Gay and lesbian aging.

Research on the lives and well being of older gay men and lesbians was virtually nonexistent 30 years ago. As such, information was based principally on anecdotal evidence, myth, and stereotype.

Unfortunately, this presumed knowledge was rooted in a culture of homophobia and reflected ideological beliefs that often labeled homosexuality as a form of evil, perversity, immorality; or illness. In fact, the American Psychiatric Association did not remove homosexuality as a form of mental illness from the Diagnostic and Statistical Manual until 1973.

Additionally, older gay men or lesbians suffered from another stigma in American society due to ageism. Thus, the persistent image was fostered of older gay men or lesbians as lonely, depressed, isolated, desperate, and sexless. (1) This image, however, does not hold up empirically.

Researchers and service providers are becoming increasingly aware that there exists a large population of older gay men and lesbians. According to Dawson, there were 3.5 million such individuals living within the United States in 1982. (2) This number has and will continue to grow as the older population as a whole is expected to double by the year 2030. (3)

INCREASED RESEARCH

Until the early 1970s, research on gay and lesbian aging was largely nonexistent. Only in the past two decades has this population become the focus of programmatic research and services developed to meet their needs.

It is worth noting, however, that those gays and lesbians who have been studied represent a select subpopulation: white, formally educated, urban, and upper middle class. In reality, older gay men and lesbians represent an unseen, highly diverse population found within all socioeconomic, geographic, educational, and ethnic backgrounds.

In addition, minimum age criteria used to define "old" in some research is as low as 40 years of age. Unfortunately, few studies solely examined individuals over 60 and ever fewer included the "oldest--old," those over 85 years of age. This becomes extremely important when considering the differences in culture and historical context experienced by individuals of different ages. (4)

Consider, for example, that those gays and lesbians now in their mid-sixties were in their mid-thirties at the time of the 1969 Stonewall riots and that the oldest-old were well into middle age. Today's older gay men and lesbians were either in middle or later adulthood at the start of the AIDS pandemic. In addition, those in their sixties or eighties each experienced different levels of discrimination, including potential psychiatric and religious persecution.

Thus, when evaluating research or providing services to older gay men or lesbians, it is imperative that one take into account the differences resulting from the historic and cultural context within which they developed.

Because of historical context, many very old gay men or lesbians have never self-defined themselves as homosexual. (5) For example, two women may have coupled and defined their relationship as roommates. Self-identification as gay men or lesbians was inhibited by the strong moral and social injunctions against homosexuality. In addition, the concept of "coming out" did not exist during their youth. Thus, the oldest gays and lesbians remain an extremely hidden population. Researchers will hopefully one day provide us with more information on this group as they undoubtedly have much insight to offer to younger gays and lesbians. It is unfortunate that so little is known about them, as these are the individuals who are today most likely in need of services and assistance.

GAY, NON-GAY AGING SIMILARITIES

There are vast similarities in aging between gay, lesbian, and heterosexual populations. Most factors related to aging, whether physical or societal, are the same for both.

When discussing how older gay men adapt to the aging process, Berger cites two individuals' responses: "Whether you are gay or straight doesn't make a difference. It's your attitude that makes the difference," and "Any person who hasn't adjusted well to other aspects of his life won't adjust well to aging, either. Being gay is just icing on the cake." (6)

Common concerns for older gay men and lesbians include age stigmatization, finances, health, fear of institutionalization, loneliness, and loss of a loved one. (7) These concerns also exist for heterosexuals.

While many aspects of aging appear universal, research on gay and lesbian aging has demonstrated specific positive and negative effects. Several are discussed below

GAY AND LESBIAN AGING

Gays and lesbians have usually experienced the stigma of homosexuality before they experience the stigma of being old. Those who have positively dealt with the former will likely experience the latter with less difficulty. By overcoming the stigma related to homosexuality, they will usually develop greater self--acceptance and the self--confidence necessary to overcome age--related stigmas. (8)

Research on overcoming stigma of homosexuality. In 1973, Francher and Henkin were the first to hypothesize that successful adaptation to--and coping with--life in a homophobic culture provides useful psychological and interpersonal skills to use later in life. (9) Other researchers have since expanded this concept.

