Publication Abstract Display
Type: Published Manuscript
Title: Disability among middle-aged and older persons with HIV infection.
Authors: Johs NA, Wu K, Tassiopoulos K, Koletar SL, Kalayjian RC, Ellis RJ, Taiwo B, Palella FJ, Erlandson KM
Year: 2017
Publication: Clinical Infectious Diseases : An Official Publication of The Infectious Diseases Society of America
Volume: 65 Issue: 1 Pages: 83-91
Abstract:Objective: Older HIV-infected adults may experience higher rates of frailty and disability than the general population. Improved understanding of the prevalence, risk factors, and types of impairment can better inform providers and the healthcare system. Methods: This was an observational study of HIV-infected participants within the ACTG A5322 HAILO study with self-reported disability by the Lawton-Brody Instrumental Activities of Daily Living (IADL) Questionnaire and frailty, measured by 4-m walk time, grip strength, self-reported weight loss, exhaustion, and low activity. Logistic regression models identified characteristics associated with any IADL impairment. Agreement between IADL impairment and frailty was assessed using the weighted kappa statistic. Results: Of 1015 participants, the median age was 51 years,15% were ≥ 60 years, 19% were female, 29% Black, and 20% Hispanic. At least one IADL impairment was reported in 18% of participants, most commonly with housekeeping (48%) and transportation (36%) and least commonly with medication management (5%). In multivariable models, greater disability was significantly associated with neurocognitive impairment, lower education, Medicare/Medicaid insurance (vs. private/other coverage), smoking, and low physical activity. Although a greater proportion of frail participants had IADL impairment (52%) compared to non-frail (11%) persons, agreement was poor (weighted kappa < 0.18, 95% CI 0.13, 0.23). Conclusion: IADL disability occurs frequently among middle-aged and older HIV-infected adults on effective ART. Potentially modifiable risk factors (smoking, physical activity) provide targets for interventions to maintain independent living. Systematic recognition of persons at greater risk for disability can facilitate connection to resources that may help preserve independence.

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