Aging and HIV: Living Life with Silver Hair

Transcription

1 Georgia Southern University Digital Southern 6th Annual Rural HIV Research and Training Conference Sep 21st, 4:30 PM - 5:15 PM Aging and HIV: Living Life with Silver Hair Barbara J. Blake Follow this and additional works at: Recommended Citation Blake, Barbara J., "Aging and HIV: Living Life with Silver Hair" (2018). 6th Annual Rural HIV Research and Training Conference This presentation (open access) is brought to you for free and open access by the Conferences & Events at Digital Commons@Georgia Southern. It has been accepted for inclusion in 6th Annual Rural HIV Research and Training Conference by an authorized administrator of Digital Commons@Georgia Southern. For more information, please contact digitalcommons@georgiasouthern.edu.

2 Barbara J. Blake, RN, PhD, ACRN, FAAN Kennesaw State University WellStar School of Nursing 6 th Annual Rural HIV Research and Training Conference September 21-22, 2018 Savannah, GA

3 Disclosure Information I do not have any conflicts of interest to disclose and I do not intend to discuss off label use of any drug or treatment during this discussion.

4 Describe the HIV epidemic among persons 50 years of age and older Review physical and mental health issues associated with aging and HIV Discuss how individuals living with HIV can age successfully

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6 Aging is normal and predictable Biological aging Genetics Environment Lifestyle (health behaviors) Ethnicity/race Influenced by Culture Aging beliefs

7 Approximately 34% of people living in the United States are 50 years of age or older Increase in adults 65 years of age over time % of the population % of the population 2030 >20% of the population Two drivers of mortality are smoking and obesity Ortman, Velkoff, & Hogan, 2014

8 Sexual Activity among Older Americans Percent At least once last year 2-3 times/month Male Female Age (yr) Lindau S.T., et al. (2007)

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11 Polling Question

12 In 2014, persons aged >50 accounted for approximately 45% of Americans living with HIV 2010 was 35% In 2015, people 50 years of age or older accounted for 17% (6,725) of new HIV diagnoses 43% Black/African American 36% Caucasian/White 17% Hispanic/Latino Centers for Disease Control and Prevention, 2018

13 Centers for Disease Control and Prevention, 2018

14 Centers for Disease Control and Prevention, 2018

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16 Persons 50 years of age and older who are living with HIV can experience high rates of comorbid illness such as: Cardiovascular disease Osteoporosis Non-AIDS defining cancers Diabetes Frailty Neurocognitive impairment Depression

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18 Persons living with HIV are times more likely to develop cardiovascular disease than the general population Biological HIV related risk factors Length of time someone is infected Dyslipidemia Abdominal fat accumulation Altered glucose metabolism Chronic inflammation caused by the virus

19 Traditional biological and environmental factors Smoking Lack of exercise Obesity Genetics Managing dyslipidemia Encourage lifestyle changes (diet and exercise) Possible ARV change Cholesterol or triglyceride lowering medication

20 Factors associated with development of hypertension Older age and family history Excess body weight Physical inactivity and unhealthy eating habits Excessive alcohol consumption Tobacco use Management similar to general population Need to be aware of potential drug interactions

21 Thinning of the bones Rate is 3 times higher in people living with HIV compared to general population Decrease in height and increase risk of fractures Women more likely to develop after menopause Other risk factors Low body mass Sedentary lifestyle Smoking and alcohol use Decreased intake of calcium and vitamin D

22 HIV related risk factors Immune dysregulation Chronic inflammation Initiation of ARVs Who should be screened for osteoporosis? Men 50 years of age or older Postmenopausal women Individuals with a history of a fracture or one or more risk factors for a fracture Persons receiving glucocorticoid treatment

23 Screening should be done using a dual x-ray absorptiometry (DXA) of the spine and hip Recommendation for reducing or preventing osteoporosis Calcium and vitamin D supplements Smoking cessation Decreased alcohol usage Weight bearing exercises If necessary, prescription medication to slow or reduce bone loss

24 AIDS defining cancers are decreasing, while non- AIDS defining cancers are increasing People living with HIV are 25 times more likely to develop anal cancer 5 times more likely to develop liver cancer 3 times more likely to develop lung cancer 10 times more likely to develop Hodgkin lymphoma Why is this happening?

25 Anal cancer is caused by human papillomavirus (HPV) Prevalence of anal HPV among men who have sex with women is 15%, MSM is 60% Currently there are no recommendations for routine anal cancer screening Some HIV specialists recommend anal cytological screening (anal paps) be offered to HIV positive men and women Anal paps should not be done unless there is access to high resolution anoscopy 24

26 Approximately 19% of the adults in the U.S. are smokers Rate of smoking is 2 3 times higher among people living with HIV Lung cancer is 2 4 times more likely to develop than non- HIV infected counterpart Diagnosed mid to late forties Smoking cessation and early screening

27 Changes in blood sugar levels can occur with aging Family history, obesity, or natural causes may lead to the development of diabetes Side effects from some HIV treatments also have been shown to cause diabetes Protease inhibitors have been associated with insulin resistance

28 Frailty is defined as a clinical syndrome in which three or more of the following criteria are present Unintentional weight loss (10 lbs. in past year) Self-reported exhaustion Weakness (grip strength) Slow walking speed Low physical activity

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30 Polling Question

31 Depression Severe anxiety HIV Associated Neurocognitive Disorder (HAND) Asymptomatic Mild AIDS Dementia Cognitive impairment Aging Alzheimer's

32 Isolation or loneliness Stigma: Being old and HIV positive Lack of support Need for long term caretakers Financial issues End of life concerns

33 It is mostly about diet, exercise, and tobacco cessation!

34 Polling Question

35 Healthy lifestyle Don t smoke Healthy eating fruits, vegetables, and whole grains Exercise Healthy weight Drink alcohol in moderation Adequate sleep

36 Calcium is one of the most important minerals for the growth, maintenance, and reproduction of the human body Dairy products are the most significant source of calcium Other sources of calcium Green leafy vegetables Salmon and sardines canned with their soft bones

37 Get at least 30 minutes of activity that makes you breathe hard on most or all days of the week Ten minutes at a time is fine Strength exercises build muscles Use weights Do things to improve balance Stretch

38 Brain training exercises have been proven to improve abilities such as memory and learning and offset or eliminate diseases like Parkinson's, Alzheimer's and Dementia

39 Reading, writing, or doing crossword puzzles Play cards, bingo or board games Engaging in activity that requires thought, such as Tai Chi, yoga or dancing. Employing hand-brain coordination Use a computer mouse or play video games Stimulating the brain by traveling Break up an accustomed daily routine to try doing different things

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44 AETC HIV and Aging Work Group. (2015). HIV and aging tool kit. Retrieved from Blake, B. J., & Taylor, G. A., (2017). Learning to age successfully with HIV. In F.M. Parks, G.S. Felzein, & S. Jue (Ed.) HIV/AIDS in rural communities. (pp ). Cham, Switzerland: Springer International Publishing Centers for Disease Control and Prevention. (2018) HIV among people aged 50 and over. Retrieved from Lindau S.T., et al. (2007). A study of sexuality and health among older adults in the United States. New England Journal of Medicine, 357(8), Ortman, J., Velkoff, V., & Hogan, H. (2014). An aging nation: The older population in the United States. Retrieved from: 43