Healthy Aging in Older Women Living with HIV Infection: a Systematic Review of Psychosocial Factors

Abstract

Due to life-enhancing effects of antiretroviral therapy, HIV-positive persons have the potential for long life comparable to their uninfected peers. Older women (age 50+) living with HIV (OWLH) are often an under-recognized aging group. We conducted a systematic review to examine psychosocial factors that impact how OWLH live, cope, and age with HIV. Initial key word search yielded 1527 records, and 21 studies met our inclusion criteria of original quantitative or qualitative research published between 2013 and 2016 with results specific to OWLH. These focused on health care and self-management, sexual health and risk, stigma, loneliness, mental health (depression, substance use), and protective factors (coping, social support, well-being). Due to the scarcity of studies on each topic and inconclusive findings, no clear patterns of results emerged. As the number of OWLH continues to grow, more research, including longitudinal studies, is needed to fully characterize the psychosocial factors that impact aging with HIV.

Psychosocial risk and management of physical diseases

“…With advancing age comes the pursuit of medical care for typical age-related complications ranging from menopause and rheumatoid arthritis to cognitive decline. Research in older adults with HIV suggest psychosocial factors such as stigma and depression might delay the seeking-out of health care, hamper appointment attendance (Emlet, 2006; Grov et al, 2010; Havlik et al, 2011; Pence et al, 2018; Rodriguez-Penney et al, 2013; Rubtsova et al, 2017; Sankar et al, 2011; Shippy & Karpiak, 2005). While negative psychosocial interactions for aging are expected, a meta-analysis highlighting a dozen studies of older adults with HIV revealed decreased short- and long-term risk for non-adherence to HAART, suggesting that some aspects of HIV self-care may be enhanced with older age (Ghidei et al, 2013).…”

Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

“…Proposed here is a conceptual framework that incorporates the relevant data from the field as summarized above to describe determinants of health-related quality of life for older aged PLWH in rural sub-Saharan Africa (Figure 2). The framework incorporates a syndromic approach to gerontology (Fried et al, 2001; Mitnitsky, Mogilner, & Rockwood, 2001) to include domains of physical, cognitive, and social functioning (Rubtsova et al, 2017; Thurn & Gustafson, 2017). It includes key determinants of these domains derived from prior work on HIV and aging in the United States, which have demonstrated independent effects of HIV-related inflammation on domains of physical and neurocognitive functioning (Erlandson et al, 2013; Lyons et al, 2011; Scully et al, 2016).…”

A systematic review of psychosocial interventions for older adults living with HIV

“…Psychosocial factors have been shown to influence adherence to medical care, disease progression, and quality of life for people living with HIV (Malow et al, 2013;Reif et al, 2011;Sumari-de Boer et al, 2012). Because psychosocial factors may also be more malleable than many social determinants of health (e.g., education, economic stability), understanding the psychosocial needs of vulnerable HIV populations is critical to developing interventions that aim to improve their overall well-being (Rubtsova et al, 2017). While most of the current research on aging and HIV is focused on biomedical processes and outcomes (e.g., HIV-associated neurocognitive disorder, impacts of long-term ART use), understanding psychosocial aspects of aging with HIV is equally important (Altschuler et al, 2004), especially because psychosocial factors such as social support or spiritual beliefs may help to mitigate impacts of HIV-related stigma (Porter et al, 2017).…”

“…However, in a recent systematic review of interventions designed to increase ART adherence among people living with HIV, only 11 out of 49 studies explored psychosocial variables as outcomes (Mbuagbaw et al, 2015). Similarly, Rubtsova et al (2017) reviewed 21 studies that evaluated the psychosocial wellbeing of older women living with HIV and suggested insufficient data and unclear patterns of how older women cope and age with HIV. To the best of our knowledge, there has not yet been a comprehensive literature review of psychosocial interventions that are specifically designed to promote well-being and enhance quality of life among older adults living with HIV.…”