness, perceptions of living
with the disease have changed. Further, the study highlights the importance of
perceptions and social construction in the participants’ lives and emotional well-being.
Finally, the prevalence of perceived ageism and accelerated aging among this group

signals a serious concern about how the LGBT community views older gay men and how

88

 

Older gay men View themselves. Social workers working with this population must
consider these ﬁndings when developing programs and interventions to improve the lives

and experiences for the older LGBT clients.

89

APPENDIX A:

CONSENT FORM

90

HOWARD BROWN HEALTH CENTER
MICHIGAN STATE UNIVERSITY
Consent Form

Attitude and Impression Survey for Gay Men Over 50

Project Investigators: Scott Berlin, MSW and Rena Harold, PhD

A. Purpose of the Study

You are being asked to participate in a study of gay men who are over 50 years
of age. The goal of the study is to assess participants’ understandings and
perceptions about aging. We hope to learn about coping skills that gay men
possess in regard to aging. You are invited to participate in this study.
Participation in this study is completely voluntary. If you decide not to participate,
this will not affect your relationship with Howard Brown Health Center or
Michigan State University or your receipt of services from these organizations in
any way.

B. Procedures

If you decide to participate, you will complete a questionnaire that will take you
approximately 30 minutes. This study consists of a one-time survey and there
will be no follow-up. In this questionnaire we are asking you to reﬂect on
thoughts and experiences about aging and related issues.

C. Eligibilty

While many men in this study will consider themselves gay, participation in the
study is open to all men who have had sex with men, regardless of their sexual
orientation or identity. To be in this study, you need to:

0 Be 50 years and older -- This is deﬁned as 50 years, 0 months, 0
days and older.

0 Identify as a man (male) - This is based on self-identiﬁcation

0 Identify as a gay man or as a man who has had sex with men

This is based on self-identiﬁcation.

D. Voluntary Nature of the Study

Your decision to take part in the study is voluntary. You are free to choose not to
take part in the study or to stop taking part at any time. If you choose not to take
part or to stop at any time, Your decision whether or not to participate will not
inﬂuence your future relations with Howard Brown Health Center or Michigan
State University.

You can refrain from answering any question on the survey that you choose.

91

E. Risks/Discomforts

While completing the survey, you will be asked questions on topics such as HIV
issues, mental/physical health status and substance use. Some people may feel
uncomfortable or embarrassed by these topics. While we need to ask these
questions in order to complete the study, you do not have to answer any
questions that make you feel uncomfortable, that you ﬁnd unacceptable, or that
you feel do not apply to you.

There may be unforseeable risks associated with the study.

F. Conﬁdentiality Statement

Everything we learn about you in the study will be conﬁdential. If we publish the
results of the study, you will not be identiﬁed in any way. Your service providers
and other people working in the agency will not be given any of the information
that you give us.

Your privacy will be protected to the maximum extent allowable by law (See the
following section F for exceptions of conﬁdentiality). Your name and identiﬁer
information will be kept in a locked cabinet. All study data will be labeled with
unique codes assigned to each participant and kept separate from identiﬁer
information. The study code and identifying information will be joined in one list
locked securely away from other study records. The information collected for the
study will be archived for no longer that three (3) years at which time all
documents will be shredded. The project investigators and study staff will be the
only individuals who will have direct access to the participant study data and
identiﬁer information.

G. Exceptions to Conﬁdentiality
We must make exceptions to conﬁdentiality in some cases. We do this to help
assure safety of participants and the public. According to the law our staff must
report some things to proper authorities. Speciﬁcally we must report if you tell us
that:

0 You intend to harm yourself or others

a A child (someone under age 18) is being physically or sexually abused

0 An elder or dependent adult is being physically or sexually abused.

H. Contacts and Questions

If you have questions or concerns regarding your rights as a study participant, or
are dissatisﬁed at any time with any aspect of this study you may contact the
Human Subjects Protection Administrator at Howard Brown Health Center (773-
388-8880). You may also contact — anonymously if you wish- Peter Vasilenko,
Ph.D., Chair of the University Committee on Research Involving Human Subjects
(UCRIHS) at Michigan State University by phone: (517) 355-2180, email
ucrihsﬂnsuedJu, or regular mail: 204b Olds Hall, East Lansing, Michigan
48823.

92

If you have any additional questions about this study, please contact the project
investigators (Scott Berlin, M.S.W., phone: 773-388-8863, email:
scottb@howg®rown.org, or regular mail: 4025 N. Sheridan Road; and/or Rena
Harold, Ph.D., phone: 517-432-3733, email: harolg@msu.edu or regular mail:
254 Baker Hall, East Lansing, MI 48824

1. Financial Information

You will receive a $15 incentive upon completion of your questionnaire. This will
be given to you in person or mailed to you in the event that mailed in your
questionnaire.

J. Injury Statement

If you are injured while participating in the study and need medical treatment, we
will refer you to get care. However, we do not pay for this treatment. Signing this
form does not mean that you are giving up any legal rights to be compensated for
harm that results from being in this study. For more information about this, you
may contact Project Investigator, at 773-388-8863.

