Dissertations & Theses (Open Access)

Date of Award

Spring 5-7-2021

Degree Name

Doctor of Philosophy in Nursing (PhD)


Rebecca Casarez, PhD

Second Advisor

Angela Nash, PhD

Third Advisor

J. Michael Wilkerson, PhD


Background: Lesbian, gay, and bisexual (LGB) adults, 50 and older, are likely to have experienced mistreatment and discrimination, contributing to poor physical and mental health and risky behaviors, such as alcohol misuse. Few studies have examined the relationships between perceived health, psychological distress, functional impairment, and alcohol use of older LGB adults and heterosexuals.

Specific Aims: The specific aims were: (1) to determine if perceived overall health status is associated with psychological distress and functional impairment in sexual minority older adults compared to heterosexual older adults, and (2) to determine if sexual minority status moderates the relationship between psychological distress and alcohol misuse.

Methods: This study is a secondary analysis of a retrospective cross-sectional design using data from the 2017-2018 National Survey on Drug Use and Health (NSDUH). Health outcomes among LGB older adults (n=462) 50 years or older were compared with heterosexual (n=16,855) peers using univariate analyses and logistic regressions. Interaction terms evaluated the influence of sexual orientation on psychological distress and alcohol consumption. Outcomes included perceived overall health, functional impairment, psychological distress, and alcohol misuse.

Results: There was no statistical difference in perceived health status between older LGB adults and older heterosexual adults. After adjusting for confounders, the findings support that older LGB adults are more likely to experience functional impairment than their heterosexual cohorts (B = -.125, SE = .038, p = .001, 95% CI [-.200, -.050]). The study did not show that older LGB adults had worse health status and psychological distress compared to older heterosexual adults. Older heterosexual adults were less likely to consume alcohol than older LGB adults. Sexual orientation did not moderate the relationship between psychological distress and the different alcohol use patterns.

Conclusion: Future research should examine the underlying causes of impaired health in the older LGB population and utilize those findings to conduct research to prevent and minimize psychological distress and functional impairment. Older LGB adults should be screened for functional impairment and mental health issues, including alcohol so that appropriate referrals and/or treatments can be initiated.


sexual minority, LGB, older adults, psychological distress, functional impairment, perceived health status, alcohol

Included in

Nursing Commons



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