LGBTQ+ Older People and Dementia: More Memory Problems, Far Too Little Data

Lesbian, gay, bisexual, transgender and queer (LGBTQ+) adults in midlife and later life report more memory and thinking problems than their heterosexual and cisgender peers in every large US survey we found. Whether they are more likely to develop dementia is still largely unknown, because we found no country that routinely records sexual orientation or gender identity alongside a dementia diagnosis.

Behind the gap in the data is a generation that grew up when, in many countries, their relationships were against the law or treated as an illness. Many built lives around partners the law did not recognise and friends who became family. Dementia tests those arrangements: who is told about a diagnosis, who is treated as next of kin, and whether a care home is somewhere a person can go on being themselves. This piece sets out what the research shows, and how thin it is.

The evidence is thin because the data are not collected

How many LGBTQ+ people are living with dementia? We could not find any country that publishes an answer. Dementia is counted through health and care records, which rarely hold a person’s sexual orientation or gender identity. Counts of LGBTQ+ people come from censuses and surveys, and they show how hard the oldest generations are to see.

In the 2021 census of England and Wales, around 1.5 million people (3.2%) identified with a lesbian, gay, bisexual or other minority sexual orientation, while 3.6 million (7.5%) did not answer the question^[4]. On gender identity, 262,000 people (0.5%) said their gender was not the same as their sex registered at birth, and 6.0% did not answer; the Office for National Statistics now labels these gender identity figures “official statistics in development” because of uncertainty about them^[5]. In the US, Gallup found that 9.3% of adults identified as LGBTQ+ in 2024, but only 1.8% of those born before 1946^[6]. Lower figures among the oldest people may partly reflect a lifetime of having to hide.

Health services have tools to record this. NHS England’s Sexual Orientation Monitoring information standard, published in October 2017, gives a consistent way to record the sexual orientation of patients aged 16 and over, but in its own words it “does not mandate a collection”^[7]. So nearly everything known comes from research surveys, most of them in the US.

LGBTQ+ adults report more memory and thinking problems in every large US survey we found

The strongest evidence concerns subjective cognitive decline: people’s own reports that their memory or thinking has got worse. It is not a dementia diagnosis, but it can be an early sign. In the US Behavioral Risk Factor Surveillance System, weighted to represent adults aged 45 and over in 25 states in 2015–2018, 15.7% of sexual and gender minority adults reported subjective cognitive decline against 10.5% of everyone else. Among those reporting it, 60.8% of sexual and gender minority adults said it limited their daily activities, compared with 47.8%^[1].

Other national surveys point the same way. In the US National Health Interview Survey (2013–2018, ages 45+), 24.5% of sexual minority adults reported subjective cognitive impairment, against 19.1% of heterosexual adults, and they were no more likely to put the problems down to dementia^[8]. A follow-up analysis found the gap held after accounting for psychological distress, and was significant for sexual minority women but not for men^[9]. A separate analysis of 172,047 respondents to the surveillance system in 2015–2019 found self-reported cognitive decline in 15% of sexual minority men and 17% of sexual minority women, against 11% of heterosexual men and of heterosexual women^[10].

The picture is sharper for transgender people, especially where racism and transphobia meet. Using the same survey for 2015–2020, one study found subjective cognitive decline in 21.6% of transgender adults aged 45+ from minoritised ethnic and racial groups, 15.0% of White transgender adults, 12.0% of cisgender adults from minoritised groups and 9.0% of White cisgender adults^[11]. After adjustment, transgender adults from minoritised groups had 2.51 times the odds of White cisgender adults; White transgender adults had 1.66 times the odds^[11].

Outside the US the evidence is sparse. The one large English study we found, using the 2007 Adult Psychiatric Morbidity Survey (7,400 adults of all ages), linked a minority sexual orientation with 1.40 times the odds of concentration complaints, but the difference in memory complaints (odds ratio 1.19) was not statistically significant^[12]. That survey is now nearly two decades old.

