Associations Between Sexual Orientation and Self-Perceptions of Aging: The Withering Role of Stress

Abstract

The study objective was to investigate the differences between sexual minority and heterosexual individuals on multiple dimensions of self-perceptions of aging (SPA) and examine the mediating role of stress. In the nationally representative German Ageing Survey, 257 sexual minority individuals were matched one-to-two with heterosexual individuals based on their age (mean 72 years) and sex (45% women). Cross-sectional linear regression and mediation models were estimated. Sexual orientation was not significantly associated with felt age or age-related perceived physical losses, personal growth, and self-knowledge. However, sexual minority individuals reported lower positive attitudes towards own aging (ATOA, Standardized β = −0.13) and more social losses (β = 0.11) than heterosexual individuals and the differences were partially mediated by stress. Although causality cannot be inferred, higher stress may explain why sexual minority individuals experience less positive ATOA and more social losses. Interventions to reduce stress and improve SPA may help in supporting sexual minority individuals’ future wellbeing.

Keywords

sexual minorities gay lesbian bisexual felt age attitudes towards own aging age-related cognitions

Literature Review

Introduction

Time is a finite resource, and every human goal, whether it is towards learning, working, building relationships, or maintaining health, requires a discerning investment of time. While time is measured on a definitive metric, social norms and structures can influence how adequate and flexible one’s subjective experience of time is and who gets to use time for what (Colen et al., 2024). It is especially a salient concept in the aging process. As one nears death, the innate awareness of the passage of time and its effects on their aging bodies becomes increasingly stronger (Diehl et al., 2014). This awareness, referred to as Self-Perceptions of Aging (SPA), is an important indicator of future morbidity and mortality. People with more positive SPA tend to be healthier and live longer (Markides & Pappas, 1982; Westerhof et al., 2023).

Sexual minority individuals’ life time is often constricted and restricted due to the greater burden of disease, disability, and early death, which are largely driven by the stress experienced due to their minoritized social status (Fredriksen-Goldsen, Emlet, et al., 2013; Fredriksen-Goldsen, Kim, et al., 2013; Kasprowski et al., 2021; Zachry et al., 2025). A drawback of most past studies of sexual minority older adults is that they are purposive samples and have no heterosexual comparison groups within the same study. This study applies the stress process model to SPA in a German probability sample and explores if sexual minority individuals in the latter half of life have more negative SPA than their heterosexual age peers and if stress mediates the association. As a proximal indicator of aging outcomes, SPA can be potentially used in identifying sexual minority individuals at most risk of poor health and also act as a point of intervention to reduce health disparities (Zhu et al., 2024).

Self-Perceptions of Aging as a Psychological Resource for Successful Aging

SPA (sometimes referred to as Personal Views on Aging) is an overarching term encompassing the various concepts and dimensions of people’s awareness of their own aging and the changes they experience in several areas of their lives, including their social roles/relationships. Commonly used SPA measures are Felt Age (Barrett, 2003), Attitudes Towards Own Aging (Lawton, 1975), and Age-Related Cognitions (Steverink et al., 2001). Felt age measures how old individuals feel relative to their chronological age (Barrett, 2003). A younger felt age is generally interpreted as an indicator of positive SPA, whereas an older felt age is considered as an indicator of negative SPA. This is because whereas a younger felt age is generally associated with better physical and mental health and cognitive functioning over time, feeling as old as or older than one’s age is a predictor of poorer physical, mental, and cognitive health, and even of greater mortality risk (Shinan-Altman & Werner, 2019; Stephan et al., 2018; Westerhof et al., 2014). At the same time, it must be noted that feeling one’s age could also be interpreted as a sign of acceptance of one’s age and aging. In western countries, including Germany, the majority of individuals feel younger than their age (Pinquart & Wahl, 2021). Attitudes toward own aging comprise an explicit personal evaluation of age-related changes (Lawton, 1975). Attitudes towards own aging are typically heterogenous among middle-aged individuals, but their increasingly become more negative with the passage from young adulthood to very old age (80 years onwards) (Miche, Elsässer, et al., 2014). Finally, Age-Related Cognitions enable a multidimensional assessment of individuals’ age-related cognitions across four domains: physical losses, social losses, personal growth, and self-knowledge (Steverink et al., 2001). While positive age-related cognitions seem high across different age groups, physical and social losses increase with older age (Wurm et al., 2025).

