Promoting successful aging with HIV through hardiness: implications for nursing practice and research

A growing number of adults will age with HIV due to the introduction of highly active antiretroviral therapy, an increase in later-life infections, and an overall aging of the population. Unfortunately, how successful aging will be expressed in this population is unknown. In the gerontological literature, the concept of hardiness is used to describe and hypothesize how people can age successfully. Using the extant HIV literature, this article extrapolates how hardiness may help people age well with this disease. Because nurses provide care for older adults with HIV, possible interventions and clinical implications for incorporating hardiness into practice and research are suggested.     

Infection with HIV in the elderly population

Infection with HIV among older adults in the United States needs to be investigated in greater detail because little substantive knowledge currently is available about HIV/AIDS in the elderly population. The Centers for Disease Control and Prevention reports that 10% of all cases of diagnosed HIV/AIDS are in people age 50 and older. The problem is that very little is known about the effects of HIV/AIDS in this population. The majority of the literature is based on limited case reports, and very little empirical research is available. This lack of knowledge limits health care professionals' ability to properly diagnose and adequately treat individuals who may be infected. This article considers various sources of infection, potential risk factors, the difficulty of diagnosis, and the rapid progression of the disease process in older adults. Signs and symptoms of common opportunistic infections are explored. Treatment challenges, nursing care of older adults infected with HIV, and psychosocial aspects of the disease are discussed.     

Older adults as an HIV-positive risk group

When older adults are admitted to the hospital, they are usually admitted with multiple diagnoses and are not usually considered to be at risk for HIV infection. The review of hospital records discussed in this article documents that people over 60 years of age are indeed infected with HIV and that 42% of the population studied were in the age range of 70 to 100 years. The review of hospital records documented that people over 60 years of age and older fell into the same high risk populations as did people from any other age group. Gerontological nurses must be informed about the methods of prevention, expected course of infection, response to treatment, and effective ways to implement nursing care for older adults who are HIV positive.     

Potential mechanisms for altered iron metabolism in human immunodeficiency virus disease.

Recently, anemia associated with human immunodeficiency virus (HIV) disease has received more attention as our understanding of the significance of anemia in this population has grown and more emphasis is placed on the quality of life of people living with HIV/AIDS. Although the diagnosis and treatment of anemia in HIV disease has been discussed in great detail, the prevalence and pathophysiology of the two most common forms of anemia, iron deficiency anemia (IDA) and the anemia of chronic disease (ACD), have not received much attention despite the difficulty and importance of differentiating between these two anemias. In addition, little attention has been given to iron overload, which has serious implications in individuals with HIV disease. This article proposes a model of altered iron metabolism in HIV disease as a basis for explaining the pathophysiology and implications of IDA, ACD, and iron overload in this population. Implications for clinical practice and recommendations for future research are discussed.     

HIV & AIDS in older adults

Many Americans mistakenly believe that older adults are not at risk for HIV/AIDS. Older people do not perceive themselves to be at risk for HIV infection, either. In reality, approximately 10% of AIDS cases are among people older than 50. Many health care providers lack an awareness of the risk of HIV/AIDS in the elderly population, and as a result, many older people with these conditions are misdiagnosed with other ailments. Major manifestations of HIV/AIDS in elderly adults include Pneumocystis carinii pneumonia, herpes zoster, tuberculosis, cytomegalovirus, oral thrush, Mycobacterium avium complex, and HIV dementia. Elderly HIV-positive women have special health concerns, such as cervical cancer. Nurses and nurse practitioners can heighten their colleagues' awareness of the existence of HIV/AIDS in the elderly population and educate their older patients on HIV/AIDS. Furthermore, information about sexuality and sexual practices of older adults should be incorporated into all health science curricula. Additional research is needed to determine the extent of the problem and how health care providers can best serve their older patients' needs.     

Aging and living with HIV/AIDS

With individuals either living longer with the disease or contracting it at a later stage in life, HIV/AIDS can no longer be regarded as just a young person's disease. In fact, people older than 50 will represent 50% of HIV/AIDS cases by 2015. The intersection of aging and HIV/AIDS is explored in this article through the use of an individual example highlighting typical age-related issues encountered in living with a chronic HIV infection and two of the more common comorbid conditions. Nursing implications for managing these conditions-depression and dyslipidemia-as well as other considerations for providing care to older adults with HIV/AIDS are addressed.     

