How Can LGBT People with ASD Achieve Successful Aging?(Literature Review)

INTRODUCTION

In the past few decades, life expectancy has increased, making successful aging and quality of life an important research topic (Stringfellow et al., 2024). However, Klein and Klinger (2024) found that only 3.3% of autistic adults experience successful aging. This essay focuses on LGBT adults with ASD over 50 years old, as there are relatively few studies specifically addressing aging in this population. In fact, Roestorf et al. (2019) discussed how to define the aging ASD population and suggested that research on aging in autism should consider individuals aged 50 years and older.

Autism spectrum disorder (ASD) is a lifelong neurological and developmental condition that affects intellectual ability, as well as psychological, cognitive, behavioral, and social functioning (Mukaetova-Ladinska et al., 2012; Dudley et al., 2019; Marsack & Hopp, 2019; Roestorf et al., 2019; Vermaat et al., 2021; Stringfellow et al., 2024).

According to Marsack and Hopp (2019), many people worldwide have ASD. In Europe, there are over 8 million individuals with ASD, and at least 20% of them are over 65 years old (Mukaetova-Ladinska et al., 2012). In the United States, approximately 50,000 people are diagnosed with ASD each year (Marsack & Hopp, 2019). In addition, Green et al. (2025) reported that about 1 in 36 children is autistic.

The aging population is growing not only for individuals with ASD but also within the LGBT community. By 2030, more than 5 million LGBT adults in the United States will be over 50 years old (Fredriksen-Goldsen et al., 2015; Perone et al., 2020), representing approximately 2.4% of the population aged 50 and above (Fredriksen-Goldsen et al., 2015). However, research on the needs of older LGBT adults remains limited (Fredriksen-Goldsen et al., 2015; Hall et al., 2020; Hillier et al., 2020; Perone et al., 2020). Notably, some studies indicate that older autistic LGBT adults are largely invisible and continue to experience discrimination, social isolation, fear of rejection, and negative experiences in clinical settings, despite being at higher risk of self-harm, suicide, and emotional distress (Fredriksen-Goldsen et al., 2015; Pereira et al., 2021; Wallisch et al., 2023). This highlights their need for targeted medical and clinical support.

This review will examine the successful aging of LGBT adults with ASD, emphasizing that they should receive equal treatment and appropriate support, comparable to heterosexual aging adults with ASD. To achieve this, the review will cover:

1.            The study methods used in the literature,

2.            Evaluation and summary of research findings, and

3.            Identification of strategies to support successful aging in this population.

Research Methods

This literature review includes surveys, case studies, interviews and scoping review for autistic adults, including the LGBT population in the United States, European countries and Australia, which was published between 2009 and 2025. Studies and data were selected to consider aging ASD people, aging LGBT people, quality of life, successful aging, current challenges, including mental and physical health and LGBT related issues. Because of limited data and studies only focusing on the aging LGBT people with ASD, this approach assists in finding a comprehensive understanding of this population’s current challenges and possible strategies to achieve successful aging. 

Research Findings

ASD is usually diagnosed in childhood (Lai et al., 2013; Stringfellow et al., 2024), but some individuals are not diagnosed until adulthood (Mukaetova-Ladinska et al., 2012; Hillier et al., 2020). In addition, the needs of people with ASD vary depending on the complexity of each individual. However, many individuals with ASD require ongoing support across their lifespan, including emotional, social, financial, and medical assistance (Mukaetova-Ladinska et al., 2012; Dudley et al., 2019; Klein & Klinger, 2024). According to Mukaetova-Ladinska et al. (2012), adults over 40 with ASD experience poorer overall quality of life compared to the general population. They also highlighted the increasing need for specialized expertise to manage the psychiatric needs of adults and older individuals with ASD.

When examining the LGBT aging ASD population, current evidence shows that older LGBT adults (over 50 years old) have historically experienced discrimination, being treated as mentally ill, criminalized, or stigmatized due to their gender and sexual identities(Pereira, H., & Banerjee(2021). As a result, many LGBT individuals became socially invisible, experienced rejection from society, family, and often chose to hide their identities to protect themselves (Fredriksen-Goldsen et al., 2015; Pereira et al., 2021). Consequently, these experiences create barriers to accessing social support due to prior stigma and discrimination (Fredriksen-Goldsen et al., 2015; Hall et al., 2020; Pereira et al., 2021; Green et al., 2025).

