By Alain Volny-Anne
Is self-assessed successful aging possible for older women living with HIV, despite the health complications they are likely to face?
Published by Dr. Anna Rubotsva and colleagues in the Journal of Acquired Immune Deficiency Syndromes, a recent survey suggests this: in 386 HIV-positive and 137 HIV-negative women, aged 50 or older, the majority of women reported successful aging with no differences by HIV status (83.7% and 82.5% in the two groups, respectively).
Definition of successful aging
Successful aging is generally defined as the absence or avoidance of illness and disability, maintaining a high level of physical and cognitive function, and an active engagement with life. This broad definition can be refined. For example, in a qualitative study published in 2017, older adults living with HIV defined successful aging in terms of six key themes:
• Accept limitations
• Stay positive
• Maintain social support.
• Taking responsibility
• Live a healthy lifestyle.
• Participate in meaningful activities.
Some researchers have analyzed individuals' holistic assessments of how well they were aging, termed "self-reported successful aging." At least two studies have shown that many people with HIV report successful aging. However, because these studies were conducted among mostly male and white participants, their findings cannot be generalized to women who face medical and psychosocial challenges unique to their gender.
Older women living with HIV in the U.S.
In the US, the number of older women with HIV is steadily increasing due to a combination of new HIV diagnoses in older adults and the increased longevity of people taking antiretroviral therapy (ART). However, aging with HIV increases the likelihood of comorbidities (including cardiovascular disease, depression, and cancer), frailty, polypharmacy, substance abuse, social discrimination, and stigma.
In addition, HIV-positive women generally fare worse than their male counterparts in terms of health outcomes, access to care, adherence, viral suppression, quality of life, morbidity, and mortality.
Another key epidemiological fact to consider is that the majority of older women living with HIV in the United States belong to ethnic minorities. In 2015, 58% were African American, and belonging to an ethnic minority is known to often intersect with many social vulnerabilities.
The study
The researchers' specific objective was to examine the prevalence and correlates of self-rated successful aging among HIV-positive women and a comparison group of HIV-negative women.
The participants were already enrolled in the Women's Interagency HIV Study (WIHS), a large U.S. cohort that, for decades, has collected data through six-monthly follow-up visits from demographically similar women living with or at risk for HIV. Each WIHS visit consists of an interview, a clinical examination, and laboratory tests.
At four WIHS sites, between 2017 and 2018, each of the women aged 50 and over was asked to complete an additional survey that included validated scales used in previous research, to assess self-reported successful aging.
Other parameters were also captured, such as stress coping levels, social support, medical outcomes, spirituality, anxiety, depression, loneliness, lifetime experience of discrimination, traumatic life events, and sociodemographic characteristics.
Recommendations
On average, participants were 57 years old. The majority were African American (74%), unemployed, and not married or in a relationship. No differences were found in these results based on HIV status.
More than a third of the women in both groups had a secondary education or less. However, education levels were lower among HIV-negative women than among HIV-positive women. In addition, HIV-negative women had:
• Greater likelihood of having a very low annual income, without health insurance and without owning your own home.
• Increased substance use.
• Low quality of life and optimism.
• Greater perceived discrimination throughout life.
Women living with HIV had high rates of ART use (94%), undetectable viral load (73%), and high CD4 cell counts (median was 750), indicating well-controlled HIV disease.
The high prevalence of self-reported successful aging was not only found at the same level in both HIV-positive and HIV-negative women, but also across three different measures that, more importantly, were highly and significantly correlated:
• 'Using your own definition, where would you rate yourself in terms of "successful aging", from "1" (least successful) to "10" (most successful)? In both groups, women scored an average of 8. Among women with HIV, 83.7% scored above 7 and among HIV-negative women, 82.5% scored above 7.
• 'Do you agree with the statement: "I am aging well" (from 1 = definitely false to 4 = definitely true)? The average reported score was 3.
• 'Rate your current life on a scale of "1" (worst possible life) to "10" (best possible life). The average score in both groups was 8.
Women who reported higher levels of positive psychosocial factors, such as personal mastery, optimism, resilience, and spirituality, were more likely to report successful aging. Conversely, those who reported negative psychosocial factors, such as anxiety, depression, loneliness, and a history of lifetime discrimination, showed the lowest rates of successful aging. Specifically, this means that, in any group, any survey participant's depression negatively impacted their rating of successful aging.
"Researchers highlight the importance of spirituality for African Americans, many of whom perceive religion as essential to their lives."
Researchers highlight the importance of spirituality for African Americans, many of whom perceive religion as essential to their lives. Spirituality can facilitate resilience to vulnerabilities, which, in turn, likely facilitates successful aging.
The survey did not reveal strong relationships between successful aging and sociodemographic characteristics, HIV disease characteristics, and comorbidities.
Overall, the levels of successful aging observed in this study are comparable to those of HIV-negative participants seen in previous studies with predominantly white male populations (e.g., in one study, 82% in HIV-negative people versus 67% in HIV-positive people).
But the survey's main finding—equivalent rates of self-reported successful aging in the two groups of women—is surprising. Based on the evidence already described, the researchers had hypothesized that women living with HIV would be poorer than their HIV-negative counterparts.
It is possible that in this study, the negative impact of HIV was offset by the greater social disadvantages among the HIV-negative participants. Furthermore, the participants were involved in a long-term research study, with regular contact with healthcare providers, and most likely benefited from social support when needed. Outside of WIHS, they might have faced greater difficulties.
A small step, perhaps, but a very important one in this field, where research must be conducted. “However, these are important findings that suggest high levels of self-reported successful aging can be achieved in older women living with HIV,” Rubotsva and her colleagues conclude. The research team also emphasizes that, to the best of their knowledge, “this is the first published report on self-reported successful aging among older women living with HIV.”
References
Rubtsova AA et al. Prevalence and correlations of self-reported successful aging among older women living with HIV. Journal of Acquired Immunodeficiency Syndromes 82: S162-S169, 2019 (open access).
From: http://www.aidsmap.com/news/jan-2020/successful-ageing-reported-most-older-women-living-hiv-us-study