For example, Kimmel hypothesized that the identity process of "coming out" as a gay or lesbian builds unique ego strengths that are adaptive in life. (10) Similarly, Friend hypothesized the development of a "crisis competence," and Berger discussed "mastery of crisis." (11) Each postulated that prior successful management of the stress of coming out and self-identification as a gay man or lesbian builds strengths that could be used to adapt to future stresses, including those associated with aging.

Each of these theories operates on the assumption that adapting to a public gay identity and becoming involved in the gay community supports life satisfaction. Indeed, research by both Friend and Berger supports such an hypothesis. (12) Research by Quam and Whitman also argues that gays need quality social support and need to be "out" in the gay community to have life satisfaction. (13)

It is important to note, however, that samples for these studies were drawn primarily from individuals actively involved in the gay community and gay friendships. Thus, the association between life satisfaction and public gay identity/community involvement may in some measure be a sampling artifact.

Other research on life satisfaction. Research conducted by Lee disputes the above conclusions. (14) His research identified three factors closely associated with successful aging--good health, social class advantage (influenced by wealth and education), and an "alliance with a significant other." He argues that successful adaptation in life and aging is not grounded in learning how to cope with crisis or stress but rather in knowing how to side--step crisis or stressors.

The above factors enable individuals to ameliorate and possibly avoid numerous difficulties in life. For many older homosexuals, the early decision not to publicly identify as a gay man or lesbian was highly functional. (15) It allowed them to avoid the stressors associated with living in the highly homophobic pre-Stonewall culture.

Research by Adelman found five factors associated with life satisfaction in older gay men and lesbians. (16)

These include:

* Highly perceived importance of a gay or lesbian identity

* Little disclosure of one's homosexuality at work

* Low involvement with other gays or lesbians

* Awareness of one's sexual orientation early in life

* Decreased saliency of one's homosexuality in later life

These factors appear to support Lee's work in the sense that while an older person's gay or lesbian identity is highly salient, it may also be highly private.

Less research on older lesbians. There is less research on older lesbians. Almvig found that most remain very private about their identities. In fact, most reveal their orientation only to a limited number of family and friends. Still, research appears to consistently demonstrate that they have a high degree of life satisfaction. (17)

Researchers have identified several factors related to older lesbians' life satisfaction. Adelman found that the largest determining factor was the degree of homophobia to which they were subjected both by others and within themselves. (18) Kehoe, in two separate studies, found that their greatest difficulties were health problems, finances, isolation and loneliness, and age-related problems. (19) Over half rated their mental health as good to excellent. Life satisfaction was consistently related to being physically and mentally healthy as well as having a positive identity as a lesbian.

General evidence of life satisfaction. Overall, this and other research, such as that conducted by Kelly, has found evidence of high levels of life satisfaction among older gay men and lesbians. (20) The factors and underlying rationales associated with this finding vary, which in part may be due to differences in sampling and cohort.

Bell and Weinberg found that lesbians and gay men were more likely than heterosexuals to have a network of close friends. (21) They postulate that heterosexuals are more likely to have family interactions rather than outside friendships. Krieger describes the lesbian community as a "haven in a hostile world." (22) Similarly, Berger states that "integration into a homosexual community is an important factor in the adaptation of older male homosexuals." (23)

Dorfman and colleagues found that older gay men and lesbians had the same level of social support as heterosexuals but that they received such support from different sources. (24) Similar to Bell and Weinberg, Dorfman found that gay men and lesbians primarily derived social support from friends and through alternative "friendship" families. Lesbians often maintained close friendships with former lovers and considered them part of this alternative family. Heterosexuals in the Dorfman study were found to receive social support primarily within traditional family structures.

