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EV0655

Gay and older: substance use patterns and minority stress among older LGBTQ+ adults

GAY AND GRAY: SUBSTANCE USE PATTERNS AND MINORITY STRESS AMONG OLDER LGBTQ+ ADULTS

Disparities in substance use among sexual and gender minority adults persist into later life, with adjusted odds ratios ranging from 1.6 to 3 compared with heterosexual peers.

The study aims to map the evidence on the intersection of minority stress, aging, and substance use patterns among sexual and gender minority (SGM) adults. Its rationale is that, despite high rates of substance use and mental illness among SGM adults, this group is underrepresented in aging research, while adults aged 50 and older face chronic illness, prescription medication use, and social isolation in addition to lifelong minority stress. The study is a scoping review involving a thematic examination of 13 studies selected through searches of five databases up to March 15, 2026; data were extracted on geography, substances, mental health outcomes, and population subgroups. Of the studies, 92% originated in North America, and only 1 of the 13 studies (reported as a proportion below 1%) focused on gender-diverse older adults; the numbers of studies by substance examined were 9 for alcohol, 5 for tobacco, 4 for cannabis, 4 for prescription opioids, 4 for illicit substances, 3 for stimulants, 2 for sedatives, and 2 for cocaine. The findings indicate that accumulated discrimination predicted tobacco use disorder, with the strongest association observed among those aged 65 and older, and that enacted stigma was associated with event-level alcohol use; bisexual women had the highest levels of cannabis and opioid misuse, and bisexual veterans had a threefold higher risk of opioid misuse. In contrast, older LGBT veterans reported lower alcohol use and greater identity centrality than their younger peers, and disparities in alcohol use disorder (AUD) narrowed after age 50. Across studies, adjusted odds ratios for substance use in this cohort ranged from 1.6 to 3 compared with heterosexual peers. The review concludes that substance use disparities persist into later life, compounded by aging-related comorbidities; that transgender older adults, racially diverse subgroups, and populations outside the United States are severely underrepresented; that nearly half of the studies share the same data source, limiting the diversity of the evidence base; and that a global cohort infrastructure is needed to understand SGM substance use across cultures and health systems.

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