K. Statement of Consent
1. l have read the above information. I know I may withdraw from the study at
anytime without any consequences after signing this form.

My signature indicates all of the following:

o l consent to participate in the study.

0 I have asked any questions l have and they have been answered to
my satisfaction.

 

Signature of participant Date

 

Printed Name of Participant:

 

Street Address to Send Stipend

 

City, State, Zip

93

 

APPENDIX B

QUESTIONNAIRE

94

Attitude and Impression Survey

For Men

 

 

Mental health professionals are becoming more aware of both
psychologicallsocial needs of older people, the needs of gay men. While
more is known than in the past, relatively little is known about the
experiences of gay men who are over 50 years old. In order to understand
and more sensitively meet the needs of gay men over 50, we would like you
to ﬁll out the following questionnaire. There are no right or wrong answers.

 

 

 

For each question, please check/circle the correct answer or ﬁll in the
blank.

 

SECTION A: PERSONAL INFORMA TION

1. Please enter today’s date
(mo/day/ year)

 

2. What is you date of birth?

 

3. What is your race/ethnicity. Check all that apply.
_African American/Black (not Hispanic)

Hispanic/Latino

Caribbean Islander

Asian or Paciﬁc Islander

Native American

White/Caucasian (not Hispanic)

Other (please specify)

 

4. What is your highest educational level?
_Less than High School
_High school or equivalent
_Some college

Associate’s degree

Bachelor’s degree

Master’s degree

Doctoral degree

95

 

 

5. What is your employment status?
_Employed Full-time

Employed Part-time

Unemployed

Retired

_Other (Please Explain)

 

6. What is (was) your most recent (last) occupation? (Please describe what kind of work you
do (did) including daily responsibilities, supervisory duties, yourjob title and the type of
business or workplace).

7. Do you have hobbies?
_ Yes

(What Types?)
_ No

 

8. What is your income?
_Below $11,000 per year
$11,000 —20,999
$21 ,000-30,999
$31 .000-40,999
$41 .000-50,999
$51 ,000- 60,999
$61 ,000- 70,999
OVER $71,000

5°
I

ow would you characterize your ﬁnancial status?
Excellent
Good
Average
Below Average
Poor

10. Do you believe you will have adequate ﬁnances to meet your current needs?
Yes

No

Maybe

Don’t know

11. Do you believe you will have adequate ﬁnances to see you through the rest of your life?
Yes
No
Maybe
Don’t know

96

 

12. What is your living situation?
__ Live with partner

Live alone

Live with roommate(s)

Live with friend(s)

Live with relative(s)

_ Other

 

13. What is your present relationship status?
__ In a relationship with a male
In a relationship with a female
Not in a relationship
Separated from a relationship with a male
Separated from relationship with a female
Widowed from a same-sex relationship
Widowed from a heterosexual relationship
_ Other (please explain)

14. Check all of the following Lesbian, Gay, Bisexual, Transgender (LGBT) community
activities that you have participated in within the past 2 months.

LGBT bars

LGBT social groups

LGBT service organizations

LGBT political organizations

LGBT religious organizations

Other (Please specify)

 

15. Have you fathered or adopted children?
Yes
No

If yes how many?
What are their current ages

 

IF YOU HAVE FATHERED OR ADOPTED CHILDREN ANSWER THE NEXT 3
QUESTIONS
OTHERWISE SKIP TO UESTION 16

15a. How would you classify your emotional relationships with your children?
_ Excellent
_ Good

Average

Below Average

Poor

15b Do you think your children will provide care to you, if and when you may need it?
Yes

No

Maybe

Don’t know

No children

97

 

 

15c Are you willing to accept help from your children, if and when you need it?
Yes

No

Maybe

Don’t know

16. What is your zip code

17a. What is your sexual orientation
Gay
_ Bisexual
_ Heterosexual
__ Other

 

17b. Are you transgender?
Yes
No

18. What is your HIV status?
_ HIV Positive
_ HIV Negative
_ Do not know HIV status
Unwilling to disclose HIV status

IF YOU ARE HIV POSITIVE PLEASE ANSWER THE NEXT 4 QUESTIONS.

OTHERWISE SKIP TO QUESTION 19

183. What year did you ﬁrst test positive for HIV?

18b. Have you had HIV speciﬁc blood work done in the past 12 months?
no

_ yes
If yes, do you know approximate levels of:

_ T-Cell Count
_ Viral Load

18c. Have you had an HIV related illness in the past 12 months?
no

yes
If yes, what illness did you have?

18d. Have you been hospitalized in the past 12 months with an HIV related illness.
no

_ yes
If yes what illness did you have?