HIV/AIDS in older adults: a case study and discussion

Infection associated with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in older adults is an increasing problem in clinical care. Often regarded as a disease of the young, more than 10% of HIV infection actually is found in people 50 years of age and older. In addition, individuals with HIV and AIDS are living longer. Approximately 71% of them currently are in their 30s and 40s. Given the current therapies available, it is conceivable that these patients will live well into their 60s and beyond. A case study describing the acute care experience of a 77-year-old African American man is reported. Pitfalls of diagnosis and management are discussed in relation to the care of an older person with HIV disease. The epidemiology of HIV in this population and a review of some recent literature and research on HIV and older adults are presented.     

Nursing research in geriatric mental health

As the population of older people in the world increases, concerns about the health and delivery of health care to these elderly people become increasingly more important. Geriatric mental health arose as a nursing specialty in response to this concern over the health of older adults. This paper focuses on a review of nursing literature relevant to the mental and cognitive health of older adults. Implications for current practice and future research are explored.     

Promoting healthy ageing: the importance of lifestyle

The UK has a rapidly ageing population with increased healthcare needs. While the population can, on the whole, look forward to longer years of good health, many people will be living with one or more chronic conditions. However, modifiable lifestyle, such as a healthy diet and physical activity, can encourage healthy ageing and improve the quality of life of older people. Nurses are ideally placed to provide advice on nutrition and physical activity to older people in an effort to reduce the burden of age-related disease. This is likely to require new ways of working, with nurses being trained to recognise opportunities for health promotion with older patients, as well as how to plan for and conduct health promotion so that it becomes integral to practice.     

Incidences of excess alcohol consumption in the older person

This article discusses some of the concerns regarding older people's excess alcohol consumption and draws specific attention to those considered to be very elderly. Concerns have been expressed that the worldwide increase in the ageing population indicates that the number of older people with alcohol problems is increasing. The article describes three types of older problem drinkers, the consequences of excessive alcohol consumption in the older age group and goes on to provide a brief indication of treatment. Three examples are provided from the author's own clinical practice.     

Student attitudes and educational support in caring for older people--a review of literature

The ageing population is currently one of the main issues facing UK healthcare systems. Nurses of the future will be faced with the task of caring for this elderly population. Meanwhile, care standards and government policies have emphasized the need for preparing students to care for the older people. Preparing nursing students to meet the care needs of an expanding ageing population is a challenge for nursing education. Moreover, caring for older people are often not seen by students as an attractive option, a perception that exerts a considerable influence on the values that inform their future professional practice. This paper examines the literature related to the students’ perceptions of caring for older people and suggests the need for specific curricular content, teaching and a structured approach to the educational preparation and support of students for their practice experience. If students are provided with the relevant preparation and support, they can engage in enriched learning experiences, deliver quality care and develop positive attitudes in caring for older people in their professional practice.     

Use of hypodermoclysis to manage dehydration

Older people, particularly those who are frail, are vulnerable to dehydration. Management of dehydration in older people can be more complex than in younger adults because of the physical effects of ageing. As the population ages, nurses will increasingly care for older patients in every setting. This article provides an overview of the physiological changes that affect the ability of older people to maintain a normal fluid balance. Risk factors for dehydration are reviewed and strategies for the prevention, detection and management of dehydration are discussed. The article focuses on subcutaneous fluid replacement for the management of dehydration in older adults.     

Developing an oral assessment and intervention tool for older people: 2

This is the second of a series of three articles relating to oral care for older people. The first article highlighted the importance of effective oral care for older people (Vol 9(17): 1124-7). This article critically analyses a number of oral care agents and interventions to identify evidence-based practice relating to oral care for older people. Recommendations for practice are highlighted to guide practitioners in implementing safe and effective nursing interventions within oral care. The third article will critique a number of published oral assessment tools and describe an oral assessment and intervention tool that has been developed.     