According to Levy’s Stereotype Embodiment Theory and its hypothesized pathways (Levy, 2009), the widely reported association between more positive SPA and greater health and longevity may be due to individuals with positive SPA typically having more positive psychological resources such as greater self-efficacy (i.e., psychological pathway), being more likely to engage in healthy lifestyles such as doing physical exercise (i.e., behavioral pathway), and being less likely to experience negative physiological changes for instance related to inflammation (i.e., physiological pathway) than individuals with less positive SPA (Klusmann et al., 2012; Stephan et al., 2011, 2023). In contrast, people with negative SPA generally believe there is little to nothing they can do to influence the way they age. Because of this, they are less likely to engage in health-enhancing behaviors, putting themselves at greater risk of poorer health and illnesses (Blade et al., 2022; Jacobsen et al., 2023; Seau et al., 2023). In the United States alone, Levy and colleagues estimated that the annual healthcare expenditure due to negative SPAs is $33.7 billion (Levy et al., 2020). In summary, negative SPA have a detrimental effect not only on individuals' health and quality of life but also on the broader economy and society. Importantly, according to Levy’s Stereotype Embodiment Theory (Levy, 2009), negative SPA can be a direct consequence of negative views on aging and, once an individual reaches old age, these negative views about older people become internalized and self-relevant.

Self-Perceptions of Aging and Social Marginalization: Sexual Minority Individuals

Having widely reported the effects of SPA on people’s behaviors and health over the lifespan, researchers are interested in identifying groups of individuals who may be at a greater risk of negative SPA and, therefore, of poorer health. These individuals would be suitable candidates for available interventions aimed at promoting more positive SPA and, consequently, promoting better health and wellbeing in their middle-age and older years (Knight et al., 2021; Zhu et al., 2024). So far, empirical evidence suggests that disadvantaged groups based on gender, race, and socioeconomic status (i.e., women, racial and ethnic minority individuals, and individuals with lower socioeconomic status) are at greater risk of negative SPA (Barrett, 2003; English et al., 2019; Toothman & Barrett, 2011; Yan et al., 2011).

For example, some studies found that women have more negative SPA than men (Brothers et al., 2016; English et al., 2019; Miche, Wahl, et al., 2014), and this may be due to women being less socially valued as they age (Sontag, 1997). Toothman and Barrett (2011) found that racial and ethnic minority individuals see the life course as more compressed (i.e., they view life stages as occurring earlier) than do White individuals. Moreover, discrimination due to one’s ethnicity/race leads to more negative SPA (Han & Richardson, 2015). Another example is that lower education and poorer perceived financial well-being and socioeconomic status are associated with more negative SPA (Barrett, 2003; English et al., 2019).

Similarly, it may be that sexual minority individuals, as a result of their devalued social status in a heteronormative world, may report more negative SPA than heterosexual individuals, but this association remains understudied. In a representative sample of middle-aged Americans (Barrett & Barbee, 2021), sexual minority individuals felt less younger than their heterosexual peers, but the difference was not statistically significant in regression analysis. In the same study, the two subsamples also did not differ in their general views on aging, such as when middle age starts or ends, or in their retrospective and anticipated changes in their bodies (Barrett & Barbee, 2017). This may be due to the sample size being too small or because the study authors controlled for financial wellbeing and health, which as potential mediators may explain the association between sexual identity and SPA. In another purposive sample of middle-aged and older Americans as well there were no differences in age stereotypes and anxiety about aging, but sexual minority individuals were more concerned about their social needs in later life, such as feeling lonely, having nobody to care for, finding health and long term care providers that are inclusive, and having visitation and inheritance rights for their close relationships (Lytle et al., 2018). Using data from the German Ageing Survey, researchers have found that sexual minorities expected to live fewer years than heterosexual individuals (Hajek et al., 2023).

Stress Process Model and Self-Perceptions of Aging

Time is a fundamental and fixed resource that cannot be paused, stored, or manufactured. Age is nothing but a time stamp on a living body that has a clear and definitive closure in death. Being aware of one’s age and the aging process is the body’s mechanism for keeping track of the time remaining and driving decisions and actions toward optimizing life and health. Although time and chronological age are standardized metrics, their subjective experience, however, is highly malleable and amenable to psychosocial forces. The withering effect of stress observed on the human body is seldom applied to time perspective or SPA (Pearlin, 1989; Schafer & Shippee, 2010). Some preliminary studies have documented that greater stress is a predictor of more negative SPA in the general population of middle-aged and older individuals (O’Brien & Sharifian, 2019; Schafer & Shippee, 2010). Racial and ethnic minority individuals report more negative SPAs and their future time perspective to be more limited than white individuals (Han & Richardson, 2015; Toothman & Barrett, 2011).

