Comparisons of Daily Functioning and Cognition in Sexual Minority and Non-Sexual Minority Older Adults

Introduction: Sexual minority (SM) refers to those who identify as lesbian, gay, bisexual, queer, or other sexual identities that are non-heterosexual (non-SM). Minority-related stressors can impact later life health outcomes. However, SM-based differences in cognitive and functional impairment remain understudied. Few studies have considered genetic risk factors for cognitive decline when investigating SM-related differences in cognition and functioning. This study examined differences between SM and non-SM adults in 1) instrumental activities of daily living (IADLs), and 2) cognition and tested if these relationships were moderated by apolipoprotein e4 (APOE4; a genetic risk factor for Alzheimer's disease) status.

Methods: Participants included in Aims 1 and 2 completed a sexual identity question. Aim 1: Participants included 11,012 adults (M age = 70.05 years, SM = 411) from the 2022 Health and Retirement Study (HRS). IADLs were assessed with a 5-item scale. Logistic regressions tested the associations between SM status (SM vs. non-SM) with IADL limitations (absent, present). Analyses included unadjusted, adjusted (controlling for age, sex, race, and Hispanic heritage), and exploratory (additionally controlling for marital status, income, insurance status, education, and depression scores) models. Aim 2: 7,726 HRS participants (M age = 68.92 years, SM = 293) completed the Telephone Interview for Cognitive Status. Linear regressions tested differences in cognition by SM status. As in Aim 1, models had the same sets of covariates. APOE4 status was tested as a moderator in adjusted models for both aims.

Results: SM participants were more likely to report IADL limitations and scored lower on cognition tests overall compared to non-SM individuals; these associations were attenuated by socioeconomic status and depressive symptoms. The main association of APOE4 and its interaction with SM status was not significantly associated with any outcomes in Aims 1 or 2.

Discussion: SM older adults may experience heightened odds for functional and cognitive decline. Importantly, results indicate that differences may be more attributable to socioeconomic and psychosocial factors. Future studies should investigate other potential factors that contribute to functional and cognitive differences between SM and non-SM older adults and identify protective factors that promote resilience.