A Wider Lens on Aging

Aging While Queer

For the LGBTQ+ community, the aging journey is often a winding path shaped by minority stress—the compounding effects of stigma, discrimination, and social isolation tied to sexual or gender identity.  

Harry Barbee, PhD, MS, an assistant professor in Health, Behavior and Society, is shedding light on the complex ways those stressors manifest across the lifespan. In a 2023 study of over 1,200 LGBTQ+ adults ages 50 to 76, Barbee found that experiencing major problems at work, such as overwork or interpersonal conflicts, nearly doubled the odds of mild cognitive impairment. 

While external stressors play a significant role, the way LGBTQ+ people perceive their own aging process—what Barbee calls “subjective aging”—also shapes health outcomes for this community.  

For many queer elders, that perception is indelibly shaped by the generational trauma of the AIDS crisis, watching vibrant lives cut short while the world looked away. Among LGBTQ+ adults ages 50 to 59, those who witnessed more AIDS-related deaths in their social networks tended to have a more pessimistic outlook on aging, which was linked to poorer self-rated health, Barbee’s research shows. 

Yet Barbee’s interviews with 41 people of different gender and sexual identities—including 10 lesbians, 10 gay men, 10 straight men, and 11 straight women—in midlife and beyond also capture resilience and growth. Gay men finding purpose in mentoring queer youth. Lesbian women boldly confronting injustice after decades of holding their tongues. Spirited talk about sex and newfound freedom.  

“I embrace the elder role that comes with age in the gay community,” one subject shares. “We have so much experience to offer.” 

Looking ahead, Barbee emphasizes the urgent need for more representative data to understand the diverse experiences of LGBTQ+ elders. “Oftentimes, when you look at these national data sets of LGBTQ+ people, it’s a lot of white people, and it’s a lot of gay men,” they note. “That’s something that I think about a lot: increasing representativeness within the data that we have.”  

Outsmarting the Flu

Of the 30,000-plus influenza deaths that occur every year, 9 in 10 are among adults 65 and older.  

It’s well accepted that the body’s immune response weakens as we age, so Jay Bream, PhD, wants to know how vaccines work in seniors and how they can be improved.  

Bream and his collaborator Sean Leng, MD, PhD, both faculty in Molecular Microbiology and Immunology, are investigating why some vaccinated seniors still catch the flu, despite receiving their seasonal vaccination. By following a group of adults over 75 for the past decade—a rare cohort in this type of research—they are uncovering clues about how aging affects the immune system’s response to flu vaccines. 

“Many studies group everyone over 65 together, but we’re learning that a 65-year-old is closer to 55 than to 75 in terms of immune function,” Bream explains. “Our study’s focus on the over-75 age group, combined with its longitudinal nature, is one of its strengths.” 

Complicating Bream’s efforts to pinpoint the factors contributing to breakthrough flu infections is the presence of cytomegalovirus. This stealthy, persistent virus infects nearly everyone by adulthood and may be monopolizing the aging immune system’s limited resources. 

Diverting a substantial part of the immune system to focus on combating the cytomegalovirus may reduce our capacity to effectively respond to other threats like influenza, Bream hypothesizes, though he cautions that more research is needed to prove this connection. 

Ultimately, Bream hopes his team’s findings could inform the design of improved flu vaccines tailored to older adults, perhaps by boosting T cell responses, altering doses, or optimizing timing.  

The road ahead is challenging. “It’s sobering that we still don’t understand so much about how aging impacts the immune system,” Bream says. “How we utilize that information eventually to make better vaccines really is the is one of the ultimate goals of this work.” 

No Safe Haven

In conflict-affected and displaced communities, such as in the Democratic Republic of Congo and Burma (Myanmar), older women and men may suffer abuse and neglect at the hands of their families—further compounding the challenges brought on by war. 

“Older people are often seen as a burden in humanitarian crises, especially if they can’t contribute financially,” explains Kathryn Falb, ScD, MHS ’07, an assistant professor in International Health. Falb’s team conducted in-depth interviews with more than 100 conflict-affected adults, including older individuals, uncovering a complex web of factors that contribute to the emotional and financial abuse they face. 

The stressors that accompany displacement, such as inability to provide for the family financially, contributed to family members’ abuse of older refugees.  

