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HIV & Aging: Psychosocial, mental health,
and behavioral issues/services/mental health policy
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Psychosocial, mental health, and behavioral issues of aging with HIV........http://www.natap.org/2014/HIVAGE/061614_02.htm
HIV & Aging - Mental Needs: Policy, Mental Health Services Program, Comorbidities, Services for Aging/Older HIV+.........http://www.natap.org/2014/HIV/092914_02.htm
from Jules: a recent anecdotal inquiry by me with HIV providers who have large practices found 30-50% of their HIV+ patients over 60 yrs old were prescribed anti-depressants.
"According to a case-controlled study comparing HIV+ and HIV- older people, people with HIV are less happy, less resilient, and have poorer attitudes toward their aging [10·]. They also report lower physical and mental health, and experience more negative life-events, anxiety, and perceived stress."
"A more integrated policy response is needed to improve the psychosocial and economic well being of older people with HIV......We have identified key areas for future research in psychosocial well being and increasing age with HIV, including effective strategies and the healthcare resources (e.g., multidisciplinary clinics and teams including psychologists, social workers, and nurse practitioners)......longitudinal studies exploring the process of aging with HIV.....lived experiences of older people with HIV, which will help health planners and policy makers address the contextual challenges of aging with HIV......About 50% of people living with HIV will develop HIV-associated neurocognitive impairments and disorders (HAND)......older people with HIV consistently performed worse on eight of nine neuropsychological and everyday functioning tests...... older age was associated with about a five-fold higher odds of developing memory deficits: about half of those over age 50 had measurable memory impairment......The more medical comorbidities someone experiences, the poorer their quality of life.....In a United States multistate study, 94% of people with HIV aged 50 years or older (n = 452) had at least one other chronic illness, with an average of three comorbid conditions (including depression) [13]. Commonly reported chronic illnesses included high blood pressure (46%), chronic pain other than headache and back pain (45%), hepatitis (39%), arthritis (35%), diabetes (21%), and major depression (14% reported symptoms consistent with major depression). The presence of more chronic conditions was also associated with decreased functioning.....In terms of sex differences, Storholm et al.[17] found that men were significantly more likely than women to report a lack of positive relations with others (50 vs. 39%), purpose in life (51 vs. 39%), self-acceptance (51 vs. 42%), and environmental mastery (53 vs. 35%). Mediation analyses showed that individuals with greater minority burden"
"individuals with greater minority burden (i.e., the number of minority statuses, including being gay or bisexual, nonwhite, disabled, low-income, foreign-born, and speaking English as a second language) experienced greater HIV-related stigma, which was associated with greater mental health burden"
A significantly higher proportion of women than men met criteria for depression (17.9% versus 14.3%, P = 0.01)
A nearly significantly higher proportion of women than men screened positive for anxiety (35.3% versus 32%, P = 0.07)
a higher proportion of women than men had both depression and anxiety (13.9% versus 11.5%, P = 0.06), stopped just short of statistical significance
More Depression in HIV+ Women Than Men, Regardless of ART,
in 15-Country Study
http://www.natap.org/2012/HIVwomen/HIVwomen_02.htm
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"The process of aging may be more challenging for people living with HIV than for the general population. This is because of the detrimental effects that HIV and its treatment have on normal aging processes as well as other factors, such as HIV-related stigma, loss of friends and social networks.....
The more medical comorbidities someone experiences, the poorer their quality of life
Older people with HIV often compare themselves to their HIV-peers and report experiencing an earlier and more rapid decline in health, which increases anxiety about the future
About 50% of people living with HIV will develop HIV-associated neurocognitive impairments and disorders (HAND)......healthcare providers, front-line workers, and policy makers should have a greater understanding of the experience of aging with HIV......policy makers......HAND can have damaging effects on older adults' psychosocial well being
healthcare providers, front-line workers, and policy makers should have a greater understanding of the experience of aging with HIV......policy makers need to develop new policies or adapt the existing ones to improve their social and economic outlook......intersection of HIV, aging, and health raises a host of issues that health research, policy, and practice need to address, including challenges related to mental health, quality of life, neurocognitive functioning, social isolation and support, and coping with aging and HIV......Front-line providers at AIDS service organizations will need to develop and integrate more programs and services that mitigate the social isolation and stigma experienced by many older people with HIV and help them cope with aging with HIV.....Interdisciplinary teams will need to find new ways to organize care and share the knowledge and skills required to address the complex mental health needs of older people with HIV in an environment in which no single discipline holds all the expertise......housing models could remove some of the barriers to subsidized housing and ensure that retirement homes and long-term facilities become more welcoming places for older people with HIV"
We have identified key areas for future research in psychosocial well being and increasing age with HIV, including effective strategies and the healthcare resources (e.g., multidisciplinary clinics and teams including psychologists, social workers, and nurse practitioners) to help older people with HIV deal with the issues related to disclosure and negotiating safer sex, and studies to understand the reciprocal relationship between psychosocial well being and HIV prevention; effective cognitive rehabilitation and behavioral treatments for neurocognitive impairment associated with HIV, especially the milder forms of HAND; interventions tailored to the needs of older adults living with HIV that target modifiable factors such as emotional or information social support and self-efficacy, which can have a positive impact on quality of life; population and context-specific interventions to help older adults living with HIV develop and nurture their own coping strategies; the epidemiology of mental health and brain health in cohorts of older people with HIV, including the use of common measures to characterize their status and needs, and document and monitor other strength-based factors that may mitigate the health decline of older people with HIV (e.g., resilience); longitudinal studies exploring the process of aging with HIV, which should result in causal inferences about the factors that could increase psychosocial well being; and qualitative research to explore in depth the subjective, lived experiences of older people with HIV, which will help health planners and policy makers address the contextual challenges of aging with HIV
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