Dudley et al. (2019) found that adults with ASD have access to fewer services compared to children and adolescents, while aging LGBT individuals with ASD face additional challenges compared with their heterosexual counterparts. Research indicates that older LGBT adults with ASD are often underdiagnosed and have not received appropriate social or medical care due to limited access to specialists (Mukaetova-Ladinska et al., 2012; Hillier et al., 2020). Marsack and Hopp (2019) also noted that little research focuses on caregivers of older adults with ASD. As Mukaetova-Ladinska et al. (2012) added, many adults with disabilities lose parental support over time and struggle to have their needs represented in society.

Several studies show that autistic adults experience co-occurring physical and mental health conditions more frequently than the general population (Roestorf et al., 2019; Perone et al., 2020; Mittertreiner et al., 2024). Klein and Klinger (2024) reported that co-occurring physical health problems are common in autistic adults aged 18–65+, including cardiovascular diseases (37%) and neurological conditions (39%). The research presented risk factors that include genetic predisposition, lifestyle, and limited access to healthcare. Mukaetova-Ladinska et al. (2012) also highlighted an increased risk of dementia in older autistic adults, linked to presymptomatic cognitive decline observed over the past three decades.

According to the National LGBT Health and Aging Center’s Aging and Health Report (2011), older LGBT individuals experience higher rates of chronic disease, mental health challenges, and disability. They are twice as likely to live alone and four times less likely to have children (Perone et al., 2020). In a study of 2,560 LGBT older adults, approximately 60% reported a lack of companionship, and over 50% reported feeling a sense of isolation or being left out (Fredriksen-Goldsen et al., 2011). GLAAD (2018) reported that discrimination against the LGBT community increased by 11% between 2016 and 2017 (Hillier et al., 2020), exacerbating vulnerability to social isolation and loneliness in older age.

Furthermore, individuals with ASD may experience social anxiety related to sensory sensitivities (McAuliffe et al., 2023). In addition to challenges in social networking, many older LGBT adults encounter discrimination within healthcare services, which creates barriers to accessing support due to fears of rejection and prejudice (Fredriksen-Goldsen et al., 2015; Hall et al., 2020; Hillier et al., 2020; Perone et al., 2020; Green et al., 2025).

Identified Strategies

According to Young et al. (2009), successful aging is defined as when a person has psychological and social strategies to maintain well-being, life satisfaction, and personal fulfilment despite physical or health limitations.

Recent studies, such as Pereira and Banerjee (2021), emphasize that a human rights framework grounded in human dignity is fundamental for successful aging among LGBT older adults. Research shows that the lower quality of life (QOL) experienced by LGBT older individuals compared to their heterosexual peers may stem from social isolation, limited access to healthcare, lack of family support, childlessness, and lifelong experiences of discrimination and stigma related to LGBT identity, all of which negatively impact health outcomes (Fredriksen-Goldsen et al., 2015; Hillier et al., 2020; McQuaid et al., 2023).

According to Pereira and Banerjee (2021), these findings align with the Minority Stress Theory, which posits that lifelong stressors negatively affect well-being and successful aging outcomes in LGBT older adults. This theory highlights issues, such as ongoing distress, increased risk of anxiety and depression, loneliness, and elevated suicide risk. Some aging LGBT individuals, however, develop strategies to cope with LGBT-phobia and ageism, demonstrating that resilience, high self-esteem, and self-efficacy can promote higher QOL through social interaction and supportive networks.

For example, the Danish National Plan for Autism (section “Life after 60”) provides home-like environments and promotes healthy lifestyles for aging adults with ASD, while the UK’s National Autistic Society implements staff training programs to better support older adults with ASD (Mukaetova-Ladinska et al., 2012). Other research highlights the need for professionals and specialists to gain a better understanding of the unique needs of LGBT adults aging with ASD (Marsack & Hopp, 2019; Wallisch et al., 2023). Hillier et al. (2020) emphasized that individualized approaches are essential, as autism impacts each person differently (Mukaetova-Ladinska et al., 2012).

Fredriksen-Goldsen et al. (2015) investigated the relationship between resilience and QOL in a national survey of 2,560 LGBT adults across 11 U.S. sites in 2010. They found that successful aging among LGBT older adults is associated less with chronological age and more on resilience factors, such as social support, positive identity, and healthy behaviors, which help maintain physical and mental health in later life.

