Growing Older With HIV/AIDS

New Public Health Challenges

Sean Cahill, PhD; Robert Valadéz, MSW

Disclosures

Am J Public Health. 2013;3(3):e7-e15. 

In This Article

Caregiving for Older Adults With HIV/AIDS

Many older adults living with HIV/AIDS are disconnected from traditional informal support networks, and rely heavily on formal care providers.[52] This is especially true of gay men with HIV, many of whom have been rejected by family members. However many people living with HIV, including racial minority women, do rely on informal caregivers. Informal caregivers in the United States report high rates of depression[53] and emotional burden related to nondisclosure of the HIV status of the person for whom they care.[54] Informal caregivers often have less time to parent and to work, causing stress that can correlate with depression and an end to caregiving assistance.[55]

Caregivers of people living with HIV/AIDS often experience "stress proliferation," a process whereby "stressors … beget stressors."[56(p223)] Primary stressors, such as the physical and emotional burden of providing caregiving assistance, can beget secondary stressors in roles and activities outside caregiving. This can occur as one's caregiving role grows and becomes perceived as all-consuming. It also occurs when the strains caused by the caregiving role affect the other roles and activities of the caregiver, such as parent, spouse or partner, and employee.[56] A study of female caregivers of men with HIV (mothers and wives of the men) found that future uncertainty was a key element in the stress proliferation process for both female caregivers and the men living with HIV who were care recipients. It was positively associated with depressive symptomatology for men with HIV, but not for the caregivers.[47]

Caring for older people with HIV/AIDS raises a new set of challenges. The Social Security system and elder care nationwide are already feeling the burden of the first cohort of "baby boomers" to reach retirement, a trend that will increasingly strain resources in subsequent years. Older adults with HIV/AIDS will add to this burden, with additional needs related to medical complications of HIV/AIDS.

Cognitive decline is a pressing concern among caregivers of older adults. HIV and age each can have profound effects on the brain and both appear to be predictors of neuropsychological impairment. In one study from the pre- HAART era, HIV-related dementia was 3 times more prevalent among HIV-positive people older than 75 years than among those younger than 35 years.[57] After the advent of HAART, cognitive impairment dramatically decreased among those living with the virus. However, research shows that the frequency of HIVrelated cognitive impairment is rising as people with HIV live longer.[58,59] The severity of cognitive impairment is associated with poorer quality of life.[60]

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