Other concerns. Physical intimacy with a partner is still important for the majority of older gay men and lesbians. (25) Most report a continuing satisfaction with this aspect of their lives. Difficulties associated with sexual functioning and intimate relationships due to physical changes, psychological expectations about "performance," menopause, or loss of a partner parallel those experienced by older heterosexuals. (26)

Most older adults find it difficult to communicate with physicians and therapists about sexual matters. However, the older gay or lesbian also has to contend with the additional possibility of negative reactions due to both ageism and homophobia. (27)

Retirement for the gay man or lesbian may have positive benefits. While in the work force, many constantly face the threat of job loss on the basis of their sexual orientation. Many find that retirement gives them the opportunity to become more socially and politically involved because disclosure of their sexual orientation is unlikely to affect their financial livelihood.

The research on coping, life satisfaction, and social support refutes the image of the older gay man or lesbian as isolated and depressed. It is important to remember, however, the sampling problems associated with this research. Thus, different results and conclusions may apply to ethnic minorities, rural, or poor older gay men and lesbians.

Erwin argues that the research findings paint too rosy a picture of life for older gay men and lesbians. (28) He points to differences between gays/lesbians and heterosexuals in suicide rates, depression, and substance abuse throughout the lifespan as evidence of his concerns. Dorfman and colleagues, however, found no differences in instances of clinical depression (approximately 15 percent) between older gay men/lesbians and heterosexuals. (29)

Many of the negative consequences related to being an aging gay man or lesbian are also related to the negative aspects of being gay or lesbian at any point across the lifespan. For example, those who accept negative stereotypes about gays or lesbians have a more difficult time adjusting to their own sexual orientation. (30) This is true for both older gay men and lesbians.

AGING CONCERNS

Many of the concerns experienced by older gays and lesbians, such as finances and health, are similar to those experienced by heterosexuals. (31) Ageism is also a common concern that has a negative impact on both groups.

Ageism may, however, include two unique issues for older gay men and lesbians. First, Baron and Cramer report that gay men usually experience "accelerated aging" and see themselves as old at an earlier age than heterosexuals. (32) Bennett and Thompson asked gay men what age they thought other gay men perceived as the beginning of middle and old age. (33) The respondents believed that others thought middle age began on average at 39 and that old age began at 54. These are substantially lower than the norms for heterosexuals.

Other researchers found no differences between heterosexuals and gays/lesbians when respondents were asked at what age they saw themselves at the beginning of middle and old age. (34) Harry argued that "accelerated aging" may be more indicative of mid-life crisis than self-perception of premature aging. (35)

The issue of accelerated aging relates to a second concern about gay and lesbian communities. That is the expansion of an orientation toward youth. (36) Thus, older adults who may have previously found a role as friend or mentor to younger individuals may find themselves excluded. (37) These concerns need more exploration and research.

Health care discrimination. The health care system has proved traditionally unresponsive in recognizing the existence of gays and lesbians in terms of providing quality health care. (38)

Health care services are aimed at a heterosexual population, and individuals who have disclosed their identity as gay or lesbian have experienced varying levels of discrimination, including both failure to treat an illness and abuse. (39) Quam and Whitford describe a woman who was afraid to tell her physician that she was a lesbian because he might decide to provide her with little or no care. (40) Her inability to communicate honestly with her doctor could only have a negative impact on her treatment. Research has also shown that many lesbians simply avoid seeing a health care professional altogether. (41)

Gay and lesbian partnerships are often not recognized, even though individuals may have lived together for many years. Many partners are not allowed to visit their loved ones in the hospital, not allowed to participate in their health care decisions, or not welcome in long-term care facilities. (42) This can have a tremendously painful effect.

Housing discrimination. Many older gay men and lesbians are concerned about housing. They wish to live in communities that are predominately homosexual, or at least sensitive to the needs of the older gay man or lesbian. A study by White demonstrated that middle-aged lesbians hope for an "Old Dykes Home" when they reach their older years. (43)

Such options are not, however, currently available. And if such facilities are opened in the future to accommodate the baby boomers, many older gays and lesbians with limited incomes will likely not be able to afford them.