Indeed, compared to heterosexual older adults, sexual minority older individuals experience greater prejudice, discrimination, stress, psychological distress, and mental health issues throughout their lives (Berger, 1984; Fredriksen-Goldsen, Emlet, et al., 2013; Heaphy et al., 2004; Kimmel, 1978). There is some evidence that compared to their heterosexual counterparts, sexual minority individuals report more negative SPA (Lytle et al., 2018) and also report significantly shorter remaining life expectancies (Hajek et al., 2023). Barrett and Barbee (2017) used the double jeopardy perspective to explain why sexual minority individuals may have more negative SPA than heterosexual individuals (Ehrenberg, 1997; Heaphy, 2007). They hypothesized that acquiring the devalued status of old compounds disadvantages associated with being sexual minority (i.e., more experiences of prejudice and discrimination stemming from one’s sexual identity) (Berger, 1984; Fredriksen-Goldsen, Emlet, et al., 2013), resulting in more negative experiences and perceptions of aging among sexual minority older adults compared to heterosexual older adults. Because of the greater experience of stress in sexual minority individuals, the possible effect of sexual identity over SPA may be at least partially due to (i.e., mediated by) sexual minority individuals being more likely to experience stress (Fredriksen-Goldsen, Emlet, et al., 2013).

Current Study

This cross-sectional study aims to compare sexual minority and heterosexual older adults in their scores on a range of measures of SPA, including felt age, attitudes towards own aging, and age-related cognitions. The study also aims to investigate the mediating role of stress in the association of sexual orientation with SPA. The study has four hypotheses. First, it is hypothesized that felt age differs between sexual minority and heterosexual individuals. However, we refrain from hypothesizing whether sexual minority individuals feel younger or older compared to heterosexual individuals. This is because while heightened stress may make sexual minority individuals feel older, they may put more effort into being perceived as younger (Kite et al., 2005) and for social acceptance (Suen, 2017). Second, it is hypothesized that sexual minority individuals have more negative attitudes towards own aging than heterosexual older adults.

Third, with regard to age-related cognitions, it is hypothesized that sexual minority individuals report more perceived physical losses and social losses compared to the heterosexual sample but that the two samples do not differ on the remaining subscales assessing perceived personal growth and self-knowledge. We expect differences in perceived physical losses because sexual minority individuals typically have poorer physical and mental health than heterosexual middle-aged and older adults (Bränström et al., 2016; Fredriksen-Goldsen, Kim, et al., 2013), and this may be reflected in how they perceive their physical body as aging. Similarly, it is hypothesized that sexual minority older adults report more perceived social losses than heterosexual older adults because empirical evidence has documented poorer social networks among sexual minority older adults (e.g., strained relationships, lack of acceptance) (Breder & Bockting, 2023; Torres & Lacy, 2021). Fourth, it is hypothesized that stress mediates, at least partially, the associations of sexual orientation with indicators of SPA.

Research Design

Data Source and Sample

The German Ageing Survey (Klaus et al., 2017) is an ongoing nationally representative cohort-sequential survey of community-dwelling Germans aged 40 years or older. The first assessment was conducted in 1996 and was repeated in 2002, 2008, 2011, 2014, 2017, 2020, and 2021. We used the most recent 2021 data collected from 5402 individuals, of which 257 identified as being sexual minority (homosexual, bisexual, or other). For the purpose of this study, the sexual minority individuals were matched one-to-two with 514 heterosexual individuals based on age and sex.

Measures

Sexual Identity Participants had four response options for the question “How would you describe your sexual orientation?”: heterosexual, homosexual, bisexual, or other. For the purpose of this study, the latter three options were categorized together as sexual minority individuals.

Felt Age was assessed with a single-item question asking survey respondents to write the age (in years) they feel most of the time. A proportional discrepancy score was calculated by subtracting respondents’ felt age from their chronological age and dividing this difference score by their chronological age (Pinquart & Wahl, 2021). It indicates the percentage by which one feels younger or older than their chronological age. Positive values indicate younger felt age, whereas negative values indicate older felt age. Felt age was specified as a continuous variable in the analyses.

