Psychosocial issues for older adults living with HIV/AIDS

Key take-home messages

• Older adults may be at greater risk of HIV-related neurocognitive dysfunction and several stressors are associated with aging with HIV, including ageism, HIV-related stigma, declines in social support, increased feelings of loneliness, declines in health status, financial distress, mitochondrial damage that may contribute to fatigue, and changes in appearance caused by lipodystrophy.
• The cognitive and neurological changes that occur with aging and with HIV may place some individuals at risk for depression and suicidal ideation. Loneliness and HIV-related stigma emerged as significant independent predictors of major depressive symptoms meaning that higher rates of stigma and loneliness place older adults at increased risk for major depressive symptoms.
• A high prevalence of psychiatric and neurocognitive problems among middle-aged and older HIV-infected individuals has been observed. Depressive symptoms appear to decrease with age, but HIV-positive older people are more likely to have depressive symptoms than their HIV-negative counterparts, and the difference in prevalence grows with age.
• Alcohol abuse or dependence is equally common among HIV-positive older people and their HIV-negative counterparts, but older HIV-positive people are more likely to have a diagnosis of alcohol abuse or dependence than their HIV-negative age-matched counterparts. In addition, current drug abuse or dependence is more common among HIV-positive older people than HIV-negative counterparts, and older HIV-positive people are more likely to report drug use than their age-matched counterparts.
• The odds of meeting HIV-associated dementia (HAD) criteria among older individuals is 2.13 times that of the younger age groups. There is also an increased risk of cognitive impairment among older HIV-positive adults. An increased risk of impairment was associated with age and alcohol abuse, and greater education was protective.
• Older age has been found to be associated with significantly better medication adherence. HIV-infected adults aged 50 years or over are three times more likely to achieve a 95% adherence rate than are younger subjects. However, adherence levels have been found to decrease among those with cognitive impairment.
• Older people with HIV often express confusion in trying to understand the cause of their symptoms. This symptom ambiguity is potentially due to the fact that they can attribute symptoms to a variety of other plausible causes such as normal aging, preexisting conditions, or drug side effects in addition to HIV disease. Symptom ambiguity appears to lead to both confusion and psychological distress and may influence subsequent treatment behavior.

• Determinants of Health
  • Stigma/discrimination
• Population(s)
  • Older adults (>50 years)
  • General HIV+ population
• Engagement and Care Cascade
  • Treatment
• Substance Use
  • Alcohol
  • Nonmedicinal drugs
• Mental Health
  • Depression
  • Neurocognitive disorders