Why might these gaps exist? The studies point to depression and the stresses of discrimination. In the 25-state US analysis, the difference shrank once depression was taken into account^[1]. In a US community sample of 210 LGBT adults aged 50 and over, nearly 25% were classed as having subjective cognitive decline, linked among other things to depression^[13]. Among 115 transgender and nonbinary adults aged 50+ in the US PRIDE Study, nearly 16% rated their memory as poor or fair, and those who had faced discrimination in medical settings had 4.5 times the odds of reporting that their memory was getting worse^[14]. These cross-sectional associations cannot show cause, but they fit a picture in which minority stress, depression and poorer access to care travel together.

For tested impairment and diagnosed dementia, the findings are fewer and more mixed

Fewer studies have used cognitive tests or clinical diagnoses, and they do not all agree. In the 2024 scoping review of 15 studies, seven of the eight using self-reports found higher rates in some minority groups. Of the seven using objective measures, three looked at clinician-recorded dementia diagnoses, and two of those found higher rates among transgender than cisgender people; of the other four, two found poorer cognitive performance or memory, one better and one no difference. The reviewers judged most studies at moderate to critical risk of bias^[2].

The All of Us estimate, the largest we found, has a confidence interval running down to 1.00, so it is consistent with anything from no difference to a modest one^[17]. The study that found no difference relied on volunteers at US research centres and inferred sexual orientation from who a participant’s study partner was, which its authors note may have biased the result^[16]. Among transgender adults, the Florida records showed higher rates of 11 of 13 dementia risk factors than in matched cisgender adults^[18], and a 2019 US survey analysis found higher late-life Alzheimer’s disease risk scores among transgender men, transgender women and non-binary adults^[19]. Risk scores are not diagnoses, and none of these studies can say how many LGBTQ+ people will develop dementia.

Partners and chosen family carry much of the care, often without recognition

One Health and Retirement Study finding speaks to recognition. Most of the higher risk among same-sex couples was explained by marital status: 72.98% of same-sex partners in the sample were cohabiting rather than legally married, against 5.42% of different-sex partners, and cohabiting people of any orientation had higher odds of cognitive impairment (odds ratio 1.53)^[3]. The authors conclude that tackling societal homophobia among older adults is a step toward reducing the risk^[3].

Who is there to help also differs. Canada’s national dementia strategy notes, citing earlier research, that LGBT people are twice as likely to live alone and three to four times less likely to have children, which may limit their support^[20]. In a 2017 AARP survey of 1,762 LGBT Americans aged 45 and over, 46% of gay men lived alone, compared with 36% of lesbians, and three in four were concerned about having enough support from family and friends as they age^[21]. Help does not always follow: in the 2015–2019 US surveillance data, sexual minority women were 22% more likely than heterosexual women to report difficulties with everyday tasks because of cognitive decline, but 17% less likely to receive any social support^[10]. (See also living alone with dementia.)

Care often comes from partners, friends and chosen family. In the largest survey of sexual and gender minority carers of people with dementia we found, 286 US carers recruited online, most were gay men, the largest group were caring for a spouse or partner, and one in five cared for a transgender person^[22]. Stress, stigma and microaggressions were linked to carers’ depressive symptoms^[22]; transgender carers reported poorer health than cisgender carers^[23]. In Australian interviews with LGBT people living with dementia, partners and service providers, some families of origin and services did not understand or value a person’s sexual orientation or gender identity, and that fear of discrimination led people to rely more on their partners for care, deepening isolation^[24]. A 2022 international review of 20 articles highlighted “families of choice” and barriers including negative staff attitudes and carers’ reluctance to seek support^[25]. Services built around spouses and adult children can miss these carers; our study of unpaid carers sets out how little support reaches carers in general.

