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Research · for LGBTQ+ older people's organisations

LGBTQ+ Older People: Living Alone, Health Gaps and Fears About Care

Published 2026-10-16

In the countries that collect the data, LGBTQ+ older people are more likely than other people their age to live alone, report higher rates of disability, poor mental health and memory worries, and many fear discrimination from the services they will rely on as they age. In Canada, half of 2SLGBTQ+ adults aged 65 and over live alone, against under a third of other people the same age[1].

Today’s LGBTQ+ older people grew up and came of age when same-sex relationships were criminalised or treated as illness in many countries, and when being openly trans could cost a job, a home or a family. Many built their lives around chosen family, friends and partners rather than children, and many spent decades deciding, room by room, whether it was safe to be themselves. Those histories do not disappear at 65. They shape who is there to help when health changes, how people feel about a doctor’s waiting room or a care worker at the door, and whether they are counted at all in the statistics that services are planned from. This study brings together the best available evidence, from several countries, on how aging affects LGBTQ+ people, and says plainly where that evidence is thin.

51%of 2SLGBTQ+ adults aged 65 and over in Canada lived alone, against 30% of other people the same age (Canadian Community Health Survey, 2019 to 2021)[1]
0.37%of people aged 75 and over in England and Wales identified as lesbian, gay, bisexual or another minority sexual orientation in the 2021 Census, against 6.91% of those aged 16 to 24[2]
15.7%of sexual and gender minority adults aged 45 and over in 25 US states reported subjective cognitive decline, against 10.5% of other adults the same age (2015 to 2018)[3]

Older LGBTQ+ people are among the least counted groups in the population

Many countries do not yet ask about sexual orientation or gender identity in their census or national surveys at all. Where they do, the picture of later life is partial. In England and Wales’ 2021 Census, around 1.5 million people, 3.2% of those aged 16 and over, identified as lesbian, gay, bisexual or another minority sexual orientation (LGB+), while 7.5% did not answer the voluntary question[4]. The share fell with each older age group, from 6.91% of people aged 16 to 24 to 0.37% of those aged 75 and over[2].

Share of people identifying as lesbian, gay, bisexual or another minority sexual orientation, England and Wales, Census 2021In England and Wales in 2021, 6.91% of people aged 16 to 24 identified as LGB+, against 3.2% of everyone aged 16 and over and 0.37% of people aged 75 and over.0%2%4%6%8%Aged 16 to 246.91%All aged 16 and over3.2%Aged 75 and over0.37%
Self-reported answers to a voluntary census question; 7.5% of people aged 16 and over did not answer. A lower share among older people reflects willingness to disclose as well as identity. Source: ONS, Sexual orientation: age and sex, Census 2021 and ONS bulletin.

The same gradient appears elsewhere. In Gallup’s 2024 telephone surveys of 14,162 US adults, 9.3% identified as LGBTQ+, but only 1.8% of Americans born before 1946 did[5]. Canada’s 2021 Census counted 100,815 transgender or non-binary people, 0.33% of the population aged 15 and over; among people aged 65 and over, the figure was 1 in 700[6]. In England and Wales, 262,000 people (0.5%) reported a gender identity different from their sex registered at birth, figures the Office for National Statistics publishes as “official statistics in development”[7].

These lower figures in later life should not be read simply as fewer LGBTQ+ older people. People who spent most of their lives when disclosure carried real risks may be less willing to tell a government survey. Even so, the numbers are not small: AARP, citing the Movement Advancement Project, puts the number of LGBT adults over 50 in the United States at more than 2.4 million[8]. Because so few national ageing studies record sexual orientation or gender identity, much of what follows comes from the United States, Canada and England, and from purpose-built surveys rather than official statistics.

Higher rates of disability, poor mental health and memory worries in later life

The largest population-based studies of LGBTQ+ older people come from US health surveys that ask about sexual orientation. Using Washington State’s Behavioral Risk Factor Surveillance System from 2003 to 2010, with a sample of 96,992 adults, researchers found that lesbian, gay and bisexual older adults had a higher risk of disability, poor mental health, smoking and excessive drinking than heterosexual adults the same age, after adjusting for other factors. Lesbian and bisexual older women also had higher risks of cardiovascular disease and obesity[9].