 

98

 

Section B:

 

Respond to the following statements by

 

 

 

circling the number that best describes Often Sometimes Rarely Never
you. Give your ﬁrst response and don’t
spend too much time on any item.
19. I feel in tune with people around me. 1 2 3 4
20. I lack companionship. 1 2 3 4
21. There is no one I can turn to. 1 2 3 4
22. | feel alone. 1 2 3 4
23. I feel part of a group of friends. 1 2 3 4
24. I have a lot in common with the 1 2 3 4
people around me.
25. I am no longer close to anyone. 1 2 3 4
26. My interests and ideas are not 1 2 3 4
shared by those around me.
27. I am an out going person. 1 2 3 4
28. There are people I feel close to. 1 2 3 4
29. I feel left out. 1 2 3 4
30. My social relationships are 1 2 3 4
superﬁcial.
31. No one really knows me well. 1 2 3 4

 

 

 

 

 

99

 

 

Respond to the following statements

 

 

by circling the number that best Often Sometimes Rarely Never

describes you. Give your ﬁrst

response and don’t spend too much

time on any item

32. I feel isolated from others. 1 2 3 4

33. I can ﬁnd companionship when I want 1 2 3 4

it.

34. There are people who really 1 2 3 4

understand me.

35. I am unhappy being so withdrawn. 1 2 3 4

36. People are around me but not with 1 2 3 4
me

37. There are people I can talk to. 1 2 3 4

38. There are people I can turn to. 1 2 3 4

 

 

 

 

 

CONTINUE ON TO THE NEXT PAGE

100

 

 

Respond to the following
statements by circling
the number that best
describes you. Give your
ﬁrst response and don’t
spend too much time on
any item.

Strongly
Agree

Moderately
Agree

Sﬁghﬂy
Agree

Neither
Agree Or
Disagree

Slightly
Disagree

Moderately

Disagree

Strongly
Disagree

 

 

 

39. Obviously
effeminate gay men
make me feel
uncomfortable.

40. I prefer to have
anonymous sexual
partners.

41. It would be easier to
be heterosexual.

42. Most of my friends
are gay.

43. I do not feel
conﬁdent about making
an advance at another
man.

44. I am comfortable in
gay bars.

45. Social situations
with gay men make me
feel uncomfortable.

46. I don’t like thinking
about being gay.

47. When I think about
other gay men, I think of
negative situations.

48. I feel comfortable
being seen in public
with an obviously gay
person.

48.l feel comfortable
being gay.

49. Being gay is morally
acceptable.

 

 

 

 

 

 

 

 

101

 

 

Respond to the
following statements by
circling the number that
bestdescﬂbesyou.
Give your ﬁrst response
and don’t spend too
much time on any item.

Strongly
Agree

Moderately
Agree

Sﬂghﬂy
Agree

Neither
Agree or
Disagree

Slightly
Disagree

Moderately
Disagree

Strongly
Disagree

 

50. I am not worried
about anyone ﬁnding
out if I am gay.

51 .Discrimination
against gay people is
still common.

52. Even if I could
change my sexual
orientation, I wouldn't.

53.Homosexuality is as
natural as
heterosexuality

54. I feel comfortable
discussing
homosexuality in a
public situation.

55. It is important to
me to control who
knows about my being

93V-

56. Being gay is not
against the will of God.

57. Society still
punishes people for
being gay.

58. I object if an anti-
gay joke is told in my
presence.

59. I worry about
becoming old and gay.

60. I worry about
becoming unattractive.

61. Most people don’t
discriminate against
_gays.

 

 

 

 

 

 

 

 

 

102

 

 

Respond to the following statements by

 

 

circling the number that best describes deﬁnitely mostly mostly deﬁnitely
you. Give your ﬁrst response and don’t false false true true
spend too much time on any Item.
62. I look forward to the future 1 2 3 4
63. I might as well give up because I 1 2 3 4
can’t make things better for myself
64. When things are going badly, I am 1 2 3 4
helped by knowing they can’t stay that
way forever
65. I can’t imagine what life will be like 1 2 3 4
mm years.
66. I have enough time to accomplish the 1 2 3 4
things I most want to do.
67. In the future, I expect to succeed in 1 2 3 4
what concerns me most.
68. My future seems dark to me. 1 2 3 4
69. I expect to get more of the good 1 2 3 4
things in my life than the average person.
70. I just don't get the breaks, and 1 2 3 4
there’s no reason to believe I will in the
future.
71. My past experiences have prepared 1 2 3 4
me well for my future.
72. All I can see ahead of me is 1 2 3 4
unpleasantness rather than pleasantness
73. I don't expect to get what I really 1 2 3 4

want.

 

 

 

 

 

103

 

 

Respond to the following statements by

 

 

circling the number that best describes deﬁnitely mostly mostly deﬁnitely
you. Give your ﬁrst response and don’t false false true true
spend too much time on any item.
74. When I look ahead to the future, I 1 2 3 4
expect to be happier than I am now.
75. Things just won’t work out the way I 1 2 3 4
want them to.
76. l have great faith in the future. 1 2 3 4
77. I never get what I want so it’s foolish 1 2 3 4
to want anything.
78. It is very unlikely that I will get any 1 2 3 4
real satisfaction in the future.
79. The future seems vague and 1 2 3 4
uncertain to me.
80. I can look fonivard to more good 1 2 3 4
times than bad times.
81. There’s no use in really trying to get 1 2 3 4

something I want because I probably
won’t get it.

