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Disabilities common in older patients with HIV
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Disabilities relating to daily tasks and household activities are common among middle-aged and older adults with HIV who are receiving effective ART, study data showed.
“The success of ART has changed the characteristics of the HIV/AIDS epidemic, such that an estimated 70% of persons living with HIV may be older than age 50 by 2030,” Kristine M. Erlandson, MD, assistant professor in the division of infectious diseases at the University of Colorado-Anschutz Medical Campus, and colleagues wrote. “Multiple studies in the current ART treatment era indicate that older, HIV–infected adults are at increased risk of both frailty and disability. The identification of factors that contribute to disability, particularly if modifiable, can inform development of interventions to prevent or limit disability in the vulnerable population of older, HIV–infected adults and ultimately improve quality of life.”
The researchers performed an observational study of 1,015 participants with HIV from the larger ACTG A5322 HAILO study. Johs and colleagues evaluated self-reported disability as defined by the Lawton-Brody Instrumental Activities of Daily Living Questionnaire, as well as frailty, measured by 4-meter walk speed, grip strength, unintentional weight loss in the past year, exhaustion and low activity.
Median age was 51 years, and most patients (81%) were men. Twenty-nine percent of patients were black, and 20% were Hispanic.
Of the total cohort, 18% reported experiencing at least one impairment, the researchers wrote. The most common impairment was with housekeeping (48%), followed by transportation (36%); medication management was the least common (5%). Greater disability was associated with neurocognitive impairment, lower education, Medicare or Medicaid insurance, smoking and low physical activity, according to Johs and colleagues. The researchers wrote that a greater proportion of participants who were considered frail had an impairment (52%) when compared with non-frail patients (11%); however, they noted that agreement was poor.
“Our findings identified modifiable factors (smoking, low physical activity) as potential targets for interventions designed to reduce Instrumental Activities of Daily impairment and to maintain independent living,” Johs and colleagues wrote. “Interventions aimed at improving socioeconomic status and support networks of those aging with HIV would likely have a significant beneficial impact on health, but would be increasingly challenging to implement at a systemic level. Lastly, by identifying persons at highest risk for disability, health providers can ensure that daily needs are met and these individuals are linked to appropriate resources.” – by Andy Polhamus
Disclosure: Johs reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.
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