A national analysis of the US National Health Interview Survey for 2013 and 2014, covering adults aged 50 and over, found a similar pattern. Lesbian, gay and bisexual older adults had higher rates of a weakened immune system and of low back or neck pain; sexual minority older women had higher rates of arthritis, asthma, heart attack, stroke and poor general health; and sexual minority older men had higher rates of angina and cancer. Disability and mental distress were higher too[10].

Transgender older people face some of the widest gaps. In a US survey of 2,560 LGBT adults aged 50 and over, transgender participants had a significantly higher risk of poor physical health, disability, depressive symptoms and perceived stress than cisgender LGBT participants. The factors that explained most of the gap were stigma and victimisation, alongside fear of accessing health services and a lack of social support[11]. Later work from the same Aging with Pride study found that lifetime experiences of violence remained a significant predictor of all three health outcomes it examined[12]. In other words, the evidence links these gaps to what people have been put through, not to who they are.

Memory is a concern too. Across 25 US states from 2015 to 2018, 15.7% of sexual and gender minority adults aged 45 and over reported subjective cognitive decline, against 10.5% of other adults the same age. Among those who reported it, 60.8% of sexual and gender minority adults reported functional limitations, against 47.8% of others[3]. Subjective cognitive decline is a person’s own report of worsening memory or thinking; it is not a diagnosis of dementia. In England, an analysis of the English Longitudinal Study of Ageing found no difference between sexual minority and heterosexual older adults in measured cognitive decline, but concluded that “poor mental health may represent the strongest driver of cognitive decline” among sexual minority older adults[13]. If so, mental health support is one of the most useful things services can offer. Our study of older people living with HIV covers a closely related group.

Subjective cognitive decline among adults aged 45 and over, 25 US states, 2015 to 201815.7% of sexual and gender minority adults aged 45 and over reported subjective cognitive decline, against 10.5% of other adults the same age. Among those with it, 60.8% against 47.8% reported related functional limitations.Sexual and gender minorityOther adults0%10%20%30%40%50%60%70%Reported subjectivecognitive decline15.7%10.5%Of those, with functionallimitations60.8%47.8%
Self-reported, Behavioral Risk Factor Surveillance System. Subjective cognitive decline is not a diagnosis of dementia. Source: Flatt et al., Alzheimer’s & Dementia: TRCI, 2021.

Half of 2SLGBTQ+ older Canadians live alone, and loneliness is linked to later depression

The clearest official figures on how LGBTQ+ older people live come from Canada. In the Canadian Community Health Survey for 2019 to 2021, 51% of 2SLGBTQ+ adults aged 65 and over lived alone, against 30% of non-2SLGBTQ+ adults the same age. The gap was widest for men: 52% of 2SLGBTQ+ men lived alone, against 21% of other men, and Statistics Canada notes that 2SLGBTQ+ men were twice as likely to live alone. Among women the figures were 49% and 38%[1].

Adults aged 65 and over living alone, Canada, 2019 to 2021Among Canadians aged 65 and over, 51% of 2SLGBTQ+ people lived alone against 30% of non-2SLGBTQ+ people; 52% of 2SLGBTQ+ men+ against 21% of other men; 49% of 2SLGBTQ+ women+ against 38% of other women.2SLGBTQ+Non-2SLGBTQ+0%20%40%60%All aged 65+51%30%Men (2SLGBTQ+ men+)52%21%Women (2SLGBTQ+ women+)49%38%
Canadian Community Health Survey, 2019 to 2021. “Men+” and “women+” include non-binary people to protect confidentiality. Source: Statistics Canada, Family and household characteristics of 2SLGBTQ+ people in Canada (2024).

