Background: Loneliness affects over a third of community dwelling older adults and is associated with poor physical and mental health, cognitive decline, and increased mortality. Transgender individuals experience health and social disparities that increase their risk for loneliness, yet there is a scarcity of research focused on loneliness in this vulnerable older adult population.

Purpose: The purpose of this dissertation was to (1) review and synthesize the scientific literature surrounding loneliness in LGBTQIA+ older adults, (2) describe the lived experience of loneliness in older adults who are transgender, and (3) identify and describe risk factors for and protective factors against loneliness in older adults who are transgender.

Methods: The first manuscript is a scoping review guided by the Arksey & O’Malley methodological framework. The second and third manuscripts are qualitative descriptive analyses guided by the adapted Health Equity Promotion Model. Participants were sampled through gender affirming care centers in Maryland and transgender support groups. Through semi-structured interviews and independent journaling, participants described their experiences with loneliness and risk factors and protective factors for loneliness. Data were coded using conventional and directed content analysis.

Results: The scoping review identified 73 studies and five themes related to loneliness in LGBTQIA+ older adults were identified: (1) experiences of discrimination, (2) end-of- life challenges, (3) living with HIV, (4) poor mental health, (5) presence of social support. There was a marked underrepresentation of transgender older adults within this literature. Next, nine participants aged 56-76 were enrolled in the qualitative descriptive study. Three themes emerged from the lived experience analysis: (1) loneliness on the inside, (2) longing for connection within relationships, and (3) loneliness imposed by the outside world. The analysis of risk factors and protective factors identified modifiable behavioral, social and community, and psychological risk and protective factors for loneliness.

Conclusions: This study provides evidence that loneliness is pervasive in older adults who are transgender and is experienced at individual, relational, and societal levels. It highlights modifiable risk for and protective factors against loneliness, providing the foundation for future research focused on preventing and decreasing loneliness in this population.