Legal planning. It is imperative that all gays and lesbians engage in active legal planning for their future. (44) Documents such as personal wills, medical powers of attorney, and nominations for guardianship/conservatorship need to be in good legal order to avoid assaults by family members, the health care industry, and the government. (45)

As gay and lesbian relationships are not legally sanctioned, the law does not recognize them in terms of health care directives, inheritances, and other related matters. It is important for gays and lesbians to work with an attorney who has experience meeting the unique needs of such clients. For example, an attorney unfamiliar with these needs might not think to include certain funeral specifics in a personal will, and the surviving partner could find himself or herself excluded from funeral arrangements or even barred from the funeral itself. (46)

Therapy. For the most part, older gays and lesbians are thought to be more reluctant to seek therapy than their heterosexual counterparts, even though many of the problems for which both seek assistance are similar. Issues that frequently bring older gays or lesbians to a therapist include relationship difficulties, bereavement issues, work worries, and financial stress. (47) The fear of discrimination and homophobia does, however, inhibit individuals from seeking help when needed. (48)

It is imperative that therapists be aware of internalized homophobia and provide an environment sensitive to their gay and lesbian clients. Simple things like limited marital status categories on intake forms can send an implicit message to clients about a therapist's acceptance of gays and lesbians before the therapist has even had the opportunity to meet the potential client. (49)

It is also important for therapists to examine their ideological perspectives about gays and lesbians. For example, as noted previously, there are cohort differences--particularly between those cohorts who identified themselves as gay or lesbian prior to the Stonewall riots and those cohorts who came after. These two groups may have very different perspectives related to being "out" and toward involvement in the gay or lesbian community. Therapists should respect these different perspectives. (50)

They should also consider that many gay men prefer to participate in psychotherapy groups that are not mixed in terms of sexual orientation. (51) Groups composed of both gay and heterosexual men may prove problematic due to homophobia.

MEETING NEEDS

To meet the needs of older gays and lesbians, several communities across the country have formed support groups. Senior Action in a Gay Environment (SAGE) (www.sageusa.org), in New York City, was formed to meet the needs of older individuals involved in the gay or lesbian community as well as to serve as an outreach program to others. (52) Its programs are a model for community efforts that recognize and provide services to the gay and lesbian population, ranging from socialization to home visits to shut-ins. Gay and Lesbian Outreach to Elders (GLOE), located in San Francisco, has similar programs. (53)

For many older gay men and lesbians, the Internet has opened the door to numerous opportunities for connection, community, and information. Lesbian and Gay Aging Issues Network (www.asaging.org), a constituent group of the American Society on Aging, and Senior Pride Network (www.pridesenior.org) both have extensive Web sites with resources and links for older gays or lesbians.

The Gay and Lesbian Association of Retiring Persons (GLARP) (www.gaylesbianretiring.org) provides an alternative to other related organizations that may not recognize or work for the needs of older gay men and lesbians.

These programs and Internet resources may not be available to poor and non-urban older gays and lesbians. Thus, programs and services are still needed to reach these and other disenfranchised gay and lesbian populations.

CONCLUSION

Empirical research demonstrates that the image of the older gay or lesbian as lonely, isolated, depressed, and sexless is, indeed, a myth. Most enjoy a high level of satisfaction in their lives, have unique coping skills which can facilitate the aging process, receive good social support from a community of friends (and, to a lesser extent, traditional family), and worry about and have difficulties with issues that impact almost all people who are aging.

The difficulties uniquely experienced by older gays and lesbians are largely the result of living with and facing discrimination. (54) Therefore, people need to address, in part through policy and legislation, the removal of discriminatory barriers and difficulties. Finally, they need to develop more programs and services across the country to meet the needs of older gays and lesbians.

REFERENCES

(1.) M. Ehrenberg, "Aging and Mental Health: Issues in the Gay and Lesbian Community," in X. Alexander, editor, Gay and Lesbian Mental Health: A Sourcebook for Practitioners (New York: Hayworth Press, 1996).

(2.) K. Dawson, "Serving the Older Gay Community," SIECUS Report, vol. 17, pp. 5-6.

(3.) A Profile of Older Americans, 2000 (Administration on Aging, U.S. Department of Health and Human Services).

(4.) G. J. McDougall, "Therapeutic Issues with Gay and Lesbian Elders," Clinical Gerontologist, 1993, vol. 14, pp. 45-57.

