Caring for Others While Caring for Yourself: What Older LGBTQIA+ Caregivers Need to Know
The Hidden Heart of Caregiving
There is a particular kind of love involved in caring for another person as they age — a love that is generous, sometimes exhausting, and often profoundly rewarding. For many older LGBTQIA+ adults, caregiving is not a new experience. This community has a long history of caring deeply for its own: through the HIV/AIDS crisis, through illness and grief, through chosen families built out of necessity and belonging.
Today, as the LGBTQIA+ community ages, so too do the individuals in this community who are providing informal care — for partners, friends, family, and chosen family. And while caregiving carries meaning, it also carries weight.
Research is beginning to illuminate what that weight looks like for LGBTQIA+ caregivers in particular, and also, what helps.
What the Research Shows
A long-term study from 2023 published in The Gerontologist by Fredriksen-Goldsen and colleagues followed 754 LGBTQ caregivers aged 50 to 98 over three years, examining how their physical and psychological health-related quality of life changed over time — and what factors shaped those changes.
While both physical and psychological wellbeing declined over the three-year period, a pattern consistent with the cumulative demands of caregiving over time — the study also identified a range of modifiable factors — things that can change positively over time — that were related to better outcomes.
Protective factors for psychological wellbeing included:
A sense of personal mastery (feeling that one has agency or control over one's life)
Social support from others
Regular socialisation and going out for enjoyment
Engagement with the LGBTQIA+ community
Physical activity meeting recommended health guidelines
Risk factors that were found to undermine psychological wellbeing included:
Day-to-day experiences of discrimination
Internalised identity stigma (negative feelings about one's own LGBTQIA+ identity)
Insufficient food intake
Notably, physical activity emerged as a particularly powerful moderating factor. Caregivers who engaged in regular physical activity showed a slower decline in both physical and psychological wellbeing over the three years. In fact, the gap in outcomes between those who were physically active and those who were not, grew larger over time — indicating that the benefits of exercise compound over time.
Why This Matters in Midlife and Later Life
LGBTQIA+ caregivers face a convergence of challenges that makes their situation distinct from the broader caregiving population.
On one hand, LGBTQIA+ caregivers are more likely to be caring for someone with whom they share no legal relationship, which can create policy-driven barriers to accessing respite and support. On the other hand, LGBTQIA+ caregivers may hesitate to access formal support services due to past experiences of discrimination in health and social care settings.
Additionally, as a community of people who have experienced disproportionate rates of disability, financial hardship, and social marginalisation, older LGBTQIA+ caregivers may already be entering this role carrying a heavier psychological load.
What the research from Fredriksen-Goldsen et al. (2023) makes clear, is that the stressors most unique to the LGBTQIA+ community — ongoing discrimination and internalised stigma — are not small background factors. They are significant, independent predictors of reduced psychological wellbeing.
Why Do LGBTQIA+ Caregivers Experience Unique Challenges?
LGBTQIA+ caregivers often face compounding stressors that go beyond the demands of caregiving itself. A lifetime of navigating discrimination, the absence of legal protections for chosen-family relationships, and fear of stigma in formal care settings can all reduce access to support and increase emotional burden — even when the caregiving relationship itself is one of deep love and commitment.
What Actually Helps
1. Mastery: The Power of Feeling in Control
A sense of personal mastery — the belief that you have a sense of ownership and control over what happens to you — was one of the strongest protective factors in the research. This aligns with a large body of psychological literature linking perceived control to resilience and psychological growth, lower anxiety, and better health outcomes in older age.
For caregivers, who often feel that their lives are shaped only by the needs of the person they care for, finding small and meaningful areas of agency matters. This might mean maintaining one activity that is entirely your own, setting realistic limits on care tasks, or seeking therapy to explore feelings of helplessness.
