3 - (IOP 27) Examining the Negative Impact of Traditional and Age-related Syndemic Conditions on Quality of Life Among Older Sexual Minority Men in Florida

Introduction: Older sexual minority men (OSMM) face persistent health disparities. Although the relationship between traditional syndemic conditions (e.g., depression, substance use) and poor health outcomes are well-documented among younger and middle-aged SMM, little is known about their impact on OSMM. Similarly, novel aging-related syndemic conditions (e.g., social isolation, internalized ageism) may directly impact quality of life (QOL) alongside more traditional syndemic conditions; however, further research is needed to tease out these effects. Therefore, to fill this gap, this study examined the prevalence of traditional and age-related syndemic conditions on OSMM, assessed their influence on OSMM’s QOL via both traditional regression and machine learning approaches, and examined whether resilience may moderate these relationships.

Methods: Eligible participants completed an online assessment battery (~50 minutes) and were a) between 55 and 90 years old, b) cisgender SMM, c) residing in Florida full- or part-time, and d) HIV-negative or HIV status unknown at enrollment. The traditional syndemic additive index (0-6) included depression, current post-traumatic stress symptoms, problematic substance use, childhood sexual abuse, intimate partner violence, and intersectional discrimination while the age-related syndemic additive index (0-7) included everyday age-related discrimination, internalized ageism, aging anxiety, sexual minority specific aging concerns, loneliness, economic marginalization, and perceived cognitive impairment. Traditional regression models explored the main and interaction effects between both indices and resilience (moderator) on OSMM’s quality of life (QOL). Classification and regression tree (CART) models examined the interplay between the most influential age-related syndemic conditions and OSMM’s QOL.


Results: OSMM (N=251) were burdened by traditional (M=2.17, SD=1.54) and age-related (M=3.32, SD=1.86) syndemic conditions. Adjusted models indicated significant relationships between the traditional (b=-0.96, SE=0.35, p< 0.001) and age-related syndemic (b=-2.02, SE=0.31, p< 0.001) indices as well as resilience (b=3.16, SE=0.78, p< 0.001) on OSMM’s QOL scores. There was significant moderation between the traditional syndemic index and resilience (b=1.18, SE=0.46, p=0.01) on OSMM QOL such that as resilience increases, the negative effects of the syndemic index on QOL decreases, leading to improved QOL among OSMM. Findings from machine learning CART modeling identified several specific age-related syndemic conditions that may be more impactful on OSMM’s QOL including sexual minority specific aging concerns, aging anxiety, social isolation, and internalized ageism.

Conclusions: Overall, OSMM from across Florida experienced a unique set of age-related syndemic conditions that differentially impacted quality of life among this group. Cognitive-behavioral therapies that address both traditional and age-related syndemic factors through approaches like cognitive restructuring, behavioral activation, and problem solving may help bolster OSMM’s resilience, and in turn, improve QOL and general mental health among this underserved group.