Special Report: The Aging AIDS Epidemic
Older HIV patients have different counseling needs
Prevention messages often lacking for older people
Older people with HIV often lack or fail to take advantage of psychosocial networks, including support groups, housing assistance, and treatment for mental health problems, according to recent research.
In an Australian study presented at the 15th International AIDS Conference, held July 11-16, 2004, in Bangkok, Thailand, HIV patients age 50+ were significantly less likely to use services routinely accessed by younger people with HIV, including health, housing, Internet, mental health, alternative therapies, counseling, and treatment services.1
The older HIV group used less of both HIV and non-HIV related services, says Marian Pitts, professor, and director of the Australian Research Centre in Sex, Health and Society at La Trobe University in Melbourne, Victoria.
"Older persons living with HIV/AIDS are living with more complex comorbidity, both with other physical conditions and with elevated levels of mental distress," Pitts says.
Are older AIDS patients more mellow?
Not all the research has found that psychological problems are worse with the older cohort of HIV patients. Another study of mostly U.S. subjects, presented at the recent conference found that HIV patients 50 and older rated their psychological condition significantly better than people 49 and younger.2
One reason for these findings could be the general trend for people to have less angst as they get older, says Kathleen N. Nokes, PhD, RN, FAAN, professor at Hunter-Bellevue School of Nursing in New York City.
Both the Australian and U.S. studies found that older people with HIV are more likely to live alone and have fewer social support networks than younger people with HIV.
The Australian study found that HIV patients younger than 50 were seven times more likely to be in a relationship than those who were 50 and older.1
Older HIV patients who live alone may run into problems when they need the sort of physical support, such as transportation, home care, carrying groceries, etc., that most people take for granted, Nokes says.
For instance, a 65-year-old AIDS patient may begin to have functional impairments, such as difficulty walking one block and carrying heavy packages, Nokes explains.
"Now they need help, and they haven’t been forthcoming in getting themselves help; and that kind of worries me," she points out. "There’s not going to be as much of a cushion for someone like that."
Traditional support groups may not work for older HIV patients because it’s hard to receive group support for HIV and comorbidity issues when the person sitting next to you is an HIV-infected teenager, Nokes notes.
"A lot of service providers are 25 years old, and it’s really hard for these service providers to look at this person who is 55 and looks like a grandmother and then talk to her as an authority figure," she says. "They have to deal with an ageist attitude."
Since there is no single picture of what an older HIV-infected person might need in terms of psychosocial support, it’s important to provide a set of services that will help people deal with the long-term implications of HIV infection, says Terje Anderson, executive director of the National Association of People Living With AIDS in Washington, DC.
"Programs need to be tailored to the starting point of what a person is dealing with," he says. "If a person is low-income, on welfare, and living in public housing, then that person’s set of needs for living long-term with this disease may be different from someone who is working a job that pays $80,000 a year."
Additional support needed
Also, older, long-term HIV patients will need additional adherence and booster support after they’ve been on antiretroviral medications for a number of years, suggests Michael Hickson, MD, chief medical officer of Housing Works in New York City.
"I may have a patient whose been stable for years; and all of a sudden, there’s a boost in the viral load, so I counsel him and refer him to a social worker or case manager, and depending on my counseling and what comes out of it, I might refer him to a psychologist or support group," he continues.
Providing prevention services to older people and identifying older people at risk for HIV infection also present a challenge to investigators and clinicians.
Investigators studied HIV infection and risk exposures among older adults living in low-income, senior housing complexes and found most of the people infected with HIV did not have new infections, although some residents continued with risk behaviors.3
Researchers theorized that the HIV infections they did find in these housing complexes were acquired before the people moved into the senior housing community, says Jean J. Schensul, PhD, a medical anthropologist and director of the Institute for Community Research in Hartford, CT.
"We did find some previously undiagnosed HIV infections, but the rates were low," she adds. "What we did find was there is risk exposure, including exchanges between older male residents in the study and younger commercial sex workers."
The other interesting finding was that residents who were older than 62 tended to not know much about HIV risk and prevention, Schensul continues.
"The older people have been out of the loop, and there’s not much in the way of HIV prevention and information that’s coming to them or directed toward them," she says. "So our study brought in people to do HIV education and stigma reduction education."
Investigators also found that older people who had not been diagnosed with HIV sometimes would have the infection, although its symptoms were masked by other symptoms related to chronic health problems associated with aging, she explains.
"The health care system is deteriorating for them, especially if they’re older and poorer, so this is a huge problem," Schensul says.
Clinicians at least could provide older patients with a personal tool for assessing their HIV risk, she notes.
"We have to look to the future," Schensul points out. "We have increasing numbers of people who are aging with HIV, and among those will be lower income African American men and women and people who will live in special housing facilities."
1. Pitts MK, Grierson W, Thorpe R, et al. Growing older with HIV. Presented at the 15th International AIDS Conference. Bangkok, Thailand; July 2004. Abstract: MoOrD1092.
2. Hamilton MJ, Corless IB, Sefcik EF, et al. Identifying differences in older (50+) and younger persons living with HIV/AIDS. Presented at the 15th International AIDS Conference. Bangkok, Thailand; July 2004. Abstract: WePeD6492.
3. Schensul JJ, Levy JA, Disch WB. Individual, contextual, and social network factors affecting exposure to HIV/AIDS risk among older residents living in low-income senior housing complexes. J Acquir Immune Defic 2003; 33(2):S138-S152.