Nursing Home Residents by Human Immunodeficiency Virus Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use

Abstract

OBJECTIVES Given an aging human immunodeficiency virus (HIV) population, we aimed to determine the prevalence of HIV for long‐stay residents in US nursing homes (NHs) between 2001 and 2010 and to compare characteristics and diagnoses of HIV‐positive (HIV+) and negative (HIV‐) residents. Also, for residents with dementia diagnoses, we compared antipsychotic (APS) medication receipt by HIV status. DESIGN A cross‐sectional comparative study. SETTING NHs in the 14 states accounting for 75% of persons living with HIV. PARTICIPANTS A total of 9 245 009 long‐stay NH residents. MEASUREMENTS Using Medicaid fee‐for‐service claims data in the years 2001 to 2010, together with Medicare resident assessment and Chronic Condition Warehouse data, we identified long‐stay (more than 89 days) NH residents by HIV status and dementia presence. We examined dementia presence by age groups and APS medication receipt by younger (aged younger than 65 years) vs older (aged 65 years or older) residents, using logistic regression. RESULTS Between 2001 and 2010, the prevalence of long‐stay residents with HIV in NHs increased from 0.7% to 1.2%, a 71% increase. Long‐stay residents with HIV were younger and less often female or white. For younger NH residents, rates of dementia were 20% and 16% for HIV+ and HIV‐ residents, respectively; they were 53% and 57%, respectively, for older residents. In adjusted analyses, younger HIV+ residents with dementia had greater odds of APS medication receipt than did HIV‐ residents (AOR = 1.3; 95% confidence interval [CI] = 1.2‐1.4), but older HIV residents had lower odds (AOR = 0.9; 95% CI = 0.8‐0.9). CONCLUSION The prevalence of long‐stay HIV+ NH residents has increased over time, and given the rapid aging of the HIV population, this increase is likely to have continued. This study raises concern about potential differential quality of care for (younger) residents with HIV in NHs, but not for those aged 65 years and older. These findings contribute to the evidence base needed to ensure high‐quality care for younger and older HIV+ residents in NHs.

The Prevalence of Drug–Drug Interactions with Antiretroviral Therapy in Human Immunodeficiency Virus–Infected Patients in the Intensive Care Unit

“…Furthermore, significant utilization of antipsychotics in PWH has been reported in other health care settings, including nursing homes and could affect risk for interactions in aging PWH across the health care spectrum. 36 Future studies are required to determine the clinical justification and safety of prescription of these common drug classes in aging PWH. We found no difference in ICU LOS between those with or without pDDIs.…”

The Quality of Nursing Homes That Serve Patients With Human Immunodeficiency Virus

“…Past work on PLWH and NHs has focused on single facilities or has used older data . Two recent studies using Medicaid data have assessed trends in HIV care among long‐stay NH residents . PLWH were found to have higher rates of dementia than those without in NHs, and older residents with HIV had poorer activity of daily living improvement than younger residents with HIV .…”

“…Two recent studies using Medicaid data have assessed trends in HIV care among long‐stay NH residents . PLWH were found to have higher rates of dementia than those without in NHs, and older residents with HIV had poorer activity of daily living improvement than younger residents with HIV . We build on this literature by focusing on the NHs that residents with HIV are admitted to, with a focus on new admissions, to get a better understanding of trends across the country.…”

What Does Aging with HIV Mean for Nursing Homes?

“…One study, published in the current issue of this journal, focused on long‐stay nursing home residents from 2001 to 2010 and compared HIV‐infected with uninfected residents. “Nursing Home Residents by HIV Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use” by Susan C. Miller and colleagues used population‐based Medicaid and Minimum Data Set data from 14 states with the highest HIV prevalence and found that the prevalence of long‐stay residents (>89 d) with HIV increased 71% from 2001 to 2010 . In the highest prevalence states of New Jersey, Louisiana, Florida, New York, and Maryland, the absolute proportion of nursing home residents living with HIV exceeded 2% by late 2008.…”

“…"Nursing Home Residents by HIV Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use" by Susan C. Miller and colleagues used population-based Medicaid and Minimum Data Set data from 14 states with the highest HIV prevalence and found that the prevalence of long-stay residents (>89 d) with HIV increased 71% from 2001 to 2010. 3 In the highest prevalence states of New Jersey, Louisiana, Florida, New York, and Maryland, the absolute proportion of nursing home residents living with HIV exceeded 2% by late 2008. If these trends have continued, nearly 4% of long-stay nursing home residents in these states are now people living with HIV (PLWH).…”