title: Physical and mental health of transgender older adults: an at-risk and underserved population.
abstract: OBJECTIVE
  This study is one of the first to examine the physical and mental health of transgender older adults and to identify modifiable factors that account for health risks in this underserved population.
  
  
  METHODS
  Utilizing data from a cross-sectional survey of lesbian, gay, bisexual, and transgender older adults aged 50 and older (N = 2,560), we assessed direct and indirect effects of gender identity on 4 health outcomes (physical health, disability, depressive symptomatology, and perceived stress) based on a resilience conceptual framework.
  
  
  RESULTS
  Transgender older adults were at significantly higher risk of poor physical health, disability, depressive symptomatology, and perceived stress compared with nontransgender participants. We found significant indirect effects of gender identity on the health outcomes via fear of accessing health services, lack of physical activity, internalized stigma, victimization, and lack of social support; other mediators included obesity for physical health and disability, identity concealment for perceived stress, and community belonging for depressive symptomatology and perceived stress. Further analyses revealed that risk factors (victimization and stigma) explained the highest proportion of the total effect of gender identity on health outcomes.
  
  
  CONCLUSIONS
  The study identifies important modifiable factors (stigma, victimization, health-related behaviors, and social support) associated with health among transgender older adults. Reducing stigma and victimization and including gender identity in nondiscrimination and hate crime statutes are important steps to reduce health risks. Attention to bolstering individual and community-level social support must be considered when developing tailored interventions to address transgender older adults' distinct health and aging needs.
authors.affiliation: *Address correspondence to Karen I. Fredriksen-Goldsen, University of Washington, School of Social Work, 4101 15th Ave. NE, Box 354900, Seattle, WA 98105. E-mail: fredrikk@u.washington.edu.
authors.forename: Karen I
authors.initials: KI
authors.lastname: Fredriksen-Goldsen
authors.forename: Loree
authors.initials: L
authors.lastname: Cook-Daniels
authors.forename: Hyun-Jun
authors.initials: HJ
authors.lastname: Kim
authors.forename: Elena A
authors.initials: EA
authors.lastname: Erosheva
authors.forename: Charles A
authors.initials: CA
authors.lastname: Emlet
authors.forename: Charles P
authors.initials: CP
authors.lastname: Hoy-Ellis
authors.forename: Jayn
authors.initials: J
authors.lastname: Goldsen
authors.forename: Anna
authors.initials: A
authors.lastname: Muraco
mesh_terms: D003625:Data Collection; D006304:Health Status; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D063106:Transgender Persons; D035862:Vulnerable Populations; D008297:Male; D005260:Female
keywords: Gender identity; LGBT; Minority health; Resilience
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