Considering the Impact of Aging When Caring For and Treating Adults With HIV.

The current study investigates how age impacts factors associated with successfully managing HIV. One hundred thirty adults with HIV were recruited for the study. Participants were divided into two groups, those age ≥50 and those age <50. Cognitive impairment and depressive symptoms were seen at higher rates in older adults, and the severity of depressive symptoms was also higher in older adults. Depressive symptoms impacted cognitive function to a higher degree in older adults compared to younger adults (r = -0.293, p = 0.018 vs. r = -0.109, p = 0.387). Polypharmacy was a greater concern in older adults, with 88% having polypharmacy compared with 60% of younger adults. Similarly, the prevalence of comorbidities was more than double in older adults compared to younger adults. Factors associated with aging complicate management of HIV. Gaining insight into the challenges of caring for this population will furnish nurses with information necessary to provide the best possible care for this growing population. [Journal of Gerontological Nursing, 46(4), 31-40.].

The Alzheimer's disease-8 and Montreal Cognitive Assessment as screening tools for neurocognitive impairment in HIV-infected persons.

The diagnosis of human immunodeficiency virus (HIV)-associated neurocognitive impairment is time-intensive and often omitted in busy outpatient settings. Brief screening tools are needed. The Montreal Cognitive Assessment (MoCA) and the Alzheimer's disease (AD)-8 have been used in neurodegenerative disorders. We evaluated the sensitivity and specificity of these brief screening tools in HIV-infected persons. The AD-8, MoCA, and formal neuropsychological testing were administered to 200 HIV-infected patients who were followed at a single institution. Normalized scores on formal neuropsychological testing were used to define neurocognitive impairment. The sensitivity and specificity of the MoCA and AD-8 were assessed to diagnose the impairment. Neurocognitive impairment was highly prevalent in this cohort: 127 persons (64 %) were diagnosed with neurocognitive impairment based on formal testing. Using the AD-8 and MoCA, 113 (57 %) and 101 (51 %) persons were identified with neurocognitive impairment, respectively. The sensitivity and specificity of MoCA were 63 % and 71 %, respectively. The sensitivity and specificity of AD-8 were 61 % and 51 %, respectively. Our findings highlight that brief screening tools correlate with formal neuropsychological testing. However, the sensitivities of these screening tools are lower than desired. Nevertheless, given their ease in administration, these tools could assist as a first line for identifying individuals who may subsequently require formal neuropsychological testing.

Depression as a Comorbid Condition: A Descriptive Comparative Study.

Studies analyzing depressive symptoms across chronic disease populations are limited. Our descriptive comparison investigation included two studies on life-limiting conditions: Human Immunodeficiency Virus (HIV) and breast cancer. In both, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). We found a mean depression score of 18.1 (± 11.8) overall (N = 243). Over half (54%) reported clinically significant depressive symptoms (CES-D ≥ 16); 26% reported severe depressive symptoms (CES-D > 24). Disease and years of education were predictors of depressive symptoms. Persons living with breast cancer showed significantly worse depressive symptoms than persons living with HIV (p < 0.0001). After adjusting for disease, fewer years of education predicted worse depressive symptoms (p < 0.0001). This study demonstrated common determinants of depressive symptoms in both disease populations, suggesting that underlying conditions known to be predictors of depression could be assessed to identify those at higher risk for depression.

Examining the effectiveness of a cognitive intervention to improve cognitive function in a population of older adults living with HIV: a pilot study.

OBJECTIVE: The purpose of this randomized-controlled pilot study was to explore the effectiveness of a home-based computerized cognitive training intervention in improving cognitive function in a population of older adults with mild cognitive impairment who are living with HIV. METHODS: In all, 24 participants were enrolled in this study. All study participants were impaired [defined as Montreal Cognitive Assessment (MoCA) score < 26]; 12 were randomly assigned to a computer-training intervention group and 12 to a control group. The intervention group used a home-based computerized cognitive training program for 8 weeks, while the control group received health-related newsletter via email and follow-up phone calls. Cognitive function was measured at study entry, immediately post intervention, and 8 and 16 weeks post intervention. RESULTS: This study achieved a 92% retention rate, losing two persons from the intervention group. Participants in the intervention group scored significantly higher on cognitive testing immediately post intervention compared to the control group: F(1, 19) = 4.92, p = 0.04. The partial Eta squared of 0.32 indicates a small to moderate effect size. DISCUSSION: Cognitive improvement was seen immediately after the intervention, and cognitive improvement was still evident 16 weeks post intervention. Cognitive training could be considered as an option for older adults with HIV experiencing mild cognitive impairment.

Preparing every nurse to become an HIV nurse.

BACKGROUND: There are currently over 1.2 million people in the United States living with HIV, and that number is increasing. Because persons infected are living longer, they must deal with numerous comorbidities complicated by underlying HIV disease. This may require frequent healthcare visits. The majority of new nurses will not be working in positions focused on HIV care, however many nurses will find themselves called upon to care for patients living with HIV regardless of their employment setting. Unfortunately, as the HIV/AIDS epidemic has faded from the headlines, HIV/AIDS education has decreased in most nursing schools, and undergraduate students receive minimal education about HIV/AIDS. Many nursing students nearing graduation report feeling unprepared to care for patients with HIV. This lack of preparation results from lack of knowledge, which can perpetuate fear and stigmatizing attitudes towards people living with HIV. AIM OF THE STUDY: The purpose of this study was to gauge the impact of utilizing speakers living with HIV, and HIV healthcare professionals in preparing undergraduate nursing students to care for patients living with HIV. RESEARCH METHOD: To assess HIV-related knowledge and attitudes of undergraduate nursing students we used a quantitative, descriptive pretest-posttest design. Nonparametric related samples tests and Wilcoxon signed-rank tests were conducted to compare knowledge and attitudes of HIV and persons living with HIV, in undergraduate nursing students before and after an HIV educational experience. CONCLUSIONS: There was a significant difference in the overall scores in HIV knowledge after the education experience (p=0.000). Questions related to stigma on the HIV/AIDS Questionnaire for Health Care Providers also revealed statistically significant improvement. Results suggest the benefits of incorporating this curriculum addition as a method of HIV education into the undergraduate curriculum may make a tremendous impact on student readiness to care for persons with HIV.

A comparison of medication management between older and younger adults living with HIV.

The aims of this study were to examine differences in medication management between older and younger adults living with HIV and to examine the relationship between age and cognitive ability, depressive symptoms, and self-efficacy on medication management. This research utilized a descriptive-correlational, cross-sectional design to compare medication management between older and younger adults living with HIV and to describe differences in predictive factors of cognition, depressive symptoms, and self-efficacy on medication management. Results indicated that both older and younger adults had poor medication management skills and high rates of mild cognitive impairment. While older adults performed worse on the medication management test than younger adults, the results were not statistically significant. In both older and younger adults, cognitive ability and depressive symptoms were predictors of medication management, with cognitive ability being the strongest predictor for both groups. Cognitive ability was a stronger predictor for older adults than for younger adults.