 

 

 

 

 

CONTINUE ON TO THE NEXT PAGE

104

 

SECTION E:

 

l—Respond to the
following statements by
circling the number that
best describes you.
Give your ﬁrst response
and don’t spend too
much time on any Item.

Very
Strongly
disagree

Strongly
disagree

Mildly
disagree

Neutral

Mildly
Agree

Strongly

Agree

Very
Strongly
Agree

 

82. There is a special
person around when I
am in need.

83. There is a special
person with whom I
can share my joys
and sorrows.

84. My family really
tries to help me.

85. I get the
emotional help and
support I need from
my family.

86. l have a special
person who is a real
source of comfort to
me.

87. My friends really
try to help me.

88. I can count on my
friends when things
go wrong.

89. I can talk about
problems with my
family

90. l have friends with
whom I can share my
joys and sorrows.

 

 

 

 

 

 

 

 

 

105

 

 

 

Respond to the
following statements by

 

 

circling the number that Very Strongly Mildly Mildly Strongly Very
best describes you. Strongly disagree disagree Neutral Agree Strongly
Give your ﬁrst response disagree Agree Agree
and don’t spend too

much time on armltem.

91. There is a special 1 2 , 3 4 5 6 7
person in my life who

cares about my

feelings

92. My family is 1 2 3 4 5 6 7
willing to help me

make decisions.

93. I can talk about 1 2 3 4 5 6 7

my problems with my
fnends.

 

 

 

 

 

 

 

 

CONTINUE ON TO THE NEXT PAGE

106

 

 

 

 

Respond to the following Definitely Mostly Neither Mostly Definitely
statements by circling the number disagree disagree agree agree agree
that best describes you. Give your nor

ﬁrst response and don’t spend too disagree

much time on any item.

94. Before going out in public, I 1 2 3 4 5
always notice how I look.

95. I am careful to buy clothes that will 1 2 3 4 5
make me look my best.

96. I would pass most physical ﬁtness 1 2 3 4 5
tests.

97. It is important that I have superior 1 2 3 4 5
physical strength.

98. My body is sexually appealing. 1 2 3 4 5
99. I am not involved in a regular 1 2 3 4 5
exercise program.

100. I am in control of my health. 1 2 3 4 5
101. I know a lot about things that 1 2 3 4 5
affect my physical health.

102. l have deliberately developed a 1 2 3 4 5
healthy life-style.

103. I constantly worry about being or 1 2 3 4 5
becoming fat.

104. I like my looks just the way they 1 2 3 4 5
are.

105. I check my appearance in the 1 2 3 4 5
mirror.

106. Before going out, i usually spend 1 2 3 4 5
a lot of time getting ready.

107. My physical endurance is good. 1 2 3 4 5
108. Participating in sports is

unimportant to me. 1 2 3 4 5

 

 

 

 

 

 

107

 

Section F

 

 

 

grooming isn’t right.

 

 

 

 

 

Respond to the following Deﬁnitely Mostly Neither Mostly Deﬁnitely
statements by circling the number disagree disagree agree agree agree
that best describes you. Give your nor
ﬁrst response and don’t spend too disagree
much time on any item.
109. My health is a matter of 1 2 3 4 5
unexpected ups and downs.
110. Good health is one of the most 1 2 3 4 5
important things in my life.
111. i don’t do anything that I know 1 2 3 4 5
might threaten my health
112. I am very conscious of even 1 2 3 4 5
small changes in my weight.
113. Most people would consider me 1 2 3 4 5
good looking.
114. It is important to me that always 1 2 3 4 5
look good.
115. I use very few grooming 1 2 3 4 5
products.

1 2 3 4 5
116. I easily learn physical skills
easily. 1 2 3 4 5
117. Being physically fit is not a strong
priority in my life. 1 2 3 4 5
118. I do things to increase my
physical strength. 1 2 3 4 5
119. I am seldom physically ill. 1 2 3 4 5
120. I take my health for granted. 1 2 3 4 5
121. I often read books that pertain to 1 2 3 4 5
heauh.
122. i like the way I look without my 1 2 3 4 5
clothes.
123. I am self-conscious if my 1 2 3 4 5

 

108

 

 

 

 

Respond to the following Definitely Mostly Neither Mostly Deﬁnitely
statements by circling the number disagree disagree agree agree agree
that best describes you. Give your nor

ﬁrst response and don’t spend too disagree

much time on any item.

124. I usually wear whatever is handy 1 2 3 4 5
without caring how it looks.

125. I do poorly in physical sports or 1 2 3 4 5
games.

126. I work hard to improve my 1 2 3 4 5
physical stamina.

127. From day to day, I never know 1 2 3 4 5
how my body will feel.

128. Ifl am sick, I don’t pay too much 1 2 3 4 5
attention to my symptoms.

129. i make no special effort to eat a 1 2 3 4 5
balanced and nutritious diet.

130. I like the way my clothes ﬁt me. 1 2 3 4 5
131. I don’t care what peOple think 1 2 3 4 5
about my appearance.

132. I take special care with my hair 1 2 3 4 5
grooming.

133. I dislike my physique. 1 2 3 4 5
134. I don't care to improve my 1 2 3 4 5
abilities in physical activities.

135. I try to be physically active. 1 2 3 4 5
136. I often feel vulnerable to 1 2 3 4 5
sickness.

137. I pay close attention to my body 1 2 3 4 5

for any signs of illness.