Attitudes Towards Own Aging were assessed with the five items: “Things keep getting worse as I get older; I have as much pep as I did last year; As you get older, you are less useful; As I get older, things are better than I thought they’d be; I am as happy now as when I was younger.” (Lawton, 1975). For each item, respondents make temporal comparisons about whether things are better (coded as 1) or worse (coded as 0). An aggregate score was obtained by summing responses on the five items, with a score of 5 indicating all positive attitudes and 0 indicating all negative attitudes. In this study, the scale was treated as a continuous variable and had adequate to good internal reliability in the current study sample (Cronbach’s alpha = 0.78).

Age-Related Cognitions were assessed with four scales - perceived physical losses, perceived social losses, perceived personal growth, and perceived self-knowledge (Steverink et al., 2001). Each scale comprises four items starting with the stem “Aging means to me that…”. A sample item for each of the four respective scales are “…I am less energetic and fit; …I feel less needed; …I can still learn new things; …I know myself better.” Respondents rate each item from strongly disagree (1) to strongly agree (4), and the summed score of each scale can range from 4 to 16. Higher scores indicate more negative age-related cognitions on the physical losses and social losses scales but more positive age-related cognitions on the personal growth and self-knowledge scales. Cronbach’s alpha for the four scales are 0.79 (good internal reliability), 0.73 (adequate internal reliability), 0.80 (good internal reliability), and 0.62 (adequate internal reliability), respectively.

Stress was assessed with a four-item Perceived Social Stress (PSS) scale developed by Cohen et al. (1983). Based on the transactional model of stress (Lazarus & Folkman, 1984), PSS evaluates not just mere exposure to stress but the psychological appraisal of the extent to which stress overwhelms one’s coping resources. The four items are: “In the last month, how often have you felt that you were unable to control the important things in your life? How often have you felt confident about your ability to handle your personal problems? How often have you felt that things were going your way? How often have you felt difficulties were piling up so high that you could not overcome them?” Respondents answered each question on a 5-point Likert scale (1 = Never; 2 = Seldom; 3 = Sometimes; 4 = Often; 5 = Very often), positive items were reverse coded, and the scale was an average of the four items (range 1 to 5). Cronbach’s alpha for this scale in DEAS is 0.71 and in the current study sample is 0.67, indicating adequate internal reliability.

Sociodemographic Variables comprised age, sex at birth (male or female), and marital status (married, separated, divorced, widowed, single). Race/ethnicity was not included as a covariate because nearly all respondents identified as White. German education was categorized as follows: low (did not complete vocational or A-level qualifications); vocational (completed vocational or A-level qualifications); technical (obtained mastery of a craft or completed technical school); and university (possessed a university degree).

Analytical Strategy

Propensity score based on age and sex was used to match every sexual minority respondent with two heterosexual respondents in the dataset. Summary statistics of study variables were reported for sexual minority and heterosexual older adults. Chi-squared tests and analysis of variance tests (ANOVA) were used to compare study variables between sexual minority and heterosexual older adults. Unadjusted and adjusted (for age, sex, education, and marital status) linear regression models were used to compare scores on indicators of SPA (i.e., felt age, attitudes towards own aging, age-related cognitions) between sexual minority and heterosexual older adults. Sexual orientation (sexual minority older adults, heterosexual older adults) was used as the independent variable, and SPA indicators were used as dependent variables. There was no multicollinearity among independent and control variables (i.e., correlation coefficients below 0.60). For categorical correlates (sex, education, and marital status), the category chosen by most participants was used as the reference category.

For all analyses, a complete case analysis was conducted as the matched sample had no missing data. For those SPA indicators whose variance was significantly associated with sexual orientation, structural equation modeling was used to test the mediating role of stress in the cross-sectional association of sexual orientation with SPA. While longitudinal designs are recommended for mediation analysis, our ability to implement such an approach was limited by concerns about participant attrition over time, particularly given the already small subsample of sexual minority individuals in the dataset (German Ageing Survey). For the mediation models, we estimated the following goodness of fit statistics: Root mean squared error of approximation (RMSEA); Comparative fit index (CFI); Tucker–Lewis index (TLI). Standardized (β) regression coefficients were reported as indicators of the effect size. Standardized coefficients ≤ 0.09 were considered negligible, 0.10–0.29 as small, 0.30–0.49 as moderate, and ≥ 0.50 as large (Cohen, 1988). Analyses were conducted using STATA version 18.