Living alone is not the same as being lonely, and many people choose it. But it does mean fewer people close at hand when health changes, and it matters for how services assume care will be provided. Many health and care systems rely on a spouse or adult children to notice problems, arrange appointments and provide help at home. Our study of older people living alone looks at that wider picture.

Loneliness itself has been measured in England. In the English Longitudinal Study of Ageing, which follows adults aged over 50, 478 of 6,794 participants (7.0%) were classed as sexual minorities, on the basis of reported sexual behaviour. They reported more loneliness than heterosexual participants, and more depressive symptoms at the following wave; loneliness explained 15% of the association between sexual orientation and later depressive symptoms. The authors note that transgender older adults could not be included because of limited gender diversity in the study’s data[14].

Surveys of LGBTQ+ older people themselves point the same way. In AARP’s online Dignity 2022 survey of 2,004 LGBTQ adults aged 45 and over in the United States, fielded in November 2021, 52% said they felt left out, lacked companionship or felt lonely, and eight in ten said they were not sure they would have adequate family or social supports as they aged. Two-thirds believed they would need someone to provide care for them in the future, and 63% were already caring for a loved one; 64% of those carers said they were emotionally stressed[8]. LGBTQ+ older people, in other words, are not only people who need care. Many of them are carers, often for partners and friends whom formal systems do not always recognise.

Fear of discrimination shapes how LGBTQ+ older people approach health and care

For many LGBTQ+ older people, the prospect of needing care brings a particular worry: that accepting help will mean hiding who they are again. In AARP’s 2018 survey of LGBT adults in the United States, 52% said they feared discrimination in health care as they aged, nearly one-third of older LGBT adults were at least somewhat worried about having to hide their identity to get suitable housing, and 88% wanted staff in long-term care facilities to be specifically trained to meet LGBT people’s needs[15]. In the 2022 survey, 85% were concerned about discrimination based on sexual orientation, and nearly three-quarters feared it in buying a home[8].

These fears are grounded in experience. In the second LGBTI survey of the EU Agency for Fundamental Rights (FRA), analysed for older respondents by AGE Platform Europe and ILGA-Europe, 10.86% of older respondents reported discrimination in accessing health care or social services, and older LGBTI people were twice as likely as LGBTI respondents of all ages to have experienced violence in a healthcare setting. The published analysis does not state the age threshold used for “older”[16].

Long-term care is where the evidence is most consistent. A systematic review of 19 studies found that long-term care providers often “lack knowledge and training on LGBT health issues”, and that LGBT people “fear discrimination from providers in LTSS” (long-term services and supports)[17]. In a 2014 survey of 189 care home staff in England, two-thirds said there was not a single resident in their home who was openly lesbian, gay, bisexual or trans, almost 80% said they had never been provided with any training in LGBT issues at their current workplace, and only 9% said their home made LGBT-specific literature available. The researchers warned that failing to recognise LGBT residents was likely to “force residents back into the closet”[18]. Our study of dementia and care homes covers care home life more widely.

The same pattern reaches the end of life. In a UK study of 40 LGBT people facing advanced illness, researchers found that “experiences of discrimination and exclusion in health care persist for LGBT people”, and that earlier experiences of discrimination or violence were “carried into future care interactions and heightened with the frailty of advanced illness”[19]. A scoping review of UK evidence on LGBT people aged 50 and over, which found 48 papers from 42 studies, shows how small this evidence base still is[20].

What the evidence asks of us

The figures point to a few clear priorities for governments, statistics offices, health and care services, regulators and funders.