 

 

 

 

 

 

109

 

 

 

 

 

Respond to the following Deﬁnitely Mostly Neither Mostly Definitely
statements by circling the number disagree disagree agree agree agree
that best describes you. Give your nor

ﬁrst response and don’t spend too disagree

much time on any item.

138. If I’m coming down with a cold or 1 2 3 4 5
ﬂu, I just go on and ignore it as usual.

139. I am physically unattractive. 1 2 3 4 5
140. I am always trying to improve my 1 2 3 4 5
physical appearance.

141. I am very well coordinated. 1 2 3 4 5
142. I know a lot about physical 1 2 3 4 5
ﬁtness.

143. I play a sport regularly 1 2 3 4 5
throughout the year.

144. I am a physically healthy person. 1 2 3 4 5
145. I am very aware of small

changes in my physical health. 1 2 3 4 5
146. At the ﬁrst sign of illness, I seek 1 2 3 4 5
medical advice.

147. I am on a weight-loss diet. 1 2 3 4 5
148. I do not actively do things to 1 2 3 4 5

keep physically ﬁt.

 

 

 

 

 

 

CONTINUE ON TO THE NEXT PAGE

110

 

FOR THE REMAINDER OF THE ITEMS IN THIS SECTION, USE THE RESPONSE SCALE
GIVEN WITH THE ITEM, AND ENTER YOUR ANSWER IN THE SPACE BESIDE THE ITEM.

_149. I have tried to lose weight by fasting or going on crash diets.
1. Never
2. Rarely
3. Sometimes
4. Often
5. Very Often

150. I think I am:
Very underweight
Somewhat underweight
Normal weight
Somewhat overweight
Very overweight

@PWNJ

151. From looking at me, most other people would think I am:
Very underweight
Somewhat underweight
Normal weight
Somewhat overweight
Very overweight

9".“wa

152-160. Use this 1-5 scale to indicate how satisﬁed you are with each of the following
areas of your body.

 

1 2 3 4
5
Very Mostly Neither Mostly
Very
dissatisﬁed dissatisﬁed satisﬁed nor dissatisﬁed satisﬁed
saﬁsﬁed

____152. Face (faciaI features, complexion)

_ 153. Hair (color, thickness, texture)

_ 154. Lower torso (buttocks, hips, thighs, legs)
_ 155. Mid torso (waist, stomach)

_ 156. Upper torso (chest, shoulders arms)
__ 157. Muscle tone

__ 158. Weight

_159. Height

160. Overall appearance

111

 

 

 

 

 

 

 

 

 

 

Respond to the following None Very A Little Some A Most All of
statements by circling the of the Rarely of the of the Good of the the
number that best Time Time Time Part of Time Time
describes you. Give your the

ﬁrst response and don’t Time

spend too much time on

any item.

161. I feel that people would 1 2 3 4 5 6 7
NOT like me if they really

knew me well.

162. I feel that others do 1 2 3 4 5 6 7
things much better than I do.

163. I feel that I am an 1 2 3 4 5 6 7
attractive person.

164. I feel conﬁdent in my 1 2 3 4 5 6 7
ability to deal with other

people.

165. I feel that I am likely to 1 2 3 4 5 6 7
fail at things I do.

166. I feel that people really 1 2 3 4 5 6 7
like to talk with me.

167. I feel that I am a very 1 2 3 4 5 6 7
competent person.

168. When I am with other 1 2 3 4 5 6 7
people I feel that they are

glad I am with them.

169. I feel that I make a 1 2 3 4 5 6 7
good impression on others.

170. lfeel conﬁdent thatl 1 2 3 4 5 6 7
can begin new relationships

if I want to.

171. lfeel that I am ugly. 1 2 3 4 5 6 7
172. I feel that I am a boring 1 2 3 4 5 6 7
person.

 

112

 

 

 

 

 

Respond to the following

statements by circling the None of Very A Little of Some of A Good Most of All of
number that best describes you. the Rarely the Time the Time Part of the the
Give your ﬁrst response and Time the Time Time
don’t spend too much time on Time

any Item.

173. I feel very nervous 1 2 3 4 5 6 7
when I am with strangers.

174. I feel conﬁdent in my 1 2 3 4 5 6 7
ability to learn new things.

175. I feel good about 1 2 3 4 5 6 7
myself.

176. I feel ashamed about 1 2 3 4 5 6 7
myself.

177. I feel that if I could be 1 2 3 4 5 6 7
more like other people then I

would feel better about

myself.

178. I feel that I get pushed 1 2 3 4 5 6 7
around more than others.

179. I feel that people like 1 2 3 4 5 6 7
me.

180. I feel that people have 1 2 3 4 5 6 7
a good time when they are

with me.

181. I feel conﬁdent thatl 1 2 3 4 5 6 7
can do well in whatever I do.

182. I trust the competence 1 2 3 4 5 6 7
of others more than I trust

my own abilities.