Collectively, these studies suggest the following strategies:

1.            Improved Assessment Tools: There is a need to develop better assessment tools, including measures of cognitive abilities such as memory and thinking skills, to accurately diagnose ASD in older adults. These tools should be informed by ongoing research into neuropathology and pharmacotherapy to understand how aging and treatment affect brain health (Mukaetova-Ladinska et al., 2012; Marsack & Hopp, 2019).

2.            Specialized Training for Health and Social Care Staff: highlights the importance of university-level training for professionals on aging and LGBT autistic issues, including mental and physical health, to reduce social isolation, alleviate fears of rejection and discrimination, improve service quality, and support successful aging (Marsack & Hopp, 2019; Pereira & Banerjee, 2021; Wallisch et al., 2023). For instance, the UK’s National Autistic Society provides training for staff who support older adults with ASD (Mukaetova-Ladinska et al., 2012).

3.            Legal Protections and Policy Development: There is a need for to ensure that aging LGBT adults have legal protections against discrimination and equitable access to healthcare and housing. Research suggests that governments could implement evidence-based policies that reflect the real needs of older LGBT adults in collaboration with community organizations. Current European and UK policies, however, focus predominantly on younger people with disabilities and ASD, often neglecting the older population (Mukaetova-Ladinska et al., 2012; Pereira & Banerjee, 2021).

Strengths and Limitations
A key strength of this research is that it focuses on two minority populations—aging adults with ASD and aging LGBT individuals—highlighting their challenges and potential strategies to overcome obstacles. This essay draws on surveys, case studies, interviews, and scoping reviews to provide a clear, evidence-based picture of the realities faced by these populations. In addition, it examines practical strategies by referencing national initiatives, such as the Danish National Plan for Autism. Furthermore, the essay includes comparisons with heterosexual populations, illustrating differences in challenges and providing concrete examples.

Older LGBT adults remain largely invisible and under-studied in research (Fredriksen-Goldsen et al., 2015; Pereira & Banerjee, 2021). Very few studies focus specifically on aging LGBT adults with ASD (Green et al., 2025), and research on heterosexual aging adults with ASD is also limited (Mukaetova-Ladinska et al., 2012). Similarly, there is a lack of data on non-White populations (Green et al., 2025). Additionally, as Mukaetova-Ladinska et al. (2012) note, ASD is a spectrum disorder, meaning that individual needs and supports vary widely. This variability limits the extent to which this essay can capture the deeper, individualized challenges and needs of this population.

Conclusion

In conclusion, previous research has shown that LGBT adults with ASD face numerous challenges to achieving successful aging, including social isolation, lack of family and social support, underdiagnosis, discrimination, stigma, increased risk of physical and mental health problems, and elevated risk of suicide. Current research remains limited in providing a deeper understanding of their lived experiences and specific needs, partly due to their invisibility and lack of data. Nevertheless, the importance of legal protections, professional training, assessment tools, and community-based programs is clear. Achieving successful aging for LGBT adults with ASD should be grounded in a human rights framework, which can help this population feel respected, valued, and recognized. Such an approach also promotes awareness of their resilience, wisdom, and personal strategies to enhance autonomy and well-being. For future research, exploring the relationship between resilience and post-traumatic growth (PTG) may provide valuable insights into fostering hope, meaning, and a sense of purpose in aging for this population.

References

Dudley, K. M., Klinger, M. R., Meyer, A., Powell, P., & Klinger, L. G. (2019). Understanding Service Usage and Needs for Adults with ASD: The Importance of Living Situation. Journal of Autism and Developmental Disorders, 49(2), 556–568. https://doi.org/10.1007/s10803-018-3729-0

Fredriksen-Goldsen, K. I., Kim, H. J., Shiu, C., Goldsen, J., & Emlet, C. A. (2015). Successful Aging Among LGBT Older Adults: Physical and Mental Health-Related Quality of Life by Age Group. The Gerontologist, 55(1), 154–168. https://doi.org/10.1093/geront/gnu081

Green, K., Weir, E., Wright, L., Allison, C., & Baron-Cohen, S. (2025). Autistic and transgender/gender diverse people’s experiences of health and healthcare. Molecular Autism, 16(1), Article 4. https://doi.org/10.1186/s13229-024-00634-0

Hall, J. P., Batza, K., Streed, C. G., Boyd, B. A., & Kurth, N. K. (2020). Health Disparities Among Sexual and Gender Minorities with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 50(8), 3071–3077. https://doi.org/10.1007/s10803-020-04399-2