(5.) A. Baron and D.W Cramer, "Potential Counseling Concerns of Aging Lesbian, Gay, and Bixexual Clients," in R. M. Perez, K. A. DeBord, and K. J. Bieschke, editors, Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (Washington, DC: American Psychological Association, 2000).

(6.) R. Berger, Gay and Gray: The Older Homosexual Man (Urbana-Champaign, IL: University of Illinois Press, 1982).

(7.) J. Kelly, "The Aging Male Homosexual: Myths and Reality," The Gerontologist, 1977, vol. 17, PP. 328-32; K. J. Quam and G. S. Whitford, "Adaptation and Age-related Expectations of Older Gay and Lesbian Adults," The Gerontologist, 1992, vol. 32, pp. 367-74; J. D. Reid, "Development in Late Life: Older Lesbian and Gay Lives," in A. R. D'Augelli and C. J. Patterson, editors, Lesbian, Gay, and Bisexual Identities over the Lifespan (New York: Oxford University Press).

(8.) R. M. Berger and J.J. Kelly, "Working with Homosexuals of the Older Population," Social Casework, vol. 67, pp. 203-10.

(9.) J. S. Francher and J. Henkin, "The Menopausal Queen: Adjustment to Aging and the Male Homosexual," American Journal of Orthopsychiatry, vol. 43, pp. 670-4.

(10.) D. C. Kimmel, "Adult Development and Aging: A Gay Perspective," Journal of Social Issues, vol. 34, pp. 113-30.

(11.) R. A. Friend, "Gayaging: Adjustment and the Older Gay Male," Alternative Lifestyles, vol. 3, pp. 231-48.

(12.) R. A. Friend, "Older Lesbian and Gay People: A Theory of Successful Aging," in J. A. Lee, editor, Gay Midlife and Maturity (New York: Hayworth Press, 1991); R. Berger, Gay and Gray: The Older Homosexual Man.

(13.) K. J. Quam and G. S. Whitford, "Adaptation and Age-related Expectations of Older Gay and Lesbian Adults," The Gerontologist, vol. 32, pp. 367-74.

(14.) J. A. Lee, "What Can Homosexual Aging Studies Contribute to Theories of Aging?" Journal of Homosexuality, vol. 13, pp. 43-71.

(15.) J. Grube, "Natives and Settlers: An Ethnographic Note on Early Interaction of Older Homosexual Men with Younger Gay Liberationists" in J. A. Lee, editor, Gay Midlife and Maturity (New York: Hayworth Press, 1991).

(16.) M. Adelman, "Stigma, Gay Lifestyles, and Adjustment to Aging: A Study of Later-life Gay Men and Lesbians," Journal of Homosexuality, vol. 20, pp. 7-32.

(17.) C. Almvig, The Invisible Minority: Aging and Lesbianism (New York: Utica College of Syracuse University, 1982).

(18.) M. Adelman, Long Time Passing: Lives of Older Lesbians (Boston: Alyson, 1986).

(19.) M. Kehoe, "Lesbians over Sixty-Five: A Triple Invisible Minority," Journal of Homosexuality, vol. 12, pp. 139-52; M. Kehoe, "Lesbians over Sixty Speak for Themselves," Journal of Homosexuality, vol. 16, pp. 1-111; 5. Deevey, "Older Lesbian Women: An Invisible Minority," Journal of Gerontological Nursing, vol. 16, pp. 35-9.

(20.) J. Kelly, "The Aging Male Homosexual: Myths and Reality," The Gerontologist, vol. 17, pp. 328-32.

(21.) A. P. Bell and M. S. Weinberg, Homosexualities: A Study of Diversity among Men and Women (New York: Simon & Schuster, 1978).

(22.) S. Kreiger, "Lesbian Identity and Community: Recent Social Science Literature," Signs, vol. 8, pp. 91-108.

(23.) R. Berger, Gay and Gray: The Older Homosexual Man.

(24.) R. Dorfman, K. Walters, et al., "Support in the Aging Process for Gays and Lesbians," Journal of Gerontological Social Work, vol. 24, pp. 29-44.

