Disability Among Middle-Aged and Older Persons With Human Immunodeficiency Virus Infection.

TitleDisability Among Middle-Aged and Older Persons With Human Immunodeficiency Virus Infection.
Publication TypeJournal Article
Year of Publication2017
AuthorsJohs NA, Wu K, Tassiopoulos K, Koletar SL, Kalayjian RC, Ellis RJ, Taiwo B, Palella FJ, Erlandson KM
JournalClin Infect Dis
Volume65
Issue1
Pagination83-91
Date Published2017 Jul 01
ISSN1537-6591
Abstract

Background: Older human immunodeficiency virus (HIV)-infected adults may experience higher rates of frailty and disability than the general population. Improved understanding of the prevalence, risk factors, and types of impairment can better inform providers and the healthcare system.

Methods: HIV-infected participants within the AIDS Clinical Trials Group A5322 HAILO study self-reported disability by the Lawton-Brody Instrumental Activities of Daily Living (IADL) Questionnaire. Frailty was measured by 4-m walk time, grip strength, self-reported weight loss, exhaustion, and low activity. Logistic regression models identified characteristics associated with any IADL impairment. Agreement between IADL impairment and frailty was assessed using the weighted kappa statistic.

Results: Of 1015 participants, the median age was 51 years, 15% were aged ≥60 years, 19% were female, 29% black, and 20% Hispanic. At least 1 IADL impairment was reported in 18% of participants, most commonly with housekeeping (48%) and transportation (36%) and least commonly with medication management (5%). In multivariable models, greater disability was significantly associated with neurocognitive impairment, lower education, Medicare/Medicaid insurance (vs private/other coverage), smoking, and low physical activity. Although a greater proportion of frail participants had IADL impairment (52%) compared to non-frail (11%) persons, agreement was poor (weighted kappa <0.18, 95% confidence interval, 0.13, 0.23).

Conclusion: IADL disability occurs frequently among middle-aged and older HIV-infected adults on effective antiretroviral therapy. Potentially modifiable risk factors (smoking, physical activity) provide targets for interventions to maintain independent living. Systematic recognition of persons at greater risk for disability can facilitate connection to resources that may help preserve independence.

DOI10.1093/cid/cix253
Alternate JournalClin. Infect. Dis.
PubMed ID28369402
PubMed Central IDPMC5815567
Grant ListUM1 AI069494 / AI / NIAID NIH HHS / United States
K23 AG050260 / AG / NIA NIH HHS / United States
UM1 AI068634 / AI / NIAID NIH HHS / United States
P30 MH062512 / MH / NIMH NIH HHS / United States
UM1 AI106701 / AI / NIAID NIH HHS / United States
U01 AI035039 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States