Hillier, A., Gallop, N., Mendes, E., Tellez, D., Buckingham, A., Nizami, A., & OToole, D. (2020). LGBTQ + and autism spectrum disorder: Experiences and challenges. International Journal of Transgender Health, 21(1), 98–110. https://doi.org/10.1080/15532739.2019.1594484

Klein, C. B., & Klinger, L. G. (2024). Aging Well and Autism: A Narrative Review and Recommendations for Future Research. Healthcare (Basel), 12(12), 1207. https://doi.org/10.3390/healthcare12121207

Lai, M.-C., Lombardo, M. V., Chakrabarti, B., & Baron-Cohen, S. (2013). Subgrouping the Autism “Spectrum": Reflections on DSM-5. PLoS Biology, 11(4), e1001544. https://doi.org/10.1371/journal.pbio.1001544

Marsack, C. N., & Hopp, F. P. (2019). Informal Support, Health, and Burden Among Parents of Adult Children With Autism. The Gerontologist, 59(6), 1112–1121. https://doi.org/10.1093/geront/gny082

McAuliffe, C., Walsh, R. J., & Cage, E. (2023). “ My whole life has been a process of finding labels that fit ”: A Thematic Analysis of Autistic LGBTQIA+ Identity and Inclusion in the LGBTQIA+ Community. Autism in Adulthood, 5(2), 127–138. https://doi.org/10.1089/aut.2021.0074

McQuaid, G. A., Gendy, J., Lee, N. R., & Wallace, G. L. (2023). Sexual Minority Identities in Autistic Adults: Diversity and Associations with Mental Health Symptoms and Subjective Quality of Life. Autism in Adulthood, 5(2), 139–153. https://doi.org/10.1089/aut.2021.0088

Mittertreiner, E. J., Ng-Cordell, E., McVey, A. J., & Kerns, C. M. (2024). Research methods at the intersection of gender diversity and autism: A scoping review. Autism : The International Journal of Research and Practice, 28(12), 2953–2969. https://doi.org/10.1177/13623613241245595

Mukaetova-Ladinska, E. B., Perry, E., Baron, M., & Povey, C. (2012). Ageing in people with autistic spectrum disorder. International Journal of Geriatric Psychiatry, 27(2), 109–118. https://doi.org/10.1002/gps.2711

Pereira, H., & Banerjee, D. (2021). Successful Aging Among Older LGBTQIA+ People: Future Research and Implications. Frontiers in Psychiatry, 12, 756649. https://doi.org/10.3389/fpsyt.2021.756649

Perone, A. K., Ingersoll-Dayton Berit, & Watkins-Dukhie Keisha. (2020). Social Isolation Loneliness Among LGBT Older Adults: Lessons Learned from a Pilot Friendly Caller Program. Clinical Social Work Journal, 48(1), 126-139. https://doi.org/10.1007/s10615-019-00738-8

Roestorf, A., Bowler, D. M., Deserno, M. K., Howlin, P., Klinger, L., McConachie, H., Parr, J. R., Powell, P., Van Heijst, B. F. C., & Geurts, H. M. (2019). “Older Adults with ASD: The Consequences of Aging.” Insights from a series of special interest group meetings held at the International Society for Autism Research 2016–2017. Research in Autism Spectrum Disorders, 63, 3–12. https://doi.org/10.1016/j.rasd.2018.08.007

Stringfellow, M. K., Fields, N. L., Lee, K., Anderson, K. A., & Brokaw, E. (2024). Healthy Aging and Older Adults With Autism: A Scoping Review. The Gerontologist, 64(11), 1. https://doi.org/10.1093/geront/gnae026

Vermaat, L. E. W., van der Miesen, A. I. R., de Vries, A. L. C., Steensma, T. D., Popma, A., Cohen-Kettenis, P. T., & Kreukels, B. P. C. (2018). Self-Reported Autism Spectrum Disorder Symptoms Among Adults Referred to a Gender Identity Clinic. LGBT Health, 5(4), 226–233. https://doi.org/10.1089/lgbt.2017.0178

Wallisch, A., Boyd, B. A., Hall, J. P., Kurth, N. K., Streed Jr, C. G., Mulcahy, A., McMaughan, D. J., & Batza, K. (2023). Health Care Disparities Among Autistic LGBTQ+ People. Autism in Adulthood, 5(2), 165–174. https://doi.org/10.1089/aut.2022.0006

Young, Y., Frick, K. D., & Phelan, E. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87-92.  http://doi.org/10.1016/j.jamda.2008.11.003