Julio J. Fonseca
Queer Elders: Aging, Resilience, and Affirming Mental Health in Later Life
I have had the benefit of co-leading two LGBTQ+ therapy groups. Each group had a participant who was in their sixties. Notably, in both groups, the presence and participation of these older members had a visible positive impact on themselves and their younger peers. In many sessions, younger group members sought out perspectives from the older participants. Specifically, they asked about their lived history, including their experiences of coming out prior to or during the Stonewall era of queer liberation, efforts to de-pathologize same-sex relationships and move away from their classification as “mental disorders,” the AIDS epidemic, the fight for decriminalization of same-sex relationships (Lawrence v. Texas, 2003), and navigating love, romance, and loss.
As a person in the generation between the oldest and youngest group members, it felt like a sacred honor to be in the space where, for the first time in many years, there were several generations of queer people. The key experience of these moments that stayed with me was seeing the experience of engagement and the feeling of usefulness of older queer folks who came in with experiences of significant depression and feelings of isolation, with trauma histories they might not have been able to articulate fully. Group Psychotherapy, specifically interpersonally based, process-oriented group therapy, offers a uniquely effective intervention for addressing the core challenges facing older LGBTQ+ adults: loneliness, lack of community, legacy struggles, and the impact of historical trauma.
Mental Health Needs of LGBTQ+ Older Adults
The older LGBTQ+ population in the United States faces significant mental health challenges. Approximately 1.5 million adults 65 and older identify as LGB, with projections suggesting this number will reach 3 million by 2030 (Hinrichs & Donaldson, 2017). Within this population, the prevalence of suicidal ideation and attempts is significant: between 38-65% report suicidal thoughts, and 16-32% have attempted suicide (Chan et al., 2025).
Transgender older adults represent an even smaller and more marginalized segment of the aging population. Among US adults 65 and older, only 0.3% identify as transgender (Pew Research Center, 2022; Williams Institute, 2022). To put this in perspective: while older adults comprise nearly 20% of all Americans, they represent just 10.5% of the total transgender population. Of the over 2.1 million transgender adults in the U.S., approximately 174,000 are age 65 or older (Williams Institute, 2022). This underrepresentation reflects decades of stigma, criminalization, and pathologization that made it unsafe for many to live authentically or survive long enough to reach older adulthood.
The historical trauma experienced by older LGBTQ+ adults has profoundly shaped their psychological landscape. During the era when same sex attraction was largely pathologized, same-sex attraction was classified as a mental illness, not removed from the DSM until 1973, or declassified by the WHO until 1992.(Hinrichs & Donaldson, 2017). The lingering impact of is evident: a 2003 survey found that 37% of men and 23% of women concealed their sexuality throughout their lives (Hinrichs & Donaldson, 2017). The AIDS crisis compounded this trauma. However, remarkably, research reveals what Hinrichs and Donaldson (2017) term “crisis competence” or what is more commonly thought of as resilience. Psychologically resilient older gay men and lesbians adjusted to aging more successfully than their heterosexual counterparts, reporting higher life satisfaction, greater flexibility in gender roles, lower self-criticism, and fewer psychosomatic problems. This represents a profound strength that can be built upon therapeutically in clinical work with older LGBTQ+ adults. A person in their sixties lived through the historical context all and is now witnessing renewed attacks on the LGBTQ+ community.
How does this impact the mental health and wellness of older LGBTQ+ adults? Older LGBTQ+ adults face staggering rates of social isolation rooted in lifelong discrimination. According to Chan et al. (2025), 61.5% of women and 54.7% of men often face discrimination, which lowers positive mental health by approximately 5%. Loneliness among this population correlates strongly with lower education levels, limited family and friend support, and a lack of connection to the LGBTQ+ community.
The social support networks of LGBTQ+ older adults typically differ from those of their heterosexual counterparts. Chang et al. (2025) describe this through hierarchical compensatory theory: heterosexual older adults typically rely on spouse and children first, followed by distant relatives, friends, and community. In contrast, LGBTQ+ older adults depend primarily on “families of choice,” close friends, and neighbors who become their essential support system. Many experienced family rejection when they came out. Unlike racial or ethnic minorities, who typically share their marginalized status with family members, sexual and gender minorities often face isolation within their own families. Years spent “in the closet” meant hiding essential aspects of themselves, and the protective effect of community membership was often absent due to this necessary concealment.
The AIDS crisis devastated many of these social networks. Friends formed the backbone of social support for many LGBTQ+ older adults, yet 71% of HIV diagnoses occurred among gay and bisexual men, and higher mortality rates severely diminished available support systems (Chang et al., 2025). Many elder queer folks in their sixties today have lost entire friendship networks to the epidemic.
