Associations of loneliness with cognitive function and quality of life (QoL) among older HIV+ adults

Transcription

1 Associations of loneliness with cognitive function and quality of life (QoL) among older HIV+ adults Marianne Harris, Marie-Josée Brouillette, Nancy Mayo, Fiona Smaill, Graham Smith, Réjean Thomas, Lesley Fellows 9 th International Workshop on HIV & Aging 2018 New York, USA September 13-14, 2018 Oral abstract #12

2 Background Loneliness, a perceived state of undesirable social isolation, is associated with adverse emotional and physical health outcomes in the general population 1. People living with HIV often face unique challenges that heighten their risk for loneliness and its consequences, including stigma, depression, substance use, lack of social connections, and physical symptoms related to HIV or comorbid conditions Valtorta NK, et al. Heart 2016; 102: Greene M, et al. AIDS Behav 2018;22:

3 Research objectives Among a Canadian cohort of older adults living with HIV, to estimate: the prevalence of loneliness the strength of the associations between loneliness and factors hypothesized to contribute to loneliness, and factors hypothesized to be consequences of loneliness.

4 Positive Brain Health Now cohort study 5 outpatient HIV clinics in Canada Eligibility criteria 35 years old HIV + for at least 1 year No dementia/known CNS disorder Able to provide informed consent Study visits every 9 months Medical information Blood tests Cognitive tasks Questionnaires NE Mayo et al. BMC Neurology, 2016, 16:8

5 Methods Cross-sectional analysis of data collected during the first study visit Loneliness was assessed by one item from the OARS Social Resource Scale 1 Do you find yourself feeling : quite often, sometimes or almost never? Cognitive function was assessed using: a computerized battery of cognitive tests (B-CAM) 2 the perceived deficit questionnaire (PDQ) 3 1. Fillenbaum GG, Smyer MA. J Gerontology 1981; 36: Koski L, et al. HIV Medicine 2011;12(8): Sullivan M, Edgley K, DeHoux E. Can J Rehabil. 1990;4:

6 Statistical methods Proportional odds regression and multiple linear regression were used to estimate the strength of the association between loneliness and cognition and other health outcomes, adjusting for age, sex and education.

7 Assessing the life impact of HIV: the Wilson-Cleary model Structural Equation Modeling (SEM) to identify the inter-relationships between variables of interest Health condition Wilson, I. B., & Cleary, P. D. JAMA 1995; 273(1),

8 Results

9 Study population 856 participants enrolled in the cohort between October 9, 2013 and June 8, responded to the loneliness question and were included in this analysis: 709 (85%) men 127 (15%) women mean age 52.0 years (SD 8.3) 591 (71%) Caucasian Do you find yourself feeling % % % 305 Quite often Sometimes Never

10 Outcomes Associations between loneliness and demographic and HIV-related variables Quite often (N=148) Sometimes (N=383) Never (N=305) P value Age, years <0.05 Insufficient funds % 18.7% 7.3% <0.001 Lung disease 16.9% 19.9% 11.8% <0.05 HIV Symptoms 2 Average number / <0.001 Severity Weighted <0.001 Score Weakness (any) 69.5% 61.8% 44.2% <0.001 Data shown are mean or % 1. Item from WHOQOL HIV BREF: Have you enough money to meet your needs? (O Connell KA, Skevington SM. AIDS Behav. 2012;16: ) 2. Revised sign and symptom checklist for HIV (SSC-HIVrev.) (Holzemer WL et al. JANAC 2001; 12:60-70.) Proportions reporting loneliness did not differ (P>0.05) between men and women, by ethnicity (Caucasian vs other), university education, time since HIV diagnosis, AIDS-defining illness, current CD4 count, viral load <50 copies/ml, C-reactive protein, or total comorbidity burden (Charlson comorbidity index)

11 Potential contributors to loneliness Outcomes (0-100; Higher is better unless otherwise stated) Quite often (N=148) Sometimes (N=383) Never (N=305) P value Stigma % 13.4% 6.0% <0.001 Fewer than 5 close 71.0% 51.2% 29.9% <0.001 people 2 Motivation: No 23.8% 9.8% 7.2% <0.001 plans/goals 3 RAND SF-36 Pain <0.001 RAND SF-36 Vitality <0.001 RAND SF-36 PF <0.001 Not working or volunteering 34.5% 31.1% 22.9% <0.05 Data shown are mean or % PF= Physical Function 1. Item from WHOQOL HIV BREF: To what extent are you bothered by people blaming you for your HIV status? Very much or An extreme amount (O Connell KA, Skevington SM. AIDS Behav 2012;16: ) 2. Item from OARS Social Resource Scale: How many people do you know well enough to visit within their homes? (Fillenbaum GG, Smyer MA. J Gerontology 1981; 36: ) 3. Item from Starkstein Apathy Scale: Do you have plans and goals for the future? Not at all vs. some/a lot (Starkstein SE et al. Stroke 1993; 24: )