Results

Descriptive Statistics and Groups Comparison

As shown in Table 1, sexual minority and heterosexual respondents both had a mean age of 72 years (Standard deviation, SD of 9.96 and 10.01, respectively), and about 45% were women. In both subsamples, the majority of individuals had either a vocational or university level education. Sexual minority respondents were less likely to be married (58.75%) than heterosexual respondents (67.37%). The sexual minority sample reported slightly but significantly more stress (M = 2.52; SD = 0.64) than heterosexual older adults (M = 2.35; SD = 0.63). Sexual minority and heterosexual respondents felt 9% and 10% younger than their chronological age, respectively, but the differences were not significant. Sexual minority respondents had significantly less positive attitudes towards own aging (M = 2.80; SD = 0.54) than heterosexual older adults (M = 2.95; SD = 0.53). Both samples reported more perceived physical losses (heterosexual individuals M = 11.04; SD = 2.14; sexual minority individuals M = 11.30; SD = 2.02) than perceived social losses (heterosexual individuals M = 7.18; SD = 2.15; sexual minority individuals M = 7.76; SD = 2.38). However, sexual minority respondents tended to report significantly more perceived social losses than heterosexual older individuals. The two samples reported experiencing similar levels of perceived personal growth (heterosexual individuals M = 11.44; SD = 2.30; sexual and gender minority individuals M = 11.16; SD = 2.14) and self-knowledge (heterosexual individuals M = 12.28; SD = 1.84; sexual minority individuals M = 12.22; SD = 1.75).

Table 1.

Descriptive Statistics for Sexual Minority and Heterosexual Older Adults

Variables	Range	Heterosexual (n = 514)	Sexual minority (n = 257)	p value	(η²)
Variables	Range	M (SD)/%	Sexual minority (n = 257)	p value	(η²)
Felt age	−1 to 1	0.10 (0.10)	0.09 (0.10)	.803	.01
ATOA	0 to 5	2.95 (0.53)	2.80 (0.54)	.001	.02
Perceived physical losses	4 to 16	11.04 (2.14)	11.30 (2.02)	.261	.003
Perceived social losses	4 to 16	7.18 (2.15)	7.76 (2.38)	.058	.01
Perceived personal growth	4 to 16	11.44 (2.30)	11.16 (2.14)	.181	.003
Perceived self-knowledge	4 to 16	12.28 (1.84)	12.22 (1.75)	.332	.0002
Stress	1 to 5	2.35 (0.63)	2.52 (0.64)	.0004	.02
Age in years	47 to 93	72.39 (9.96)	72.50 (10.01)	.936	0.0
Sex				.798
Women		44.55	45.53
Men		55.45	54.47
Education				.211
Low		03.26	05.81
Vocational		42.99	46.51
Technical		14.59	13.57
University		39.16	34.11
Marital status				.025
Married		67.37	58.75
Separated		1.34	1.17
Divorced		8.45	7.39
Widowed		16.70	20.62
Single		6.14	12.06

Note. N = 771. η² = Eta-squared. Sexual minority older respondents comprised those who reported being homosexual, bisexual, or “other.” The two samples were matched based on age and sex. For eta-squared, effect sizes between 0.01 and 0.05 are interpreted as small, between 0.06 and 0.13 are interpreted as moderate, and of 0.14 or above are interpreted as large (Cohen, 1988). ATOA – Attitudes Toward Own Aging.

Differences in the Self-Perceptions of Aging Between Sexual Minority and Heterosexual Older Adults

In the regression models (see Table 2; Supplemental Table 1), after adjusting for age, sex, education, and marital status, sexual minority respondents had more negative attitudes toward own aging than heterosexual respondents. The effect size was small (β = −0.13). Moreover, sexual minority respondents reported more perceived social losses than heterosexual older respondents. The size of this effect was also small (β = 0.11). After controlling for socio-demographic characteristics, sexual minority older adults reported feeling about 7 % standard deviations older compared to heterosexual older adults, but the p-value was below the conventional significance threshold. Sexual orientation was not significantly associated with perceived physical losses, perceived personal growth, and perceived self-knowledge. Supplemental Table 2 reports results for regression models with number of physical health conditions and number of important social contacts as additional covariates. However, these two variables may be in the causal pathway between sexual orientation and SPA. Hence, these results should be interpreted with caution.

