Queer elders deeply fear aging in isolation and encountering discrimination, according to a new report by the American Association of Retired Persons (AARP).

The “Maintaining Dignity Research Report” paints a complicated picture of LGBTQ aging, with bright spots in healthcare and alarming trends among bisexual and transgender people.

More than 75 percent of LGBTQ elders 45 and older worry they won’t have enough social or familial support as they age. A staggering 73 percent don’t have access to LGBTQ-specific senior services.

The report looks at a cross section of 1,762 LGBTQ adults ages 45 and over.

It largely found that seniors are happy with their healthcare. Three-fourths of respondents said they were out as LGBTQ to their physician, and 84 percent described that relationship as “honest” or “good.” Ninety-seven percent of those surveyed reported they were insured, while 86 described their health as good.

Still, participants expressed high anxiety about facing discrimination, with 57 percent expressing concerns about healthcare providers not being sensitive to LGBT needs. More than half (52 percent) worried discrimination or prejudice would affect their quality of care.

Among gay and lesbian participants, just under half expressed a concern about having to hide their identities to receive healthcare, For transgender people, that number rocketed to 70 percent.

The study says that angst about healthcare alongside satisfaction with providers can be explained. According to previous research, the study notes, LGBTQ people have found affirming medical providers through trial and error.

“Often, changing providers is a response to experiencing discrimination or unwelcoming treatment,” the report says. “This may explain why LGBT adults at mid-life or older are both satisfied today and wary of experiencing discrimination or lack of competence in the future.”

Largely it found participants lived in LGBTQ-friendly communities (83 percent). But that didn’t stop them from wanting more LGBTQ-welcoming housing developments; 90 percent expressed interest in that option.

Those numbers could be explained by a fear of discrimination. Thirty-four percent of respondents said they worried they would have to hide their LGBTQ identity to find housing as they age. That same number jumped to 54 percent among transgender and “gender expansive” participants.

Transgender people were more than three times as likely to experience discrimination in housing with 14 percent reporting discrimination, compared to four percent of lesbian, gay and bisexual respondents.

The report also sheds light the experiences of bisexual elders. That group was least likely to be out as LGBT to important people in their lives at a stunning 48 percent compared to the overall average at 74 percent. They were least likely to report an honest and open relationship with their doctors (61 percent compared to the overall at 74 percent).

In a statement, LGBTQ elder advocacy organization SAGE praised the new report as a vital addition to understanding the lives of queer people as they age.

“The important work now is to do everything possible to respond to the acute needs documented in the survey,” says SAGE CEO Michael Adams, “so that LGBT older people have the same opportunities in their later years as all older Americans.”

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