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Survey Challenges Assumptions About Aging With HIV in United States
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XIX International AIDS Conference, July 22-27, 2012, Washington, DC
Mark Mascolini
Contrary to common assumption in some quarters, HIV-positive US residents in their 60s had better mental health and less depression than younger people with HIV, according to results of a 1293-person survey [1]. Fewer 60-and-over seniors had AIDS, and their physical functioning proved as robust as that of younger HIV-positives.
The survey is cross-sectional, it focused on a convenience sample of adults with HIV, and analyses did not factor in education or income. But the findings may raise caution about assuming that all 60-and-older HIV-positives suffer an undue burden of psychosocial and physical deficits. The study also offers one of the first looks at a 60-plus HIV cohort rather than considering everyone over 50 "older."
The overall study involved 2182 HIV-positive people recruited at HIV clinics and service organizations in the United States, Canada, Puerto Rico, Namibia, China, and Thailand from February 2010 to July 2011. This analysis focused on 1293 US participants in three age groups: 687 (53%) from 40 to 49 years old, 514 (40%) from 50 to 59, and 92 (7%) 60 and older.
Similar proportions of the 40-to-49 group, the 50-to-59 group, and the 60-plus group were men (71%, 73%, and 79%). The two younger groups had a slightly higher proportion of blacks (47% and 52% versus 37%), a lower proportion of whites (26% and 26% versus 38%), and a similar proportion of Hispanics (20%, 14%, 15%). A higher proportion of 60-plus participants had non-HIV medical conditions (87% versus 71% in 50-to-59s and 64% in 40-to-49s), and a higher proportions of 60-plus people were taking antiretrovirals (91%) than were 50-to-59s (82%) or 40-to-49s (81%). But a slightly lower proportion of the oldest group had an AIDS diagnosis (40%) than did 50-to-59s (46%) or 40-to-49s (52%).
The researchers used the Social Capital scale to estimate participants' community involvement, neighborhood connections, relations with friends and family, role limitations due to health issues, and social functioning limitations due to mental health problems. They evaluated depression with the nondiagnostic CES-D screening tool. And they assessed treatment self-efficacy with HIV-ASES, which gauges an HIV-positive person's confidence in carrying out health-related behaviors like keeping appointments and taking medications.
Compared with 40-to-49s, the 60-plus group and 50-to-59s notched a significantly better social capital score (81.5 in both older groups versus 78.5 in the youngest group, P = 0.008). Physical functioning was equivalent across the three groups: 42.7 in 60-plus people, 41.3 in 50-to-59s, and 42.6 in 40-to-49s.
Treatment self-efficacy was significantly higher in 60-and-older people (100.5) than in 50-to-59s (96.8) or 40-to-49s (91.3) (P = 0.000), and the oldest group had the best mental functioning scores (50.8 versus 45.4 in 50-to-59s and 43.6 in 40-to-49s) (P = 0.000). People 60 and older had a significantly lower depressive symptom score (14.8) than did 50-to-59s (20.5) and 40-to-49s (22.2) (P = 0.000).
"Although older HIV-positive people are living with more comorbidities," the researchers concluded, "they are more likely to be taking HIV medications and less likely to have AIDS." Older people had significantly better mental functioning, fewer depressive symptoms, and better treatment self-efficacy.
In further analyses, the investigators plan to control for variables such as race and education, although these three age groups were not greatly imbalanced racially. The researchers did not speculate about selection bias, which may be impossible to eliminate in a survey like this: HIV-positive people who survive into their 60s are more likely to have better overall health than those who die, and survivors may also have better coping skills and social support systems.
Reference
1. Nokes K, Sefcik E, Johnson MO, et al. Getting older while living with HIV in the United States. XIX International AIDS Conference. July 22-27, 2012. Washington, DC. Abstract THPDD0201.
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