Oral health care needs of dependent older people: responsibilities of nurses and care staff

The population of older people as well as the number of dependent older people is steadily increasing. Those unable to live independently at home are being cared for in a range of settings and varying degrees of dependency means that many are unable to attend fully to their needs, one aspect of which is oral care. The fact that the oral and dental health of the UK population is generally improving, makes more emphatic the responsibilities of nurses and care staff in this area. This review of the literature reveals that oral health of older people in continuing care settings is generally inadequate and that nurses' and care staff's knowledge and practice of oral care for older people is variable. Inadequate oral care is identified as multifactorial, with implications for educators, policy makers, practitioners and researchers. The need to address oral care for nurses pre- and post-registration as well as adequate preparation for support workers is highlighted. Development of a robust oral assessment tool, as well as empirical investigation of the effectiveness of oral cleaning agents, equipment and techniques to inform standard setting is indicated, with monitoring of standards being imperative.     

The U.K. national study of abuse and neglect among older people

This article reports briefly on the first UK prevalence study (undertaken in 2006-7) of the abuse and neglect of older people living in the community. Older people living in the community who reported mistreatment and neglect (2.6 per cent) equate to about 227,000 of the population aged 66 years and over. If figures are broadened to include neighbours and acquaintances, prevalence increases from 2.6 per cent to 4.0 per cent. This article identifies risk factors of loneliness, depression and poor quality of life. It suggests that nurses have a key role in day-to-day clinical practice in enabling older people to report abuse and neglect.     

HIV and the older adult.

Infection with HIV, the virus that causes AIDS, is now considered a chronic disease of years rather than an acute condition resulting in death. AIDS in older adults accounts for 11% of all AIDS cases. This article discusses current epidemiological trends and statistics; HIV risk factors related to aging; immunity and the aging process; diagnosis and treatment challenges; as well as gerontological nursing implications related to HIV prevention and counseling for adults age 50 and older. HIV infection is preventable. Nurses have a unique opportunity to develop theory-based intervention programs to reduce risk behaviors, while encouraging healthy behaviors in the older adult population.     

HIV and the older adult taking the necessary precautions

1. With the awareness that the population of older adults with whom nurses and other health-care workers come in contact may indeed be HIV infected, the need for universal precautions becomes imperative in all health-care settings. 2. The subpopulations of older adults in which HIV infection is most likely to be concentrated are the same as those for any other age group; ie, homosexual and bisexual men, IV drug users and their partners, people who have received blood products, and sexual partners of people who are HIV infected. 3. It is important for nurses to recognize that older adults may be manifesting the signs of symptoms of AIDS; for example, some people diagnosed with Alzheimer's disease may actually have AIDS-related dementia. 4. Gerontological nurses need to be the initiators of implementing universal precautions in their health-care settings.     

HIV prevalence in older adults

The "overlooked epidemic," "silent risk group" and "forgotten population" are phrases used when referring to HIV/AIDS and the population group aged 50 and older Health Canada reports that almost 12 per cent of the positive HIV test reports in Canada since the epidemic began are among those 50 and older. Despite the availability of this information, older adults (and those who care for their health) are often not aware of the risk in this group. Older adults are often stereotyped as asexual beings and health-care providers frequently omit a sexual history as part of their assessments. Symptoms of AIDS such as fatigue and memory loss can be dismissed as part of the normal aging process and this may lead to the fact that older people frequently present with AIDS at the same time they are diagnosed with HIV. Research, prevention and education programs are typically geared toward younger adults. Multiple intervention programming must be designed and implemented specifically for older adults in order to reduce HIV transmission in this group. The nursing community is in a strategic position to intervene. The authors discuss various strategies for action.     

Caring for minority ethnic older people in nursing care homes

This article aims to identify best practice guidance in relation to caring for minority ethnic older people in UK care homes that provide nursing care, highlighting key issues and identifying gaps that require redress. Current best practice guidance focuses on client issues, such as the recognition of cultural preferences, and organizational issues, such as workforce and the environment. However, while there is some best practice guidance regarding the care of minority ethnic older people in care homes, it is not sufficiently explicit. The article concludes by suggesting key strategies to help address the needs of minority ethnic older people in care homes.     

Factors influencing health and well-being in the older adult

Both in New Zealand and internationally there are increasing numbers of people living well into their senior years. Not only are more individuals reaching late adulthood, more are living beyond this stage. Because of corresponding increases in illness and/or disability this phenomenon has implications for the provision of health care to communities. This article offers a literature review of selected factors influencing the health and well-being of older people, with a particular emphasis on the older male. Implications for nursing practice in New Zealand are discussed.