2. Community: Connection That Understands You
LGBTQIA+ community engagement was particularly related to better psychological wellbeing — above and beyond general social support. This is psychologically meaningful. It indicates that connection within a community that shares one's identity and experiences offers something distinctive: a sense of belonging, and feeling understood and accepted.
For older LGBTQIA+ caregivers who may have experienced years of concealment, rejection, or invisibility in mainstream services, this kind of belonging can be restorative in ways that generic social contact may not be.
If formal caregiving services feel unwelcoming, peer support within LGBTQIA+ communities — whether in-person or online — may be a more accessible starting point.
3. Respite Is Not Indulgence — It Is Necessary
The research measured ‘socialisation’ as simply going out for enjoyment. Yet this modest-sounding factor was a consistent predictor of better psychological outcomes. Respite — time away from caregiving responsibilities — is not a luxury. It is a legitimate and evidence-supported component of sustainable care.
LGBTQIA+ individuals may face particular barriers to accessing respite, including discomfort with mainstream services and the absence of legal frameworks that recognise their caregiving relationships. Advocating for welcoming, inclusive respite services, and for policy that recognises diverse caregiving relationships, is both a clinical and a social priority.
4. Moving Your Body Protects Your Mind
Physical activity meeting standard guidelines (150 minutes of moderate activity per week) was one of the clearest protective factors across both physical and psychological outcomes — and its benefits grew over time. For caregivers whose schedules and energy levels are already stretched, this finding is worth exploring.
Movement does not need to be elaborate or expensive. For example, walking, yoga, swimming, or dancing — whatever a person enjoys and can sustain — appears to offer meaningful protection against the wellbeing decline that sometimes accompanies long-term caregiving.
A Note on Internalised Stigma
One of the most impactful findings in this research is the role of internalised identity stigma — negative feelings directed at one's own LGBTQ identity — as a predictor of lower psychological wellbeing.
For many older LGBTQIA+ adults, decades of social and legal marginalisation have left their mark not just externally but internally and psychologically. The shame or discomfort that may have been absorbed during formative years does not always dissolve when society changes. It can continue to shape how an individual relates to themselves, their relationships, and their willingness to seek help.
Therapeutic work that is affirming and culturally informed for individuals in the LGBTQIA+ community can be a way of exploring how to untangle what was learned from what feels authentic to you.
Caring for Others Matters — So Does Getting Support Yourself
At Upside Stories, we support individuals approaching midlife and beyond who are in caregiving roles, with a personal focus on the LGBTQIA+ community (meet our clinical psychologist, Bruce). If this article resonated with you, please reach out for a free 20-minute consultation to see if we’re a good fit for you.
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References & reading
Fredriksen-Goldsen, K., Jen, S., Emlet, C. A., Kim, H.-J., & Jung, H. H. (2023). Key determinants of physical and psychological health-related quality of life over time among midlife and older LGBTQ and sexual and gender-diverse caregivers. The Gerontologist, 63(4), 751–761. https://doi.org/10.1093/geront/gnac112
Fredriksen-Goldsen, K. I., Kim, H.-J., Barkan, S. E., Muraco, A., & Hoy-Ellis, C. P. (2013). Health disparities among lesbian, gay, and bisexual older adults: Results from a population-based study. American Journal of Public Health, 103(10), 1802–1809. https://doi.org/10.2105/AJPH.2012.301110
Fredriksen-Goldsen, K. I., Simoni, J. M., Kim, H.-J., Lehavot, K., Walters, K. L., Yang, J., Hoy-Ellis, C. P., & Muraco, A. (2014). The Health Equity Promotion Model — Reconceptualization of lesbian, gay, bisexual, and transgender (LGBT) health disparities. American Journal of Orthopsychiatry, 84(6), 653–663. https://doi.org/10.1037/ort0000030
Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97–109. https://doi.org/10.1037/A0012844
Knauer, N. (2016). LGBT older adults, chosen family, and caregiving. Journal of Law and Religion, 31(2), 150–168. https://doi.org/10.1017/jlr.2016.23
Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583