183. I feel that I mess things 1 2 3 4 5 6 7
up.

184. I wish that l were 1 2 3 4 5 6 7
someone else.

 

 

 

 

 

 

 

 

113

 

 

SECTION H:

185. In general, would you say your health is:
_Excellent
_Very Good
_Good
_Fair
_Poor

186. Compared to one year ago, how would you rate your health?
_Much better now than 1 year ago
_Somewhat better now than 1 year ago
_About the same as 1 year ago
_Somewhat worse than 1 year ago
_Much worse better now than 1 year ago

187. How many hours per day do you generally sleep?
188. Do you take regular naps?

_ Yes
_ No

 

During the east 4 weeks, have you had any of the following
problems with your work or other regular daily activities as a result

of your 2h zsical health?

Yes

No

 

 

189. Cut down the amount of time you spent on work or other activities.

190. Accomplished less than you would like.

191. Were limited in the kind of work or other activities.

192. Had difﬁculg performing the work or other activities.

 

 

 

CONTINUE ON TO THE NEXT PAGE

114

 

 

SECTION I:

 

Respond to the following statements by Often Sometimes Rarely Never
circling the number that best describes
you. Give your ﬁrst response and don’t
spend too much time on anLItem.

 

 

193. During the past week, I was 1 2 3 4
bothered by things that usually don’t ’

bother me.

194. During the past week, I did not feel 1 2 3 4

like eating; my appetite was poor.

195. During the past week, I felt like I 1 2 3 4
could not shake off the blues even with
the help from family and friends.

196. During the past week, I felt that l 1 2 3 4
was just as good as other people.

197. During the past week, I had trouble 1 2 3 4
keeping my mind on what I was doing.

198. During the past week, I felt 1 2 3 4
depressed.
199. During the past week, I felt that 1 2 3 4

everything I did was an effort.

200. During the past week, I felt hopeful 1 2 3 4
about the future.

201. During the past week, I thought my 1 2 3 4
life had been a failure.

202. During the past week, I felt fearful. 1 2 3 4
203. During the past week, my sleep was 1 2 3 4
restless.

204. During the past week, I was happy. 1 2 3 4

 

 

 

 

 

115

 

 

 

 

 

 

 

 

 

Respond to the following statements by

circling the number that best describes

you. Give your ﬁrst response and don't

spend too much time on any item. Often Sometimes Rarely Never
205. During the past week, I talked less 1 2 3 4
than usual.
206. During the past week, I felt lonely. 1 2 3 4
207. During the past week, people were 1 2 3 4
unfriendly.
208. During the past week, I enjoyed life. 1 2 3 4
209. During the past week, I had crying 1 2 3 4
spells.
210. During the past week, I felt sad. 1 2 3 4
211. During the past week, I felt that 1 2 3 4
people disliked me.
212. During the past week, I could not 1 2 3 4

“get going.”

 

 

CONTINUE ON TO THE NEXT PAGE

116

SECTION J:

 

 

 

could.

 

 

 

 

 

Respond to the following statements by Strongly Disagree Agree Strongly
circling the number that best describes you. Disagree Agree
Give your ﬁrst response and don’t spend too
much time on any item.
213. As I grow older, things seem better 1 2 3 4
than I thought they would be.
214. l have gotten more breaks in life than 1 2 3 4
most of the people I know.
215. This is the dreariest time in my life. 1 2 3 4
216. l amjust as happy as when I was 1 2 3 4
younger
217. My life could be happier than it is now. 1 2 3 4
218. These are the best years of my life 1 2 3 4
219. Most of the things I do are boring and 1 2 3 4
monotonous.
220. I expect some interesting and pleasant 1 2 3 4
things to happen to me in the near future.
221. The things I do are as interesting to 1 2 3 4
me now as they ever were.
222. I feel old and somewhat tired. 1 2 3 4
223. I feel my age but it does not bother 1 2 3 4
me.
224. As I look back on my life, I am fairly 1 2 3 4
well satisﬁed.
225. I would not change past life even if I 1 2 3 4

 

117

 

 

 

Respond to the following statements by
circling the number that best describes you.

 

 

Give your ﬁrst response and don’t spend too Strongly Disagree Agree Strongly
much time on any item. Disagree Agree
226. Compared to other people my age, I 1 2 3 4
have made a lot of foolish decisions in my ‘
life.
227. Compared to other people my age, I 1 2 3 4
make a good appearance.
228. l have made plans for things I’ll be 1 2 3 4
doing a month or a year from now.
229. When I think back over my life, I didn’t 1 2 3 4
get most of the important things I wanted.
230. Compared to other people, I get down 1 2 3 4
in the dumps too often.
231. I've gotten pretty much what I 1 2 3 4
expected out of life.
232. In spite of what people say, the lot of 1 2 3 4

the average person is getting worse, not
beﬁer

 

 

 

 

 

CONTINUE ON TO THE NEXT PAGE

118

 

 

