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Less Resilience in Older People With vs Without HIV Tied to Drops in Daily-Living Activities
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3rd International Workshop on HIV and Aging, November 5-6, 2012, Baltimore
Mark Mascolini
Older HIV-positive people had less clinically determined resilience than HIV-negative people in a small US comparative study, and low resilience correlated with declines in Instrumental Activities of Daily Living (IADL) [1].
Resilience, a measure of stress-coping ability, can be quantified on the Connor Davidson Resilience Scale, a 10- or 25-item survey in which higher scores reflect greater resilience [2,3]. Because resilience and its association with IADL have not been closely studied in aging HIV populations, University of California, San Diego (UCSD) researchers conducted this comparative study in 42 HIV-positive and 20 HIV-negative people.
All study participants completed the 10-item Connor Davidson Resilience Scale and the Lawton and Brody Activities of Daily Living Questionnaire, which assesses mood, lifetime orientation, emotional support, and life events. The UCSD team classified participants as IADL dependent if they had at least two declines on IADLs (for example, financial management and medication adherence) and reported that those declines resulted from neurocognitive problems. Participants not classified as IADL dependent are called IADL independent.
The HIV-positive and negative groups were similar in average age (60.8 and 59.4), years of education (14.7 and 13.8), and proportion of Caucasian (79% and 75%, P = 0.86). The HIV group had a significantly higher proportion of men (83% versus 50%, P = 0.006).
Average resilience score was lower in the HIV group than in the HIV-negative group, and that difference approached statistical significance (27.0 versus 31.0, P = 0.06). Four HIV-positive people and 1 HIV-negative person were IADL dependent, and that difference lacked statistical significance (P = 0.29).
HIV-positive IADL-dependent people were significantly less resilient than HIV-positive and HIV-negative IADL-independent people (P < 0.05):
Average resilience by HIV status and IADL dependence
-- HIV-positive IADL dependent: 20.3
-- HIV-positive IADL independent: 29.7
-- HIV-negative IADL independent: 30.5
But resilience was similar in HIV-positive and negative IADL-dependent people (20.3 and 20.0).
Current CD4 count, nadir CD4 count, AIDS status, and viral load in cerebrospinal fluid did not differ significantly between HIV-positive IADL-dependent people and HIV-positive IADL-independent people.
The researchers concluded that in this study population HIV-positive people have lower resilience levels than HIV-negative people and that lower resilience in HIV-positive people is associated with greater IADL dependence.
"Given that HIV disease characteristics were comparable between the IADL-dependent and independent groups," the UCSD team proposed, "resilience may be an important determinant of daily functioning above and beyond HIV disease severity."
References
1. Rooney A, Badiee J, Grant I, Moore DJ. Less resilient older HIV-infected persons evidence instrumental activities of daily living declines. 3rd International Workshop on HIV and Aging. November 5-6, 2012, Baltimore. Abstract: P_11.
2. Connor Davidson Resilience Scale. http://www.connordavidson-resiliencescale.com/.
3. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety. 2003;18:76-82.
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