12 Lifestyle factors Outcomes Quite often (N=148) Sometimes (N=383) Never (N=305) P value Hours physical activity per week <0.001 Seldom active 37.4% 22.1% 19.9% <0.001 Hours of TV per week <0.05 Opioid use 14.6% 10.4% 5.4% <0.05 Current smoker 40.1% 31.3% 28.4% NS Data shown are mean or % No association with smoking, alcohol consumption, marijuana use or use of most other drugs (benzodiazepines, inhalants, amphetamines, hallucinatory drugs, cocaine) with the exception of opioids which was associated with loneliness independently of pain.

13 Consequences of loneliness to cognition and mental health Outcomes (Higher is better unless otherwise stated) Quite often (N=148) Sometimes (N=383) Never (N=305) P value Cognitive Ability B-CAM (0 40) <0.001 PDQ (0 100 worst) <0.001 Stress TICS (0 100 worst) <0.001 Mental Health RAND SF-36 MHI (0-100) Depression risk (RAND MHI <60) WHO5-Wellbeing (0 100) HADS (0-14 worst) < % 45.8% 16.1% < <0.001 Depression <0.001 Anxiety <0.001 Data shown are mean or % TICS, Trier Inventory for the Assessment of Chronic Stress MHI, Mental Health Inventory HADS, Hospital Anxiety and Depression Scale

14 Consequences of loneliness to self-rated health and QoL Outcomes (Higher is better unless otherwise stated) Quite often (N=148) Sometimes (N=383) Never (N=305) P value Self-rated health by RAND SF-36 <0.001 Excellent or Very good 25.0% 45.1% 61.3% Good 48.6% 40.6% 29.2% Fair or Poor 26.3% 14.4% 9.5% Self-rated Health Today by VAS (0-100) <0.001 Health-related Quality of Life (HRQL) EQ-5D Utility (0-1) <0.001 SF-6D (0 1) <0.001 Quality of life by WHO QOL BREF Excellent or Very good 37.8% 68.6% 89.8% Good 29.1% 24.3% 6.2% Fair or Poor 33.1% 7.1% 3.9 % <0.001 Quality of life by PGI <0.001 Data shown are mean or % VAS, Visual Analogue Scale PGI, Patient-Generated Index

15 Loneliness and SF-36 GHP General health perception PFI PAIN Often Sometimes Almost never Contributors 20 SOCIAL Social functioning 0 VITAL Vitality (energy/fatigue) ROLEM Role limitations due to emotional problems p<0.001 ROLPH Role limitations due to physical health MHI Mental health inventory (emotional well-being)

16 Model of Loneliness Contributors to Consequences of Downstream effects This model suggests that loneliness impacts on QOL through activity, poor lifestyle choices, impaired cognition, stress, and depression.

17 Limitations Mostly (85%) men, 71% Caucasian Cross-sectional analysis Directionality of associations, e.g. Loneliness depression Loneliness cognitive decline Other measures of loneliness e.g. UCLA 8, 10, and 20 item scales include severity Need qualitative information on the experience of loneliness from the patient s perspective

18 Conclusions In this cohort of HIV+ adults aged >35 years, 64% experienced loneliness sometimes or quite often. The results support that physical symptoms (e.g. pain, fatigue), apathy, stigma, and restricted social network contribute to loneliness and that loneliness has consequences for reduced activity, poor lifestyle choices, impaired cognition, stress, and depression, all of which contribute to poor quality of life. Interventions to engage people in socially meaningful activities, shown to be effective for loneliness in other conditions, should be developed for older adults living with HIV.

19 Acknowledgments The participants of the Positive Brain Health Now cohort (CTN 273) The research assistants Melissa Vu Laurence Desjardins Sandra Mendoza Marianna Rusler Tsubasa Kozai, Esther Eyawo, Maryam Asadian The community partners Hesham Ali Kenneth Monteith Heidi Exner