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"Aging well" more frequent than frailty in Canadian HIV group
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9th International Workshop on HIV and Aging, September 13-14, 2018, New York
from Jules: its noteworthy that 14% were "aging well" in this 800 person cohort in Canada.
Today the 2nd and last day of the Aging Workshop ended with a panel discussion where we discussed what needs to be done for aging to get the attention it needs, and I said national advocates have dismissed and ignored the aging psyco-social problems of those aging with HIV over 65: loneliness, social isolation, PTSD, depression, reduced mobility, cognitive impairment, physical impairment, inability to navigate the healthcare system. Yes advocates who say they speak for HIV+ only promote cure & prevention, and ignore aging; they don't understand the impact and do not represent the interests of people with HIV.
Mark Mascolini
A cross-sectional study of 802 Canadian adults with HIV found that 14% met criteria for aging well, compared with 8% who met criteria for frailty [1]. Factors that favored aging well included maintaining physical activity, better cognitive performance, and having a social network.
Much research has focused on rates and risk factors for clinically defined frailty in people with HIV [2,3]. A recent AIDS Clinical Trials Group (ACTG) analysis of 1016 HIV-positive people 40 or older determined that 6% were frail and 38% met prefrailty criteria* [4]. But little research addresses rates of aging well among people with HIV, and factors that contribute to aging well. Understanding factors that favor aging well could help clinicians promote healthier aging.
Researchers from Montreal's McGill University and collaborators at other Canadian centers aimed to explore those issues in HIV-positive adults enrolling in the Positive Brain Health Now cohort. People entering that cohort must be 35 or older and have HIV for at least 1 year. So far 856 people have enrolled, 84% of them men.
The research team assessed aging well with 8 subscales of the SF-36, which measures health and quality of life [5]. The subscales are physical function, pain, vitality, social function, role physical, role emotional, mental health, and self-rated health. The investigators used data from the general Canadian population to classify HIV-positive people as at or above norms for age and sex on each subscale. They defined aging well as being at or above the norm on 7 or 8 of the 8 subscales.
This analysis included 802 people making their first cohort visit. Age averaged 53 years and ranged from 35 to 81. Overall 19% of cohort members stood at or above the norm on none of the SF-36 subscales, 7% stood at or above the norm on all subscales, and 5% stood at or above the norm only for physical function. While 14% of cohort members met aging-well criteria, 8% met standard frailty criteria. The frailty rate is similar to the 6% frailty prevalence in the ACTG study [4]. (The Canadian study did not determine prefrailty prevalence.)
Factors associated with aging well were having a university education, not having arthritis or lung disease, better cognitive testing, having fewer self-reported cognitive problems, being physically active, having friends or family, not being lonely, low stigma, and not smoking. Factors not related to aging well were age, sex, nadir CD4 count, body mass index, drinking alcohol, cardiovascular risk, global comorbidity, hours of meaningful activities, and inflammation (C-reactive protein).
The researchers stressed that the cross-sectional nature of this analysis means factors linked to aging well cannot be considered causal. They observed that certain factors often determined early in life (like education, friends, and physical activity) appear to favor aging well. And they suggested that other factors (like lower stigma, less loneliness, and better cognition) may contribute to, rather than result from, aging well.
The Canadian team proposed that more research on aging well with HIV may not only promote successful aging, but also identify ways to arrest frailty. From the glass-half-empty perspective, it is worth noting that about 6 of 7 study participants were not aging well.
References
1. Mayo N, Brouillette M, Harris M, et al. Aging with HIV: I'm fine, thanks for asking. 9th International Workshop on HIV and Aging, September 13-14, 2018, New York. Abstract 2.
2. Piggott DA, Erlandson KM, Yarasheski KE. Frailty in HIV: epidemiology, biology, measurement, interventions, and research needs. Curr HIV/AIDS Rep. 2016;13:340-348.
3. Leng SX, Margolick JB. Understanding frailty, aging, and inflammation in HIV infection. Curr HIV/AIDS Rep. 2015;12:25-32.
4. Erlandson KM, Wu K, Koletar SL, et al. Association between frailty and components of the frailty phenotype with modifiable risk factors and antiretroviral therapy. J Infect Dis. 2017;215:933-937. www.natap.org/2017/HIV/jix063.pdf
5. RAND Health. 36-Item Short Form Survey (SF-36).
https://www.rand.org/health/surveys_tools/mos/36-item-short-form.html
*In the ACTG study [4], prefrailty meant fulfilling 1 or 2 of 5 frailty criteria.
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