Interdisciplinary Topics in Gerontology and Geriatrics

In addition to physical health challenges, older people living with HIV/AIDS (PLWHA) experience mental health burdens and challenges to their social well-being that diminish their overall health. These health states are synergistic and are driven by HIV and HIV treatments, the aging process itself, and psychosocial and structural conditions of their lives. However, resilience, which we understand as both a trait and a process, may serve to buffer the effects that HIV/HIV treatments, aging, and social/structural conditions may have on the overall well-being of the individual...

Over 50% of adults with HIV exhibit some form of HIV-associated neurocognitive disorder, ranging from mild asymptomatic neurocognitive impairment to HIV-associated dementia. As adults age with HIV and become susceptible to cardiovascular and metabolic comorbidities, the prevalence and severity of such neurocognitive disorders are likely to increase. With compromised renal and hepatic functioning often accompanying HIV, pharmaceutical interventions to address such neurocognitive disorders may not be the best strategy and are not without risks...

Social networks of older adults with HIV have been characterized as fragile, with a greater reliance on friends as compared to family. However, we know little about the subgroup differences in the social network constellations of this population, how such characteristics are related to social support resources, and their relationship with psychosocial well-being. We developed a typology of social networks of older HIV-positive adults and examined if they would be related to receipt of informal assistance, perceptions of support sufficiency, and psychosocial well-being...

Both the Joint United Nations Program on HIV/AIDS and the US National HIV/AIDS Strategy identify HIV stigma as a barrier to care, a barrier to service access, and deleterious to personal and social well-being. This chapter discusses the topic of HIV stigma from a conceptual basis, including the mechanisms of prejudice and discrimination, and defining anticipated, enacted, and internalized stigma. Stigma is then placed in a historical context of HIV and AIDS, and events exacerbating HIV stigma are discussed...

Sexuality is an important aspect of health across the lifespan and includes sex, gender identities, sexual orientation, intimacy, pleasure, reproduction, and free from coercion and discrimination. In 2010, individuals 50 years and older living with HIV in the US made up 8.5 per 100,000 persons affected by the virus, with African Americans accounting for 46% of seroconversion in the same year, which was 10.7 times greater than Whites. African American women are particularly at-risk. Although there are many promising HIV prevention interventions to date, there are few that focus specifically on older adults...

People aging with HIV present a unique challenge for providers. HIV-infected patients experience accentuated aging and multimorbidity, but are typically disconnected from geriatric care, which is limited by a shortage of geriatric providers worldwide. Consequently, HIV providers are tasked with managing multiple age-related illnesses, within service networks that are historically not designed to care for aging patients. While comfortable with the management of antiretroviral therapy, HIV providers may have limited training on how to recognize or manage geriatric syndromes, especially in the context of multimorbidity...

Persons surviving to older ages with HIV/AIDS often face an accelerated aging accompanied by increased comorbidity and decline in health and function. In this chapter, we review the process of disablement among persons aging with HIV/AIDS, from chronic conditions to impairments and functional limitations, leading to disability. Chronic immune activation related to chronic HIV infection may contribute to early development of chronic conditions that are common in older adults resulting in premature disablement...

In this chapter, we will describe the state of the literature on behavioral health, which includes mental health and substance use problems, and the available treatment interventions to ameliorate these problems, for older adults living with HIV (OALH). The scientific literature on the behavioral health of OALH is highly underdeveloped, especially in terms of the creation of empirically supported interventions to alleviate psychological distress. From the literature that does exist, there are a number of salient factors that emerge, including stereotypes (i...

Nearly 50% of HIV patients in the US are now over 50, and the problem of comorbidities associated with the aging process is becoming increasingly complicated. In this chapter, we will review the challenge of polypharmacy and suggest ways of minimizing drug-drug interactions. Newer medications and combinations that reduce the pill burden, and allow the healthcare provider to customize HIV treatment while remaining mindful of other medical issues will be addressed. Adherence to medication schedules and possible future alternative drug delivery systems will also be presented...

