Frailty over the rainbow: a cross-sectional study on LGBT+ adults over fifty

Abstract

Abstract Background Frailty is associated with several adverse outcomes in older adults, including functional dependency, hospitalizations, and death. However, it has not been determined whether older LGBT + individuals are at a higher risk of frailty than the overall population. Therefore, we aimed to investigate the prevalence of frailty in older LGBT + adults, comparing them with heterosexual-cisgender individuals. Methods A cross-sectional study involving Brazilians aged 50 and over was performed. They were invited to answer an anonymous online-based survey between August 2019 and January 2020. The survey was widely distributed in neighborhood associations, day centers, non-governmental organizations, and social media. Participants were encouraged to forward information about the study to their contacts. Those who identified as homosexual, bisexual, pansexual, non-heterosexual, transgender, travesti, or non-binary were grouped as LGBT+; cisgender and heterosexual participants as non-LGBT+. Frailty was measured using the FRAIL scale, and participants were categorized as robust, prefrail, or frail. We used generalized ordered logistic models to examine the adjusted association between being LGBT + and frailty, according to age group and sex. Results We included 6,693 participants with a median age of 60 years. Overall, 1332 were LGBT+ (19.9%), and 5361, non-LGBT+ (80.1%). Pre-frailty or frailty was found in 656 (49%) LGBT + participants and 2,460 (46%) non-LGBT + participants (p = .03). In our multivariable analyses, we found that being LGBT + was independently associated with frailty in female participants aged ≥ 50 years (OR = 1.52, 95%CI = 1.08–2.13, p = .02) and in male participants aged ≥ 60 years (OR = 2.83, 95%CI = 1.41–5.69, p = .004). Non-cisgender participants were also more likely to be frail than cisgender participants (OR = 2.21, 95%CI = 1.42–3.42, p < .001). Conclusion Being LGBT + was independently associated with frailty in female adults over 50 and males over 60. More research in this area and inclusive government policies are needed to promote healthy aging and address the needs of the LGBT + population.