SECTION K:
CHECK THE ANSWER THAT BEST APPLIES TO YOU

233. Does the thought of growing old occur to you?

_Never

_Very infrequently
_Sometimes
_ Often
_Constantly

234. Do you worry about growing old?

_Never

_Very infrequently
_Sometimes
_Often
_Constantly

235. Does the thought of dying occur to you?

Never

Very infrequently
Sometimes
Often

Constantly

236. Do you worry about dying?

_Never

_Very infrequently
_Sometimes
_Often
_Constantly

237. How much has HIV/AIDS had an impact on your outlook about getting older?

_Not at all
_A little
_Some

_A great deal

238. How has HIV/AIDS impacted your outlook about getting older?
_Positively

_Negatively

119

 

_Neither positively or negatively
_Not at all

239. At what age do you consider a person as being “old?

240. At what age do you consider a gay man as being “old”? _

241. About how many people have you known whom have died from HIV/AIDS?__
242. How many of your close friends or relatives have died from HIV/AIDS?___

243. How many of your partners have died from HIV/AIDS?
244. Most young gay men think that older gay men are pretty dull.

_Strongly Disagree
_Disagree
_Agree
_Strongly Agree

245. In the gay/lesbian community most young people do not want to make friends with
an older lesbian! gay person.

_Strongly Disagree
_Disagree
_Agree
_Strongly Agree

246. There Is a lot of ageism in the gay/lesbian community.
Strongly Disagree
Disagree
Agree
Strongly Agree
247..Do you currently participate in Gay/Lesbian organizations?

Yes
No

248. Do you receive social services provided for older Gay/Lesbian adults.

_Yes
_No

249. Do you receive social services provided the general population of older adults?

_Yes
_No

120

 

250. What age are most of your friends?

_50 and older
_30-40
_30 and younger

 

251. Until what age do you think you will live to be?

CONTINUE TO THE NEXT PAGE

121

Section L:

 

 

day at a time.

 

 

 

 

 

 

 

 

_Respond to the following Very Strongly Mildly Very
statements by circling the Strongly disagree disagree Neutral Mildly Strongly Strongly
number that best disagree Agree Agree
describes you. Give your Agree
ﬁrst response and don’t
spend too much time on
any item.

252. When I make plans 1 2 3 4 5 6 7
I follow through with

them.

253. I usually manage 1 2 3 4 5 6 7
one way or another.

254. I am able to 1 2 3 4 5 6 7
depend on myself more

than anyone else.

255. Keeping 1 2 3 4 5 6 7
interested in things is

important to me.

256. I can be on my 1 2 3 4 5 6 7
own if I have to.

257. I feel proud that I 1 2 3 4 5 6 7
have accomplished

things in my life.

258. I usually take 1 2 3 4 5 6 7
things in stride.

259. I am friends with 1 2 3 4 5 6 7
myself.

260. I feel I can handle 1 2 3 4 5 6 7
many things at a time.

261. I am determined. 1 2 3 4 5 6 7
262. I seldom wonder 1 2 3 4 5 6 7
what the point of it all is.

263. I take things one 1 2 3 4 5 6 7

 

122

 

 

—Respond to the following
statement by circling the
number that best
describes you. Give your
first response and don’t
spend too much time on
Lny Item.

Very
Strongly
disagree

Strongly
disagree

Mildly
disagree

Neutral

Mildly
Agree

Strongly
Agree

Very
Strongly
Agree

 

 

264. I can get through
tough times because I’ve
experienced difﬁculty
before.

265. l have self-
discipline.

I keep interested in
things.

266. I can usually ﬁnd
something to laugh
about

267. My belief in myself
gets me through hard
times.

268. In an emergency,
I’m someone people can
generally rely on.

269. I can usually look at
a situation in a number of
ways.

270. Sometimes I make
myself do things whether
I want to or not.

271. My life has meaning.

272. I do not dwell on
things that I can’t do
anything about.

' 273. When I’m in a
difﬁcult situation, I can
usually ﬁnd my way out
of it.

274. I have enough
energy to do what I have
to do.

275. It’s okay if there are
people who don't like me.

 

 

 

 

 

 

 

 

Section M:

123

 

 

 

 

Respond to the following Almost Often Sometimes Seldom Almost
statement by circling the always Is True True Never
number that best describes True True True
you. Give your ﬁrst response
and don’t spend too much
time on any item.
276. I get embarrassed when 1 2 3 4 5
someone begins to tell me .
personal things.

1 2 3 4 5
277. I am warm and friendly.
278. It’s important to me to be 1 2 3 4 5
completely open with my friends.
279. I keep what I really think and 1 2 3 4 5
feel to myself.
280. I think it's crazy to get too 1 2 3 4 5
involved with people.
281. I care deeply for others. 1 2 3 4 5
282. I’m basically a loner. 1 2 3 4 5
283. l have (have had) a close 1 2 3 4 5
physical and emotional
relationship with another person.
284. I prefer not to show too much 1 2 3 4 5
of myself to others.
285. I ﬁnd it easy to make close 1 2 3 4 5
fnends.
286. I feel that I have left my mark 1 2 3 4 5
on the world through my inﬂuence
on others.
287. I spend a great deal of time 1 2 3 4 5
thinking about myself.
288. I have a sense that there is a 1 2 3 4 5

purpose in my life.