  • Count LGBTQ+ older people. The UN Decade of Healthy Ageing (2021–2030) says that “data must be produced and disaggregated to better understand issues affecting their health and well-being”, and that “older people are not a homogeneous group”[21]. National ageing studies and health surveys should ask about sexual orientation and gender identity in ways that older people can answer safely, and publish results by age. Without that, transgender older people in particular remain almost invisible in the data[14].
  • Train the care workforce. When almost 80% of care home staff in one English survey said they had never been provided with any training in LGBT issues at their current workplace[18], and 88% of LGBT adults in a US survey wanted trained long-term care staff[15], the gap is plain. Training, inclusive policies and visible signs of welcome are the responsibility of providers and commissioners, not of residents.
  • Plan for people without a spouse or children to call on. With half of 2SLGBTQ+ older Canadians living alone[1], services that assume a relative will coordinate care will miss people. Recognising chosen family, friends and partners as carers and next of kin is part of the answer.
  • Treat mental health and loneliness as core health care. Loneliness is linked to later depression in sexual minority older adults[14], and poor mental health may be the strongest driver of their cognitive decline[13]. LGBTQ+-affirming social and mental health support is prevention.
  • Make end-of-life care safe to be open in. UK research with LGBT people facing advanced illness set out ten recommendations for health professionals and services[19]; services should not leave people to choose between honesty and good care at the end of life.

Language: this piece says “older people” rather than “the elderly”, and uses “LGBTQ+ older people” (lesbian, gay, bisexual, trans, queer and other people of minority sexual orientation or gender identity), a term widely used by organisations working with and led by this group. Where a source uses its own term, such as LGB+, LGBT, LGBTI, 2SLGBTQ+ (which in Canada includes Two-Spirit people) or “sexual and gender minority”, we keep it, because each describes who that study actually counted.

Why we're publishing this

We compiled this evidence because LGBTQ+ older people, and the organisations that work alongside them, deserve the research in one place, cleanly sourced and ready to put in front of a minister, a commissioner, a care provider or a journalist. This generation lived through criminalisation, stigma and, for many, the AIDS crisis, and helped win the rights younger people now take for granted. They should not have to hide again to get good care. The case here is theirs; our part is to set out what the data show and to say where the data are missing.

How to read this data

The census figures from England and Wales and from Canada are official statistics based on voluntary questions answered by individuals; England and Wales’ gender identity figures are “official statistics in development”. Lower shares in older age groups reflect willingness to disclose as well as identity. The Canadian living-alone figures come from a national health survey. The US health findings come from population surveys (the Behavioral Risk Factor Surveillance System and the National Health Interview Survey) that compare people by self-reported sexual orientation, mostly from 2003 to 2018; they show associations, not causes, and are based on abstracts where full texts were not open. The English Longitudinal Study of Ageing analyses classed sexual minority status by reported sexual behaviour. AARP’s surveys and the FRA survey are large, but they are not random samples of all LGBTQ+ older people; AARP notes that its participants publicly identify as LGBTQ and that its results may under-represent people who are not open. The 2014 English care home figures come from a university summary of a staff survey. Evidence on trans, non-binary, intersex and bisexual older people, on LGBTQ+ older people of colour, and on low- and middle-income countries is thin. Figures from different countries, years and methods are not directly comparable.

Use this data

Free to cite with attribution to Understanding Aging. LGBTQ+ older people’s organisations, charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Suggested citation: Understanding Aging (2026). LGBTQ+ Older People: Living Alone, Health Gaps and Fears About Care. https://understandingaging.org/research/lgbtq-older-people

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.