Many fear having to hide who they are to get care, and services are not yet ready

Dementia often brings people into home care and care homes, where they depend on staff for the most personal help. In AARP’s 2017 survey, just under half of lesbian, gay and bisexual respondents, and 70% of transgender and gender-expansive respondents, were concerned about being “forced to hide one’s identity as a condition of receiving care”; 88% said they would feel more comfortable with providers specifically trained in LGBT patients’ needs^[21].

Canada’s dementia strategy cites a survey in which 23% of transgender people had not seen a doctor or sought medical care for fear of being mistreated, and notes concerns about stigma in long-term care homes^[20]. A 2024 scoping review of sexual and gender minority older adults with dementia in residential care found that, although they need more long-term care services, they are less likely to use them, partly through fear of discrimination^[26]. A survey of 829 transgender and gender-diverse adults, mostly in the US and Canada, found anticipated discrimination among the main worries about later-life care^[27].

Services show a gap between good will and readiness. When 105 US dementia care providers rated themselves on a seven-point scale, their affirming attitudes were very high (average 6.67), but their knowledge (5.32) and clinical preparedness (4.93) were only moderate^[28]. In an interview study published in 2025, LGBTQ+ people with cognitive impairment and their carers described feeling left “on the margins” of dementia care and wanting their identities recognised and celebrated^[29]. For people whose memories are changing, not having to explain a partner, a past or a gender again and again is part of good care. See also dementia in care homes.

What the evidence asks of us

The evidence is thin but consistent, and the people it describes cannot wait for a perfect dataset. Canada’s 2019 dementia strategy names LGBTQ2 individuals among the groups at higher risk of dementia or facing barriers to equitable care, and notes evidence that lesbian, gay and bisexual adults may experience delays in dementia diagnosis and difficulty finding support because of stigma and social marginalisation^[20]. The evidence suggests what recognition should lead to:

• Count people. Health and care systems that hold dementia data can record sexual orientation and gender identity, voluntarily and safely, using standards that already exist, such as NHS England’s, which does not currently require collection^[7]. Researchers have called for sexual minority status questions in dementia research and surveillance^[16], and for long-term studies that use objective measures of cognition^[2].
• Train staff. Reviews of carers’ and residents’ experiences repeatedly call for inclusion training for dementia and long-term care staff and for inclusive organisational policies^[25][26], and the gap between providers’ attitudes and their knowledge suggests where to start^[28].
• Recognise partners and chosen family. Carer assessments and information-sharing should treat partners, friends and chosen family as the carers they are, whatever their legal status. Researchers on transgender later life recommend helping people record advance wishes, including how their gender is to be affirmed if they lose capacity^[27].
• Close the support gap. Where LGBTQ+ people report the same or greater cognitive difficulty but receive less help, as sexual minority women did in US data^[10], home and community support needs to be explicitly affirming and actively offered.

None of this treats LGBTQ+ people with dementia as a problem. It asks services to stop the gap in data, training and recognition from deciding who gets good care. See also the dementia research library and our study of ethnicity and dementia.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

LGBTQ+ people living with dementia, and the partners, friends and chosen families who care for them, are among the least visible people in dementia statistics. Organisations making the case for inclusive services often rely on scattered studies; we have brought the main ones together, with their limits stated. The case is theirs; we hope this makes it easier to put.

How to read this data

Most figures here come from US surveys of people aged 45 or 50 and over, in which people report their own sexual orientation, gender identity and memory or thinking problems. Subjective cognitive decline and impairment are self-reported, not diagnoses, and surveys use different questions, so their percentages are not directly comparable. Studies of same-sex couples infer sexual orientation from a partner’s sex, which misses single people and bisexual people in different-sex relationships. Odds ratios are reported as “times the odds”, not risk. Nearly all studies are cross-sectional, showing associations, not causes. Evidence from the UK, Canada and Australia is mostly qualitative or from small samples, and we found no national dementia statistics broken down by sexual orientation or gender identity.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

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