But the problem isn’t just within families. Falb’s research also reveals a systemic failure by humanitarian organizations to address the unique needs of older refugees.  

“Older people are often invisible in these settings,” she explains. “Aid programs are designed for the general population, and it’s difficult to take into account the specific challenges of aging, like mobility issues or chronic health conditions.” 

The consequences of this neglect can be devastating. Older refugees are left to navigate the daily hardships of displacement without the support they need, from accessing food and water to managing complex medical needs. And when abuse does occur, which happens to 1 in 6 people over age 60, there are few places to turn for help. 

But Falb’s research also points to potential solutions. She and her team are engaging local organizations and community groups to shift social norms around aging and promote the value and rights of older people. 

They’re also exploring and advocating for a more inclusive approach to humanitarian aid, which could include simple measures like more accessible cash transfers, or more complex interventions like tailoring violence and health services to meet the specific needs of those who need it most. 

Disarming a Crisis

Spencer Cantrell has spent her legal career working with survivors of domestic and sexual violence. Now a practitioner at the Johns Hopkins Center for Gun Violence Solutions, she’s bringing that experience to bear on a different aspect of the gun violence epidemic: preventing firearm suicide among older adults. 

“People 75 and older are at the highest risk for dying by gun suicide,” says Cantrell, JD. “We know that when someone has access to a firearm, it increases the risk of firearm suicide. And we know that there isn’t a lot of ‘means substitution’ when it comes to suicide attempts. So if you take away the firearm, that individual is not likely to die by some other means.” 

One promising tool to reduce this risk is extreme risk protection orders (ERPOs), which allow law enforcement and family members to temporarily remove firearms from individuals at risk of harming themselves or others. Cantrell’s research has shown that for every 10 to 20 ERPOs issued, one life is saved. 

ERPOs have strong due-process protections and have received bipartisan support in more than 21 states and Washington, D.C.  

But removing firearms is just the first step, Cantrell emphasizes. 

“We don’t want to just remove the firearm and then wash our hands of the situation,” she says. “We want to remove the firearm, think about what were the underlying factors that led to that crisis, and try to address those factors.” 

By connecting at-risk individuals with social services and mental health support, Cantrell believes ERPOs can be a crucial tool not only for saving lives in the short-term but putting people on a path to long-term wellbeing and safety.

Reprogramming Cells to Fight Dementia 

In the quest to tackle neurodegenerative diseases like Alzheimer’s and ALS, most research has focused on targeting the misfolded proteins that clump together and wreak havoc in the brain. These plaques, such as the beta-amyloid in Alzheimer’s, are the hallmark pathologies of these devastating diseases.  

But Jiou Wang, MD, PhD, Walder Foundation Distinguished Professor in Biochemistry and Molecular Biology, is shifting the battle lines. His strategy? Bolstering brain cells’ own defense mechanisms against these malformed molecules. 

In healthy brains, proteins are regularly broken down and cleared away, with lifespans ranging from hours to months. But as we age, this process can go awry. Proteins start to misfold and stick together, forming toxic plaques that can overwhelm the cell’s clearance systems. Over time, this buildup can lead to the death of brain cells and the devastating symptoms of neurodegenerative diseases. 

Rather than playing whack-a-mole with individual misfolded proteins, Wang’s team is searching for master switches that can reprogram brain cells to better handle and clear out these dangerous aggregates. 

Using genetic screens, they’ve identified several promising candidates—genes that, when tweaked, can enhance the cell’s ability to dispose of misfolded proteins. Just as the immune system can be bolstered through vaccination to better recognize and combat specific threats, Wang believes that brain cells can be reprogrammed to more effectively target and eliminate toxic protein aggregates.  

Wang envisions that modulating these genetic switches, either through gene therapy or drugs that mimic their effects, could reprogram brain cells to be more resilient against toxic protein buildup. Although plaques could still accumulate, the cell’s enhanced defense mechanisms could help prevent or delay the onset of neuronal dysfunction. 

By targeting multiple genes and pathways, Wang’s solution offers a more comprehensive solution than targeting individual misfolded proteins alone. “Neurodegeneration is almost an irreversible process,” he notes. “It takes more effort than fixing one or two things.”