Sources

  1. Statistics Canada. Family and household characteristics of 2SLGBTQ+ people in Canada (infographic, Canadian Community Health Survey 2019–2021). Statistics Canada, 2024. www150.statcan.gc.ca/n1/pub/11-627-m/11-627-m2024046-eng.htm
  2. Office for National Statistics. Sexual orientation: age and sex, England and Wales: Census 2021. ONS, 2023. ons.gov.uk/…/sexualorientationageandsexenglandandwales/census2021
  3. Flatt JD, Cicero EC, Lambrou NH, Wharton W, Anderson JG, Bouldin ED, McGuire LC, Taylor CA. Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015–2018. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 2021. europepmc.org/article/MED/34337136
  4. Office for National Statistics. Sexual orientation, England and Wales: Census 2021. ONS, 2023. ons.gov.uk/…/sexualorientationenglandandwales/census2021
  5. Gallup. LGBTQ+ identification in the U.S., 2024 telephone surveys. Gallup, 2025. news.gallup.com/poll/656708/lgbtq-identification-rises.aspx
  6. Statistics Canada. 2021 Census of Population: transgender and non-binary people. The Daily, 27 April 2022. www150.statcan.gc.ca/n1/daily-quotidien/220427/dq220427b-eng.htm
  7. Office for National Statistics. Gender identity, England and Wales: Census 2021. ONS, 2023. ons.gov.uk/…/genderidentityenglandandwales/census2021
  8. AARP Research. Dignity 2022: The Experience of LGBTQ Older Adults. AARP, 2022. aarp.org/research/topics/life/info-2022/lgbtq-community-dignity-2022.html
  9. Fredriksen-Goldsen KI, Kim HJ, Barkan SE, Muraco A, Hoy-Ellis CP. Health disparities among lesbian, gay, and bisexual older adults: results from a population-based study. American Journal of Public Health, 2013. europepmc.org/article/MED/23763391
  10. Fredriksen-Goldsen KI, Kim HJ, Shui C, Bryan AEB. Chronic health conditions and key health indicators among lesbian, gay, and bisexual older US adults, 2013–2014. American Journal of Public Health, 2017. europepmc.org/article/MED/28700299
  11. Fredriksen-Goldsen KI, Cook-Daniels L, Kim HJ, Erosheva EA, Emlet CA, Hoy-Ellis CP, Goldsen J, Muraco A. Physical and mental health of transgender older adults: an at-risk and underserved population. The Gerontologist, 2014. europepmc.org/article/MED/23535500
  12. Fredriksen-Goldsen K, Prasad A, Kim HJ, Jung H. Lifetime violence, lifetime discrimination, and microaggressions in the lives of LGBT midlife and older adults: findings from Aging with Pride. LGBT Health, 2023. europepmc.org/article/MED/37754926
  13. Manca R, Flatt JD, Venneri A. Differential impact of risk factors for cognitive decline in heterosexual and sexual minority older adults in England. Brain Sciences, 2025. europepmc.org/article/MED/39851457
  14. Wright T, Solmi F, Ajnakina O, Ingram E, Kandola A, Lee S, Iob E, Steptoe A, Thomas B, Lewis G. The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: a prospective cohort study. Journal of Affective Disorders, 2024. europepmc.org/article/MED/38593941
  15. AARP. Majority of LGBT adults concerned about social support and discrimination in long-term care (Maintaining Dignity survey). AARP, 2018. aarp.org/press/releases/2018-3-26-majority-lgbt-adults-concerned-social-support-discrimination-long-term-care.html
  16. AGE Platform Europe. Intersections: diving into the FRA LGBTI II survey data – older people. AGE Platform Europe and ILGA-Europe, 2023. age-platform.eu/intersections-diving-into-the-fra-lgbti2-survey-data-older-people
  17. Caceres BA, Travers J, Primiano JE, Luscombe RE, Dorsen C. Provider and LGBT individuals’ perspectives on LGBT issues in long-term care: a systematic review. The Gerontologist, 2020. europepmc.org/article/MED/30726910
  18. University of Nottingham. Back in the closet: LGBT people in England’s care homes (Almack K, Simpson P). University of Nottingham, 2014. nottingham.ac.uk/news/pressreleases/2014/march/back-in-the-closet-lgbt-people-in-englands-care-homes.aspx
  19. Bristowe K, Hodson M, Wee B, Almack K, Johnson K, Daveson BA, Koffman J, McEnhill L, Harding R. Recommendations to reduce inequalities for LGBT people facing advanced illness: ACCESSCare national qualitative interview study. Palliative Medicine, 2018. europepmc.org/article/MED/28502218
  20. Kneale D, Henley J, Thomas J, French R. Inequalities in older LGBT people’s health and care needs in the United Kingdom: a systematic scoping review. Ageing & Society, 2021. europepmc.org/article/MED/34531622
  21. World Health Organization. UN Decade of Healthy Ageing (2021–2030). WHO. who.int/initiatives/decade-of-healthy-ageing