Table 2.

Regression Models Demonstrating Differences in Self-Perceptions of Aging Reported by Sexual Minority Individuals With Reference to Heterosexual Older Individuals

Dependent variables	Regression models
	Unadjusted		Adjusted
	β	p	β	p	R² of variable	R² of full model
Felt age	−0.07	.046	−0.06	.083	0.004	0.02
Attitudes towards own aging	−0.14	.001	−0.13	.001	0.02	0.07
Perceived physical losses	0.06	.108	0.05	.208	0.002	0.04
Perceived social losses	0.12	.001	0.11	.002	0.01	0.04
Perceived personal growth	−0.06	.111	−0.05	.164	0.002	0.09
Perceived self-knowledge	−0.01	.685	−0.03	.468	0.001	0.03

Note. Adjusted models included age, sex, education, and marital status. β = Standardized regression coefficient. R² = Coefficient of determination.

Mediating Role of Stress in the Associations of Sexual Orientation with Attitudes Towards Own Aging and Perceived Social Losses

In the model adjusted for age, sex, education, and marital status, stress played a partially significant mediation role in the cross-sectional association of sexual orientation with attitudes towards own aging (direct effect β = −0.08: indirect effect β = −0.05) and perceived social losses (direct effect β = 0.08; indirect effect β = 0.04). For both sets of outcomes, the fit statistics indicate that the models fit the data well. More specifically, in the model with ATOA as outcome, RMSEA was 0.01 (90% CI: 0.01–0.09); CFI was 0.999; and TLI was 0.993. In the model with perceived social losses as outcome, RMSEA was 0.00 (90% CI: 0.00–0.06); CFI was 1.00; and TLI was 1.00. Effect sizes are moderate and a sizeable amount of outcomes’ variance is explained (R² of 0.31 and 0.22 for attitudes towards own aging and perceived social losses respectively). (see Figure 1).

Figure 1.

The mediating role of stress in the association of sexual orientation with attitudes towards own aging and perceived social losses.

Discussion

This study used cross-sectional data from the German Ageing Survey to compare SPA between sexual minority and heterosexual older adults and to investigate the mediating role of stress in the association of sexual orientation with SPA. Sexual minority individuals feel 7% less young than their chronological age compared to heterosexual individuals but the difference is not statistically significant. As hypothesized, sexual minority individuals had more negative attitudes towards their own aging and reported more perceived social losses compared to heterosexual older adults. Moreover, as expected, sexual minority and heterosexual older adults did not differ in perceived personal growth and self-knowledge. Contrary to the study hypothesis, sexual minority and heterosexual older adults did not differ in perceived physical losses. Finally, as expected and in line with previous evidence reporting higher burden among sexual minorities in Germany compared to heterosexual individuals (Kasprowski et al., 2021), Cohen’s (1988) measure of stress partially mediated the cross-sectional associations of sexual orientation with attitudes towards own aging and with perceived social losses. That is, sexual minority older adults experienced more stress, which, in turn, was associated with more negative attitudes towards own aging and more perceived social losses.

The finding that sexual minority older adults have more negative attitudes towards own aging than heterosexual older adults reflects more negative overall experiences of aging among sexual minority older adults (Fredriksen-Goldsen, Emlet, et al., 2013; Fredriksen-Goldsen, Kim, et al., 2013; Heaphy et al., 2004). As observed in a previous study (Barrett & Barbee, 2017), although the difference between sexual minority and heterosexual older adults was not statistically significant for felt age, sexual minority individuals felt less young than their chronological age than heterosexual individuals, suggesting a non-significant trend towards more negative SPA in sexual minority older adults. Feeling older than their chronological age aligns with the relatively compressed future time perspective expressed by sexual minority older adults, i.e., in the German Ageing Survey, they reported expecting to die earlier than their heterosexual peers (Hajek et al., 2023).

Results for the multidimensional scales assessing age-related cognitions made it possible to have a better understanding of the domains in which sexual minority older adults experience their own aging more negatively. More specifically, study results suggest that sexual minority older adults report of more negative experiences of aging may be associated with them experiencing more social losses. In contrast, they experience/perceive physical losses, personal growth, and self-knowledge similarly to heterosexual older individuals. In an earlier study too, compared to heterosexual older adults, sexual minority older adults reported more concerns about aging related to being socially isolated, lonely, and having no one to care for them in their older age (Lytle et al., 2018).

