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Stephen Karpiak, PhD Associate Director for Research Mark Brennan-Ing, PhD

The Challenges of Multimorbidity Management And Caregiving HIV and Aging: The Challenge of the Epidemic’s Fourth Decade 2012 IAS Meetings. Stephen Karpiak, PhD Associate Director for Research Mark Brennan-Ing, PhD Senior Research Scientist

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Stephen Karpiak, PhD Associate Director for Research Mark Brennan-Ing, PhD

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  1. The Challenges of Multimorbidity Management And Caregiving HIV and Aging: The Challenge of the Epidemic’s Fourth Decade 2012 IAS Meetings Stephen Karpiak, PhD Associate Director for Research Mark Brennan-Ing, PhD Senior Research Scientist AIDS Community Research Initiative of America ACRIA ACRIA Center on HIV and Aging NY, NY New York University College of Nursing

  2. ART

  3. ROAH1: 1000 HIV+ NYC Residents Age 50 and Older 1 Karpiak et al., ROAH, 2006

  4. Average Number of ComorbiditiesROAH1: 1000 HIV+ NYC Residents Age 50 and Older Average Age= 55 Years Brennan et al., 2009 n=1000 NYC HIV+ Over 50

  5. % on Non-ART Medication by AgeSwiss Cohort N = 8575 Hasse et al., ..Swiss HIV Cohort, 2011 CID53:1130-1139

  6. Cardiovascular disease • Cancers • Bone fractures; osteopenia • Left ventricular dysfunction failure • Liver Failure • Kidney Failure • Frailty • Immune System

  7. These Illnesses Associated with Old Age Occur as a Result of MULTIPLE Increased Risks CONTEXT

  8. Multi-morbidity in HIV: Regional Factors In North America and Europe: HCV co-infection, alcohol, tobacco, and opioid abuse In Africa: Tuberculosis, malaria, obstructive lung disease (smoke inhalation) and alcohol abuse

  9. AAHIVM: Guides for the Management of Older Adults with HIV American Academy of HIV Medicine Expert Panel of Leaders in HIV Treatment Research and Geriatric Care American Geriatrics Society ACRIA Center on HIV and Aging Dec 1, 2011

  10. Summary report from the Human Immunodeficiency Virus and Aging Consensus Project: Treatment Strategies for Clinicians Managing Older Individuals with the Human Immunodeficiency Virus. J Amer Geriatrics Society 2012 May;60(5):974-9.

  11. What are the implications of multimorbidity management ?

  12. Correlation Between Depressive Symptoms and Illnesses in Older Adults with HIV • Vision Loss .160** • Hearing Loss .094** • Dermatological Problems .134** • Heart Conditions .086* • Respiratory .167** • Stroke .059 • Diabetes .067* • Broken Bones .079* • Impotence .092** • Neuropathy .049 p <. 05*, p <. 01** Havlik, Brennan, & Karpiak …2011

  13. Over 50-75% of study groups of older adults with HIV show moderate to severe depression Depression Causes Non-Adherence to ALL Medication including HIV Meds

  14. What is the most burdensome disease in the world today? According to the World Health Organization,  the disease that robs the most adults of the most years of productive life is not AIDS, not heart disease, not cancer. It is depression. According to the World Health Organization, three-quarters of the world’s neuropsychiatric disorders are in low-income or low-middle income countries. Where health care professionals are few: task shifting…training and supporting people with lower levels of education to do the work of doctors and nurses.

  15. Amadiwas 59 lost five of 9 children… 3 of them to AIDS. She was numb and passive, sad and irritable. She could not care for her family, work in her garden, or do her mat-weaving. Using a faith-based group's infrastructure to recruit peer facilitators and the women The study designed to test interpersonal therapy, proved as effective as medicine at curing major depression in Western settings. The women all became active in the community, and each talked to her own family members about H.I.V. infection and how to prevent it. Helena Verdeli, assistant professor of clinical psychology and director of the Global Mental Health Lab Columbia University’s Teachers College. NY Times Julky

  16. 18 weeks after starting …Amadi had no more symptoms of depression. She was once again, to use her husband’s words, the fierce, loving, strong woman  she had been.

  17. Caregiving Mark Brennan-Ing PhD Senior Research Scientist

  18. Background

  19. Caregiving Issues in High Income Countries In resource-rich countries like the U.S., there has been wide-spread access to ARVs resulting in the aging of the population living with HIV This success has brought about the challenge of multi-morbidity: Multiple chronic illnesses result in disability and increase caregiving needs However, many lack caregiving resources and options

  20. CAREGIVERSare derived fromSOCIAL NETWORKS • Social networks are a significant healthcare resource • Informal caregiving worth approximately 450 Billion Dollars in the U.S. (AARP, 2009) • PLWHA are both care providers and care recipients in their networks

  21. Need for Caregiving: PLWHA 50+ in the U.S. • Average Age= 55.5 Years • Average Number Comorbid Conditions = 3.4 • 46% reported difficulty with at least one Instrumental ADL • 22% reported difficulty with at least one Personal ADL Brennan, M., Karpiak, S. E., London, A. S., & Seidel, L., (2010). A Needs Assessment of Older GMHC Clients Living with HIV.http://www.acria.org/files/GMHCFinal.pdf

  22. The Problem:Fragile Social Networks! • The social networks of older adults living with HIV are fragile – lack of family involvement and reliance on friends, many who are also HIV+ • Fragile social networks result from: • Stigma • Self-Protective Withdrawal (Emlet, 2006) • Rejection due to stigmatized behaviors (e.g., drug use, homophobia) (Flowers et al., 2006; Lichtenstein et al., 2002; Mayers & Svartberg, 2001; Trzynka & Erlen, 2004) • MSM are much less likely to have partner/spouse/children to rely on in times of need

  23. Proportion Living Alone: ROAH vs. Community-Dwelling NYC Elderly 1 Brennan, M., Karpiak, S. E., Shippy, R. A., & Cantor, M. H. (2009). Older adults with HIV: An in-depth examination of an emerging population. New York: Nova Science Publishers.

  24. ROAH:Informal Network Composition

  25. Caregiving Issues in Low Income Countries In resource-poor areas, such as Africa and Southeast Asia, the brunt of caregiving resulting from HIV infection is borne by older adults (age 50+) • Older adults care for their children who are HIV-infected • Older Adults care for orphaned grandchildren whose parents have died of HIV/AIDS

  26. Caregiving in Sub-Saharan Africa (Bock & Johnson, 2008; Ogunmefun et al., 2011; Ssengonzi, 2007; 2009)

  27. Caregiving in Southeast Asia (Kespichayawattana & Van Landingham, 2009; Knodel, 2008; Knodel & Wassana, 2004)

  28. Conclusions

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