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Loneliness in Older Adults Living with HIV

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Abstract

We conducted a cross-sectional study among HIV-positive adults age ≥ 50 in San Francisco to evaluate the frequency of loneliness, characteristics of those who reported loneliness, and the association of loneliness with functional impairment and health-related quality of life (HRQoL). Participants (N = 356) were predominately male (85%); 57% were white; median age was 56. 58% reported any loneliness symptoms with 24% reporting mild, 22% moderate and 12% severe loneliness. Lonely participants were more likely to report depression, alcohol and tobacco use, and have fewer relationships. In unadjusted models, loneliness was associated with functional impairment and poor HRQoL. In adjusted models, low income and depression remained associated with poor HRQoL, while low income, higher VACS index and depression were associated with functional impairment. A comprehensive care approach, incorporating mental health and psychosocial assessments with more traditional clinical assessments, will be needed to improve health outcomes for the aging HIV-positive population.

Resumen

Realizamos un estudio transversal en adultos mayores de 50 años con VIH en San Francisco para evaluar la frecuencia de la soledad, características de aquellos que reportan soledad, y la asociación de la soledad con el deterioro funcional y la calidad de vida relacionada con la salud (HRQoL). Los participantes (N = 356) fueron principalmente hombres (85%); 57% de raza blanca, la mediana de edad fue 56 años. El 58% reportó cualquier síntoma de soledad con un 24% reportando soledad leve, 22% soledad moderada, y 12% soledad severa. En los participantes que refirieron soledad era más probable que reportaran depresión, consumo de tabaco o alcohol, y menos relaciones sociales. En modelos sin ajustar, la soledad estaba asociada con deterioro funcional y baja calidad de vida relacionada con la salud. En modelos ajustados, tener bajos ingresos y depresión continuaron teniendo asociación con una baja calidad de vida relacionada con la salud, mientras que tener bajos ingresos, un índice más alto de VACS y depresión estaban asociados con deterioro funcional. Un sistema de cuidado integral, incorporando la salud mental y valoraciones psicológicas y sociales con evaluaciones médicas tradicionales, serán necesarios para poder mejorar los índices de salud de las personas VIH positivas que envejecen.

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Acknowledgements

We would like to acknowledge Terrence Marcotte, NP for his contribution to this project at San Francisco General Hospital and Bill Blum, MSW at the San Francisco Department of Public Health for his role in organizing the Silver Project. We would like to thank Daniel W. Russell, Ph.D., Professor, Department of Human Development and Family Studies at Iowa State University for his assistance with cut points for the UCLA loneliness scale. We would also like to thank Mark Brennan-Ing, Ph.D., Director for Research and Evaluation, ACRIA—Center on HIV and Aging, Adjunct Asst. Professor, NYU College of Nursing and Liz Seidel, MSW, Manager for Research and Evaluation, ACRIA—Center on HIV and Aging, Adjunct Professor, Graduate School of Social Service, Fordham University for their help in providing comparative loneliness data from the ROAH study.

Funding

This work was supported by the California HIV/AIDS Research Program (CHRP) under Grant A116894 “California HIV/AIDS Research Programs for Integrating HIV and Geriatric Care for PLWH 50 & over.” Dr. Greene receives funding from P30AG044281 from the NIA at the NIH and received salary support from NIH (5-T32-AG000212) during this project.

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Authors and Affiliations

  1. Division of Geriatrics, Department of Medicine, University of California San Francisco, 3333 California St. Suite 380, San Francisco, CA, 94143-1260, USA

    Meredith Greene & Carla Perissinotto

  2. Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA, USA

    Nancy A. Hessol

  3. Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Nancy A. Hessol, Roland Zepf, Amanda Hutton Parrott & Malcolm John

  4. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Cameron Foreman

  5. Robert Whirry & Associates, Los Angeles, CA, USA

    Robert Whirry

  6. Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Monica Gandhi

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  1. Meredith Greene
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  2. Nancy A. Hessol
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  3. Carla Perissinotto
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  9. Malcolm John
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Correspondence to Meredith Greene.

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Conflict of interest

Dr. John is on the speaker’s bureau and advisory boards of Gilead Sciences, Inc.; Merck & Co., Inc.; and ViiV Healthcare. Dr. Greene, Dr. Hessol, Dr. Perissinotto, Dr. Zepf, Dr. Hutton Parrott, Mr. Foreman, Mr. Whirry and Dr. Gandhi declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Greene, M., Hessol, N.A., Perissinotto, C. et al. Loneliness in Older Adults Living with HIV. AIDS Behav 22, 1475–1484 (2018). https://doi.org/10.1007/s10461-017-1985-1

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