(25.) J. Kelly, "The Aging Male Homosexual: Myths and Reality," The Gerontologist, vol. 17, pp. 328-32.

(26.) R. A. Friend, "The Individual and Social Psychology of Aging: Clinical Implications for Lesbians and Gay Men," Journal of Homosexuality, vol. 14, pp. 307-31.

(27.) A. P. Haas, "Lesbian Health Issues: An Overview," in A. J. Dan, editor, Refraining Women's Health: Multidisciplinary Research and Practice (Thousand Oaks, CA: Sage, 1994).

(28.) K. Erwin, "Interpreting the Evidence: Competing Paradigms and the Emergence of Lesbian and Gay Suicide as a Social Fact," International Journal of Health Services, vol. 23, pp. 437-53.

(29.) R. Dorfman, K. Walters, et al., "Support in the Aging Process for Gays and Lesbians," Journal of Gerontological Social Work, vol. 24, pp. 29-44.

(30.) S. Rice and J. Kelly, "Choosing a Gay/Lesbian Lifestyle: Related Issues of Treatment Services," in C. S. Chilman, E. W Nunnally, and F. M. Cox, editors, Variant Family Forms (Newbury Park, CA: Sage, 1988).

(31.) R. M. Berger and J. J. Kelly, "Gay Men and Lesbians Grown Older," in R. P. Cabaj and T. S. Stein, editors, Textbook of Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, 1996).

(32.) A. Baron and D. W Cramer, "Potential Counseling Concerns of Aging Lesbian, Gay, and Bisexual Clients;' in R. M. Perez, K. A. DeBord, and K. J. Bieschke, editors, Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (Washington, DC: American Psychological Association, 2000).

(33.) K. C. Bennett and N. L. Thompson, "Accelerated Aging and Male Homosexuality: Australian Evidence in a Continuing Debate," in J. A. Lee, editor, Gay Midlife and Maturity (New York: Hayworth Press, 1991).

(34.) F. Minnigerode, "Age Status Labeling in Homosexual Men," Journal of Homosexuality, vol. 1, pp. 273-5; M. R. Laner, "Growing Older Male: Heterosexual and Homosexual," The Gerontologist, vol. 17, pp. 328-32.

(35.) J. Harry, Gay Children Grown Up, (New York: Praeger, 1982).

(36.) J. Grube, "Natives and Settlers: An Ethnographic Note on Early Interaction of Older Homosexual Men with Younger Gay Liberationists" in J. A. Lee, editor, Gay Midlife and Maturity (New York: Hayworth Press, 1991); M. S. Weinberg and C. J. Williams, Male Homosexuals: Their Problems and Adaptations (New York: Oxford University Press, 1974); J. A. Lee, "What Can Homosexual Aging Studies Contribute to Theories of Aging?," Journal of Homosexuality, vol. 13, PP. 43-71.

(37.) J.A. Lee, "What Can Homosexual Aging Studies Contribute to Theories of Aging?," pp. 43-71.

(38.) M. Poor, "The Older Lesbian," in M. Cruikshank, editor, Lesbian Studies (Old Westbury NY: Feminist Press, 1982); R. A. Friend, "The Individual and Social Psychology of Aging: Clinical Implications for Lesbians and Gay Men," Journal of Homosexuality, vol.14, PP. 307-31.

(39.) A. P. Haas, "Lesbian Health Issues: An Overview' in A.J. Dan, editor, Refraining Women's Health: Multidisciplinary Research and Practice (Thousand Oaks, CA: Sage, 1994); A. Banks and N. K. Gartrell, "Lesbians in the Medical Setting," in R. P. Cabaj and T. S. Stein, editors, Textbook of Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, 1996).

(40.) K. J, Quam and G. S. Whitford, "Adaptation and Age-related Expectations of Older Gay and Lesbian Adults," The Gerontologist, vol. 32, PP. 367-74.

(41.) A. P. Haas, "Lesbian Health Issues: An Overview," in A.J. Dan, editor, Refraining Women's Health: Multidisciplinary Research and Practice (Thousand Oaks, CA: Sage, 1994); A. Banks and N. K. Gartrell, "Lesbians in the Medical Setting," in R. P. Cabaj and T. S. Stein, editors, Textbook of Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, 1996).