Higher levels of perceived social losses among sexual minority older adults may be due to several factors leading to social differences between sexual minority and heterosexual older people. First, sexual minority older adults are less likely to have children and hence to benefit from interactions with children and grandchildren, that are often a positive source of social engagement in older age (Bordone & Arpino, 2015). Second, sexual minority older adults may be at greater risk of losing social ties than heterosexual older adults, for example, due to family estrangement, moving from their hometowns to the safety and anonymity of bigger cities (Breder & Bockting, 2023; Keene et al., 2017; Torres & Lacy, 2021). Third, ageism may be particularly high among sexual minority older adults (Wight et al., 2015) and internalized homophobia and being in the closet may prevent opportunities to develop new friendships. In addition, social networks of sexual minority older adults are more friend focused. Unlike intergenerational family ties, age homophilous friend networks are more at risk of losses due to ill health, disability and death. Loss of friends, partners and community members due to HIV and elevated levels of suicide may also contribute to higher levels of perceived social loses among sexual minority individuals. The history of such losses may be a continued source of stress, challenging their sense of control over their social relationship and leading to more negative SPA. However, all these hypotheses should be directly tested with future research.

The finding that sexual minority and heterosexual older adults did not differ in perceived physical losses was unexpected as sexual minority older adults, including those living in Germany, typically have poorer physical health than heterosexual middle-aged and older adults (Bränström et al., 2016; Fredriksen-Goldsen, Kim, et al., 2013; Jacobsen et al., 2023; Kasprowski et al., 2021). Moreover, in the general population, poorer physical health is consistently associated with more negative SPA (Sabatini et al., 2020; Westerhof et al., 2023). However, in the current study sample sexual minority individuals did not have a higher number of health conditions than heterosexual individuals. Hence, lack of difference in objective physical health reflected by lack of differences in perceived physical health. Because the study analyses are based on a cohort study in which some respondents had been in the study for more than 10 years, it is possible that study respondents had better physical health and functioning than average sexual minority older adults. Few available studies that investigate the bidirectional associations between SPA and health have found that SPA is a stronger predictor of health rather than the opposite, which are likely not picked up by the cross-sectional nature of our study design.

The empirical literature has widely reported that sexual minority individuals experience higher psychological distress and subjective and objective discrimination than heterosexual individuals (Fredriksen-Goldsen, Emlet, et al., 2013; Hoy-Ellis & Fredriksen-Goldsen, 2016; Jackson et al., 2008). Lytle et al. (2018) reported that discrimination was associated with negative SPA among their sexual minority sub-sample. In our study sample too, sexual minority older adults scored higher on Cohen’s measure of stress than heterosexual individuals and higher stress, likely overwhelming their psychological coping resources, such as a sense of control or mastery, in turn, was associated with more negative attitudes towards own aging and more perceived social losses. Hence, despite the cross-sectional nature of this study and the need for further longitudinal evidence, based on the stress process model (Pearlin, 1989), the more negative attitudes towards own aging and greater perceived social losses among sexual minority older adults may be understood as the withering effect of stress and erosion of coping reserves. However, it is important to note that many factors could contribute to levels of stress in sexual minority individuals (including financial strain, experienced homophobia and transphobia), many of which were not assessed in this study and should be considered in future studies (Mays & Cochran, 2001; Nguyen et al., 2024).

One of the many avenues that could be pursued to reduce experiences of stress and discrimination among sexual minority individuals is to promote greater legal inclusion and social acceptance of sexual minority older adults. Indeed, evidence suggests that societies with greater legal inclusion of sexual minorities also have higher social acceptance of sexual minorities (Flores & Park, 2018). Depending on which country, city, and rural versus urban area they live, sexual minority individuals may experience different levels of discrimination, social exclusion, and stress (Bettinsoli et al., 2020; Jackson et al., 2008). It would, therefore, be important to replicate the current study results in different geographical and socio-political settings to have a more nuanced understanding of stress and, consequently, of negative SPA among sexual minorities. At the same time it would be important to increase services to help support sexual minority individuals in increasing self-efficacy and managing stress, possibly through targeted advertising of stress management courses and activities aimed partially at stress management (e.g., meditation and yoga) that are available in communities (Sun et al., 2022). The crisis competence developed by sexual minority older adults through their coming-out experiences may represent a valuable resource for enhancing their SPA. (Kimmel, 1978; Porter et al., 2019).

