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Older Adults With HIV Spend Most Time Home, Alone, and Passive
  6th International Workshop on HIV and Aging
October 5-6, 2015, Washington, DC
Mark Mascolini
Twenty HIV-positive adults in their 50s and 60s spent "a remarkable amount of time" home, alone, and absorbed in passive activities, according to results of a pilot study using real-time activity reporting via smartphone [1]. Neurocognitive performance correlated inversely with time spent in passive activities.
Older age often brings with it substantial physical and neurocognitive impairment, a subject of increasing concern and study in people with HIV infection. Research on everyday functioning and functionally relevant behaviors often relies on self-report, which can be influenced by retrospective bias. A team at the University of California, San Diego (UCSD) tested a novel real-time self-report method in older adults with HIV, ecological momentary assessment (EMA) relayed by smartphone. Their study aimed to test the acceptability and feasibility of this approach and to assess relationships between EMA-measured daily functioning and neuropsychological performance.
The study involved 20 HIV-positive people averaging 59 years in age (range 51 to 67). All participants completed the lab-based Repeatable Battery for Assessment of Neuropsychological Status (RBANS) to establish neuropsychological function. Then for 1 week they completed daily at-home EMA assessments prompted by smartphone five times a day, reporting where they spent their time, whether they were alone or with others, and daily activities such as self-care, cognitively stimulating activities, and passive leisure activities.
Fourteen participants (70%) were white, 3 (15%) women, and 18 (90%) on antiretroviral therapy. Only 1 person had a detectable viral load, and current CD4 count averaged 476 (range 108 to 750). Calculating EMA adherence as number of surveys completed divided by total number of possible reports, the UCSD researchers figured an adherence rate of 86%. Participants also reported low perceived burden to operating the phone or answering calls for responses, which came at random times during the day. These findings led the investigators to conclude smartphone-based EMA is feasible and acceptable in this population of older adults with HIV.
Throughout the week study participants spent 74% of their time at home, 63% of their time alone, 32% of their time watching TV, and only 23% of their time in intellectual pursuits (which broadly included any computer or tablet use). Cognitive performance measured by the RBANS score was inversely related to time spent on passive leisure activities (r = -0.57, P = 0.01). But RBANS score was not related to time spent in self-care or engaged in cognitively stimulating activities. Greater depression correlated positively with greater variability in cognitively stimulating daily life activities (Wald chi-squared 4.7, P = 0.03).
The researchers concluded that these older HIV-positive adults "spent a remarkable amount of time at home, alone, and engaged in passive activities." They suggested that EMA technology can be used "to deliver interventions aimed at reducing social isolation and depressed mood and enhancing cognitive stimulation in an effort to diminish disability in this population." The UCSD team is launching a larger study to explore differences in daily functioning between older people with versus without HIV and to address reasons for functional disability.

1. Moore RC, Rooney AS, Depp CA, et al. Ecological momentary assessment of daily functioning among older adults living with HIV. 6th International Workshop on HIV and Aging. October 5-6, 2015, Washington, DC. Abstract 4.