(42.) A. P. Haas, "Lesbian Health Issues: An Overview"; R. M. Berger and J. J. Kelly, "Gay Men and Lesbians Grown Older," in R. P. Cabaj and T. S. Stein, editors, Textbook of Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, 1996).

(43.) H. Waite, "Lesbians Leaping Out of the Intergenerational Contract: Issues of Aging in Australia," Journal of Gay and Lesbian Social Services, vol. 3, pp.109-27; A. Baron and D. W. Cramer, "Potential Counseling Concerns of Aging Lesbian, Gay, and Bisexual Clients," in R. M. Perez, K.A. DeBord, and K.J. Bieschke, editors, Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (Washington, DC: American Psychological Association, 2000).

(44.) J. D. Reid, "Development in Late Life: Older Lesbian and Gay Lives," in A. R. D'Augelli and C.J. Patterson, editors., Lesbian, Gay, and Bisexual Identities over the Lifespan (New York: Oxford University Press); R. A. Friend, "The Individual and Social Psychology of Aging: Clinical Implications for Lesbians and Gay Men," Journal of Homosexuality, vol. 14, pp. 307-31.

(45.) P. L. Ettelbrick, "Legal Issues in Health Care for Lesbians and Gay Men," in K.J. Peterson, editor, Health Care for Lesbians and Gay Men: Confronting Homophobia and Heterosexisim (New York; Harrington Park Press, 1996); A. Baron and D. W. Cramer, "Potential Counseling Concerns of Aging Lesbian, Gay, and Bisexual Clients," in R. M. Perez, K.A. DeBord, and K.J. Bieschke, editors, Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (Washington, DC: American Psychological Association, 2000).

(46.) D. C. Kimmel, "Adult Development and Aging: A Gay Perspective," Journal of Social Issues, vol. 34, pp. 113-30.

(47.) J. B. Bradford, C. Ryan, et al., "National Lesbian Health Care Survey: Implications for Mental Health Care," Journal of Consulting and Clinical Psychology, vol. 62, pp. 228-42.

(48.) M. Ehrenberg, "Aging and Mental Health: Issues in the Gay and Lesbian Community," in C. Alexander, editor, Gay and Lesbian Mental Health: A Sourcebook for Practitioners (New York: Hayworth Press, 1996).

(49.) R. M. Berger and J. J. Kelly, "Gay Men and Lesbians Grown Older' in R. P. Cabaj and T. S. Stein, editors, Textbook of Homosexuality and Mental Health (Washington, DC: American Psychiatric Press, 1996).

(50.) A. Baron and D.W. Cramer, "Potential Counseling Concerns of Aging Lesbian, Gay, and Bisexual Clients," in R. M. Perez, K. A. DeBord, and K. J. Bieschke, editors, Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (Washington, DC: American Psychological Association, 2000); R. Dorfman, K. Walters, et al., "Support in the Aging Process for Gays and Lesbians ,"Journal of Gerontological Social Work, vol. 24, pp. 29-44.

(51.) J. C. Frost, "Group Psychotherapy with the Aging Gay Male: Treatment of Choice," Group, vol. 21, PP. 267-85; B. Ratigan, "Working with Older Gay Men," in D. Davies and C. Neal, editors, Pink Therapy: A Guide for Counsellors and Therapists Working with Lesbian, Gay, and Bisexual Clients (Philadelphia: Open University Press, 1996).

(52.) M. Grenwald, "The SAGE Model for Serving Older Lesbians and Gay Men," Journal of Social Work & Human Sexuality, vol. 2, PP. 53-61.

(53.) S. Goldberg, "GLOE: A Model Social Service Program for Older Lesbians," in M. Adelman, editor, Longtime Passing: Lives of Older Lesbians (Boston: Alyson, 1986).

(54.) J. D. Reid, "Development in Late Life: Older Lesbian and Gay Lives," in A. R. D'Augelli and C.J. Patterson, editors, Lesbian, Gay, and Bisexual Identities over the Lifespan (New York: Oxford University Press).