With effective antiretroviral therapy, HIV has become a chronic disease, and life expectancy among HIV-infected persons is approaching that of HIV-uninfected persons. Despite this success, epidemiologic evidence suggests that the burden of multiple aging-related diseases, including cardiovascular disease, liver disease, metabolic abnormalities, chronic kidney disease, cognitive dysfunction, and osteoporosis, is higher in HIV-infected persons compared to their HIV-uninfected peers. These comorbid diseases tend to cluster in a single person, leading to multimorbidity and polypharmacy...

HIV infection may potentiate specific biomarkers that influence the development of premature clinical indices commonly associated with aging. Therefore, predicting mortality outcomes in people living with HIV is extremely important as this population ages. This chapter describes biomarkers associated with inflammation, coagulation, and immune activation in HIV, and reviews the association between specific biomarkers and the development of co-morbid conditions in individuals with HIV. Measures that incorporate specific biomarkers related to HIV infection, designed to predict mortality outcomes in individuals with HIV, are also discussed...

Aging is a complex biological process that leads to several physiological changes. Among these changes, the most striking are those involving the innate and adaptive parts of the immune system. Furthermore, these changes are associated with a low-grade inflammation called inflamm-aging, which is the result of several lifelong antigenic stimulations, including chronic viral infections such as cytomegalovirus. Immunosenescence, concomitantly with inflamm-aging, is considered as the leading cause of age-related diseases including cardiovascular, neurodegenerative and metabolic diseases, and cancer...

With increasing success in treating HIV, infected persons are living longer, and a new challenge has emerged - the need to understand how HIV-infected adults are aging. What are the similarities with typical aging and what are the unique aspects that may have resulted from HIV infection, interacting with characteristic life style factors and other comorbid conditions? Are specific diseases and conditions (comorbidities), typically seen as part of the aging process, occurring at accelerated rates or with higher frequency (accentuated) in HIV-infected adults? At this juncture, conclusions should be tentative...

This introduction serves to foreground current patterns associated with HIV and aging, globally. We highlight key trends by World Health Organization sub-region, and identify gaps in existing knowledge. HIV and aging is insufficiently documented, as prevalence data for those over age 49 have not generally been captured by many countries, or by UNAIDS. Despite limited data and data systems, several dominant trends among adults aged 50 and older are discernible, including: growing HIV risk and prevalence is increasingly evident among maturing adults, worldwide; older individuals at risk of or living with HIV, and their health providers, fail to recognize risk and symptoms, leading to disease progression and delayed treatment...

No abstract text is available yet for this article.

Both intrinsic and extrinsic factors contribute to health. Intrinsic factors are familiar topics in health research and include medical conditions, medications, genetics and frailty, while extrinsic factors stem from social and physical environments. This chapter builds on others in this volume, in which a deficit accumulation approach to frailty has been described. The concept of social vulnerability is presented. Social vulnerability stems from the accumulation of multiple and varied social problems and has bidirectional importance as a risk factor for poor health outcomes and as a pragmatic consideration for health care provision and planning...

Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons...

In this chapter, we consider how health and social care can best be organized for older people with frailty. We will consider the merits of routine frailty identification, including risk stratification methods, to inform the provision of evidence-based treatment and holistic, goal-oriented care. We will also consider how best to place older people with frailty at the heart of health and social care systems so that the complex challenges associated with this vulnerable group are addressed.

The increasing prevalence of frailty within the aging population poses challenges to current models of chronic disease management and end-of-life care delivery. As frailty progresses, individuals face an increasing frequency of acute health issues requiring medical attention. The ability of health care systems to recognize and respond to acute health issues in frail patients using a holistic understanding of health and prognosis will play a central role in ensuring their effective and appropriate care, including that at the end of their lives...

Rehabilitation approaches to frailty are in the early stages of development. Frailty also shows promise as a prognostic indicator for rehabilitation programs, similar to its application in other areas of medicine. However, care should be taken not to exclude frail older people from rehabilitation, as has been the case at some centers for people with cognitive impairment or very severe disability. There are clear theoretical reasons to expect that a rehabilitation approach will be effective. Some experimental data are also available suggesting that rehabilitation is effective in frail and pre-frail older people...