Financial and housing insecurity compound this isolation. Nearly one-third of older LGBTQ+ adults live at or below the federal poverty line, compared to 26% of the general older adult population (Chang et al., 2025). H using discrimination remains pervasive: 48% of elder LGBTQ+ couples have experienced it, and 90% believe discrimination exists in long-term care facilities. Their fears are not unfounded. A 2010 study found that facility staff rated same-sex intimacy more negatively than heterosexual intimacy (Chang et al., 2025), forcing many to hide their sexual orientation again at a vulnerable stage of life.
Group Therapy’s Benefits for LGBTQ+ Older Adults
LGBTQ+ individuals consistently experience high rates of psychological distress and disproportionately seek therapy, including group modalities (Lefevor & Williams, 2021). However, significant barriers persist: a lack of trained therapists and a scarcity of sexual and gender minority specific process groups. Among LGBTQ+ populations, bisexual, queer, and transgender/gender queer individuals face even higher risk than lesbians and gay men.
Group therapy offers distinct advantages that address the unique needs of LGBTQ+ older adults (Lefevor & Williams, 2021). First, group therapy directly combats isolation by providing a consistent community connection. For LGBTQ+ older adults who lost social networks to the AIDS crisis, experienced family estrangement, or face barriers to community participation due to poverty or long-term care settings, the therapy group itself becomes a vital “family of choice.” Regular attendance creates reliable relationships and a sense of belonging that counters the epidemic of loneliness affecting 61.5% of older LGBTQ+ women and 54.7% of men. The group provides not just emotional support, but the experience of being seen, known, and valued. This directly addresses the social isolation that drives poor mental health outcomes in this population.
Second, the group creates an affirming environment for identity exploration. It is particularly crucial for those who spent decades “in the closet.” The group provides a safer space where members can experiment with pronouns, names, and gender expression. Additionally, perspectives from members with non-monosexual identities and orientations (bisexual, pansexual, queer) can introduce expansive ways of thinking about sexuality and gender that may not have been previously available to other members.
Third, group therapy effectively addresses shame and internalized negativity. Internalized homophobia and transnegativity can be identified, processed, and dispelled as they are enacted in real time within the group. Peer feedback helps members distinguish between discrimination hypervigilance and the range of experiences born of living through significant and legitimate threats. Fourth, group therapy empowers through autonomy. By emphasizing client autonomy, group therapy directly counters the powerlessness LGBTQ+ older adults may have experienced in larger society and provides agency that can counter a history of marginalization.
Finally, group therapy allows for self-direction around identity issues. Members can focus on their sexual or gender identity when they see it as relevant, rather than having a therapist either over-focus (relating everything to identity) or under-focus (remaining resistant to discussing discrimination). This member-driven approach represents an improvement over both support groups and individual therapy (Lefevor & Williams, 2021).
In the therapy groups I have had the pleasure of co-leading, moments of connection, joint processing, examination of sorrow, and sharing of joy have all featured elements of these five advantages. Group therapy offers more than treatment for this population; it provides restoration of what was systematically denied: community, visibility, and the opportunity to transform survival into legacy. When we create affirming therapeutic spaces where multiple generations of LGBTQ+ people can gather, we do more than address isolation and depression; we honor the strength it took to reach older adulthood as an openly queer person, and we ensure that the wisdom earned through that journey is not lost. These elders deserve to be valued, and their wisdom has the power to heal not only younger group members but also themselves. The LGBTQ+ community once again faces systematic attempts at erasure, and younger members grapple with unprecedented levels of anxiety and fear. Creating spaces where generations can connect is no longer simply therapeutic. It has become urgent and essential for collective resilience and survival.
References
Chan, A. S. W., Tam, H. L., Leung, L. M., Wong, F. K. C., Chi, J. H. M., & Yan, E. (2025). Examining the interplay of psychological well-being, health, and aging in older LGBT adults: A systematic review. Sexuality Research and Social Policy, 22, 964–978. https://doi.org/10.1007/s13178-024-01024-0
Chang, K., Khanpour, S., Campbell, A., & Despain, A. (2025). Challenges of aging: Contextual factors in therapy with older lesbian, gay, and bisexual clients. The Family Journal: Counseling and Therapy for Couples and Families, 33(3), 438–449. https://doi.org/10.1177/10664807251318970
Herman, J. L., Flores, A. R., & O’Neill, K. K. (2022). How many adults and youth identify as transgender in the United States? The Williams Institute, UCLA School of Law. https://williamsinstitute.law.ucla.edu/publications/trans-adults-united-states/