 

 

 

 

 

 

124

 

 

 

 

Respond to the following Almost Often Sometimes Seldom Almost
statement by circling the always Is True True Never
number that best describes True True True
you. Give your ﬁrst response

and don’t spend too much

time on any item.

289. I feel inadequate in my 1 2 3 4 5
interactions with others. '

290. It’s important to me to feel 1 2 3 4 5
that I have made a contribution in

life.

291. I have difﬁculty relating to 1 2 3 4 5
people different than me.

292. I have discovered no 1 2 3 4 5
mission or purpose in life.

293. I worry how others perceive 1 2 3 4 5
me.

294. It’s more important to work 1 2 3 4 5
on behalf of those I care about

than to work just for myself.

295. I am proud of what I have 1 2 3 4 5
accomplished in my life.

296. As I look over my life, I feel 1 2 3 4 5
the need to make up for lost time.

297. I feel that l have the wisdom 1 2 3 4 5
an experience to be a help to

others.

298. I have many regrets about 1 2 3 4 5
what I might have become.

299. I am afraid of growing old. 1 2 3 4 5
300. My achievements and

failures are largely a 1 2 3 4 5
consequence of my own actions.

301. There’s a lot about my life 1 2 3 4 5

that I am sorry about.

 

 

 

 

 

 

125

 

 

 

 

Respond to the following Almost Often Sometimes Seldom Almost
statement by circling the always Is True True Never
number that best describes True True True
you. Give your ﬁrst response

and don’t spend too much

time on any Item.

302. I am disgusted by other 1 2 3 4 5
people.

303. I feel at peace with myself. 1 2 3 4 5
304. If I could live my life over, 1 2 3 4 5
there is little I would change.

305. As I look back over my life, 1 2 3 4 5

I realize my parents did the best
they could do for me.

 

 

 

 

 

 

306. Are there any additional comments you would like to add to this questionnaire?

 

 

 

THANK YOU FOR YOUR PARTICIPATION!

126

 

 

 

APPENDIX C

HUMAN SUBJECTS APPROVAL

127

 

MICHIGAN STATE
0 N I R

 

It?

 

FIE

 

 

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I—

 

 

I ‘0

 

OFFICE OF
REGULATORY
AFFAIRS

Human Research
Protection Programs

BIOMEDICAL 8: HEALTH
INSTITUTIONAL REVIEW
BOARD (BIRB)

COMMUNITY RESEARCH
INSTITUTIONAL REVIEW
BOARD (CRIRB)

SOCIAL scrENcer
BEHAVIORAL l EDUCATION
INSTITUTIONAL REVIEW
BOARD (SIRB)

202 Olds Hall

East Lansing, Michigan
48824-1046
517-355-2180

Fax: 5174324503

wwwhumanresearchmsuedu
SIRB 8 BIRB: IRB@msu.edu
CRIRB: crirb@msu.edu

 

MSU it an aﬂinnativcaacrfan
equal-opportunity institution.

Renewal
Application
Approval

VE SITY

February 6. 2007

To: Rena HAROLD
232 Baker Hall

Re: IRB # 05-184
Renewal Approval Date:
Project Expiration Date:

Category. EXPEDITED 2-8
February 6, 2007
February 4. 2008

Title: ATTITUDES AND IMPRESSIONS OF GAY MEN AND MEN WHO HAVE SEX WITH MEN OVER
50 YEARS OF AGE

The Institutional Review Board has completed their review of your project. I am pleased to advise you that the
renewal has been approved.

This protocol has been bumped down to 2-8 expedited.

This letter notes approval for data analysis only (contact with subject and data collection Is complete).
Any further recruitment, data collection or contact with subject‘wlll require IRB review and approval
via a revision before Implementation.

The review by the committee has found that your renewal is consistent with the continued protection of the
rights and welfare of human subjects, and meets the requirements of MSU's Federal Wide Assurance and the
Federal Guidelines (45 CF R 46 and 21 CFR Part 50). The protection of human subjects In research Is a
partnership between the IRB and the investigators. We look forward to working with you as we both fulﬁll our
responsibilities.

Renewals: IRB approval is valid until the expiration date listed above. If you are continuing your project, you
must submit an Application for Renewal application at least one month before expiration. If the project Is
completed, please submit an Application for Permanent Closure.

Revisions: The IRB must review any changes in the project, prior to Initiation of the change. Please submit an
Application for Revision to have your changes reviewed. If changes are made at the time of renewal. please
include an Application for Revision with the renewal application.

Problems: If issues should arise during the conduct of the research. such as unanticipated problems, adverse
events, or any problem that may Increase the risk to the human subjects, notify the lRB ofﬁce promptly. Forms
are available to report these issues.

Please use the IRB number listed above on any forms submitted which relate to this project, or on any
correspondence with the IRB ofﬁce.

Good luck in your research. If we can be of further assistance, please contact us at 517-355-2180 or via email
at IRB@msu.edu. Thank you for your cooperation.

Sincerely,
aw:

Peter Vasilenko, Ph.D.
SIRB Chair

02 Scott Berlin

128

 

 

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