Unmet health and social service needs in LGBTQ+ older adults in California: a quantitative analysis of a large community-based sample

BackgroundLGBTQ+ older adults experience substantial unmet health and social service needs, yet little is known about whether chronological age is independently associated with unmet need or primarily reflects broader structural vulnerability. We examined the association between age and unmet health and social service needs among LGBTQ+ older adults using the Equitable Aging in Health Framework.MethodsWe conducted a cross-sectional analysis of 3,713 LGBTQ+ adults aged 50 years and older participating in California’s first statewide survey of LGBTQ+ older adults. Any unmet health and social service need during the previous 12 months was the primary outcome. Sequential multivariable logistic regression models evaluated the association between chronological age and unmet need after adjustment for intersecting positionalities, social and political determinants of health, domains of power, and health status. Missing covariate data were addressed using multiple imputation by chained equations. Adjusted predicted probabilities and sensitivity analyses were also performed.ResultsOverall, 36.6% of participants reported at least one unmet health or social service need. Greater chronological age was associated with lower odds of unmet need in unadjusted analyses [odds ratio (OR) per 10-year increase, 0.90; 95% confidence interval (CI), 0.83–0.97; p = 0.008], but this association was no longer statistically significant after full adjustment (OR, 1.08; 95% CI, 0.98–1.19; p = 0.100). Financial insecurity, transportation barriers, poorer physical health, depression, HIV-positive status, housing instability, caregiving support needs, lifetime trauma, and race and ethnicity remained associated with unmet need after multivariable adjustment, while chronological age did not.ConclusionChronological age was a relatively weak marker of unmet health and social service need among LGBTQ+ older adults, when considering broader social, structural, and health-related factors. Findings from one of the first quantitative applications of the Equitable Aging in Health Framework suggest that social and structural conditions may provide a more informative basis for understanding vulnerability than age alone, supporting more equitable approaches to aging policy, service delivery, and future research.