as a result of lifelong experiences of marginalization and oppression. Such experiences continued to the present day, with many instances of overt homophobia and ageism and covert experiences of neglect and invisibility being reported—both within the LGBT community and more broadly.

As previously noted, few studies have explicitly examined racial and ethnic groups in their samples. One exception is David and Knight (2008), who found in a study of 383 white and black gay men from across the adult life course that the older black gay men experienced significantly higher levels of ageism than the older white gay men and higher levels of perceived racism than the younger black gay men. The authors suggest that the differences in perceived racism may be a cohort difference, reflecting the views of society when the older men were coming of age. It is notable that these older black gay men did not experience higher levels of negative mental health outcomes.

The combined stigma of being elderly and transgender can serve as a strong traumatizing force, potentially exacerbating both forms of discrimination and stigma (Witten and Eyler, 2007). Studies of the particular experiences of stigma in this population appear to focus on the health care system and are reported later in the chapter.

Violence

Another area that is substantially underresearched is LGBT elders’ experiences of violence. In a previously mentioned study involving LGB adults, D’Augelli and Grossman (2001) asked participants (n = 416, aged 60–91) about their lifetime experiences with violence based on their sexual orientation. They found that 63 percent reported verbal abuse, 29 percent had been threatened with violence, 16 percent had experienced assault, 12 percent had experienced assault with a weapon, and 11 percent had had an object thrown at them.

Systematic examination of the violence experienced by transgender elders has been inadequate, although several authors have commented that rates of violence and crime in this population are sufficiently acute to warrant consideration as a primary health priority for the transgender community (Xavier et al., 2007). A small, online survey of 30 transgender adults aged 50–70 revealed that 64.8 percent had experienced emotional or psychological abuse more than once in their lives (Cook-Daniels and Munson, 2010).

Substance Use

Tobacco and alcohol use appear to be greater among older LGB populations than among older heterosexuals (Gruskin et al., 2007; Tang et al.,



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