Strengths and Limitations

This study has several strengths. First, it is one of the few studies comparing SPA between sexual minority and heterosexual older adults. Second, this study also included both unidimensional and multidimensional measures of SPA. Multidimensional measures made it possible to potentially detect differences between sexual minority and heterosexual older adults in specific domains of SPA while finding similarities in other domains. Third, sexual minority respondents were matched based on age and sex with heterosexual respondents. This is a strength as it made it possible to control for age and sex, two variables that often influence SPA.

This study also has limitations. First, due to power issues, we grouped homosexual, bisexual, and individuals who reported having another sexual orientation into an overall group of sexual minorities. For the same reason, we were not able to disaggregate and examine sex and gender differences within and across sexual minority and heterosexual groups. Future studies should investigate whether SPA also differ between different subgroups within sexual minorities and also based on sex and gender. Second, the study’s cross-sectional nature does not make it possible to reliably test mediation models and understand the causal pathways involving health and social resources. For example, the association between health and SPA are likely reciprocal (Tully-Wilson et al., 2021). Minority stress may have a direct negative association with SPA but also indirectly through poorer health. Similarly, the influence of minority stress on the association between social relationships and SPA may be bidirectional. Future studies should incorporate longitudinal study design to explicate these associations. Third, the German Aging Survey questions to assess stress focused more on one’s perceived ability to deal with stressors rather than the experience of stress as a consequence of discrimination and social exclusion. Future studies should test the mediating role of discrimination in the association of sexual orientation with SPA.

Conclusions

Although causality cannot be inferred in this cross-sectional study, the higher levels of stress that sexual minority individuals tend to have may be related to them having more negative attitudes towards own aging and perceiving more social losses than heterosexual individuals. Because several systematic reviews and meta-analyses have provided sound evidence for the detrimental effect of negative SPA (Tully-Wilson et al., 2021; Westerhof et al., 2023) on health and wellbeing, sexual minority individuals may greatly benefit from group-based psychoeducational interventions, decreasing negative views on aging, negative SPA and promoting accurate and realistic knowledge about aging and positive SPA (Knight et al., 2021; Zhu et al., 2024). However, fostering greater inclusion of sexual minority older individuals through more inclusive legislation and social initiatives would reduce the stress experienced by them and, in doing so, it may lead to more positive experiences of aging.

Supplemental Material

Supplemental Material - Associations Between Sexual Orientation and Self-Perceptions of Aging: The Withering Role of Stress

Supplemental Material for Associations Between Sexual Orientation and Self-Perceptions of Aging: The Withering Role of Stress by Serena Sabatini, Anyah Prasad in Research on Aging

Footnotes

Acknowledgments

SS is supported by the Academy of Medical Sciences, the British Academy, the Royal Academy of Engineering, the Royal Society, and the La Caixa Foundation.

ORCID iDs

Serena Sabatini

Anyah Prasad

Ethical Considerations

This study used de-identified and publicly available secondary data.

Author Contributions

Serena Sabatini and Anyah Prasad were equally involved in developing the research questions, designing the study, interpreting the results, and drafting the manuscript. SS conducted study analyses.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Serena Sabatini received an Academy of Medical Sciences Networking Grant (NGR1\1907). Serena Sabatini received a La Caixa Junior Leader Postdoctoral Fellowship [LCF/BQ/PI24/12040008].

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

This study utilizes secondary data from the German Ageing Survey, which can be accessed online at .

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Serena Sabatini is a La Caixa Junior Leader Postdoctoral Fellow at the University of Barcelona, Department of Clinical Psychology and Psychobiology and Institute of Neurosciences. She undertook a PhD on the topic of Awareness of Age-Related Changes at the University of Exeter, several postdoctoral positions at the University of Exeter, University of Italian Switzerland, and University of Nottingham and, befor joining the University of Barcelona, she has been lecturer at the University of Surrey.

Anyah Prasad is a postdoctoral scholar in the Department of Medicine, Health and Society at Vanderbilt University. Her research agenda focuses on how social stress and social networks influence health and longevity through subjective aging and biological aging pathways among marginalized older adults.

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