Magazine article Aging Today

Mental Health and Substance Abuse in Older HIV-Infected Adults

Magazine article Aging Today

Mental Health and Substance Abuse in Older HIV-Infected Adults

Article excerpt

Though older adults contract HIV in the same way as younger people, they may not be as cognizant of risk factors or prevention strategies. Their numbers are growing rapidly because of improvements in childhood healthcare, and in the control and treatment of infectious diseases throughout the life cycle. Rates of HIV/AIDS among older people are approximately 12 times higher for African Americans, and five times higher for Latinos than they are for whites. But despite their HIV status, people living with HIV/AIDS can age successfully if their mental health issues are well-managed and they avoid substance abuse.

Mental Health, Substance Abuse and HIV/AIDS

An HIV diagnosis can be a life event spurring growth and maturity, or it may trigger emotional trauma and the manifestation of mental health disorders, or engaging in addictive behaviors (approximately 15 percent of all adults who have a mental disorder also experience a cooccurring substance use disorder).

Research shows at least 30 percent of all people living with HIV/AIDS require mental health services to treat the emotional and cognitive results of the infec- tion. Sixty percent of these people have either a major depression or chronic depression within a 12-month period; 26 percent experience some form of anxiety disorder within a 12-month period. Sometimes depression improves with medication or social changes no matter what age, but it is important to note that depression is not a normal part of aging.

There are three types of people ages 50 and older with HIV: those who have lived with HIV for many years; those recently diagnosed; and those newly infected with HIV. About half of elders with AIDS have been infected for one year or less.

Very little HIV-prevention education is targeted to older people, and there is little understanding about the relationship between HIV-related co-morbid conditions in newly infected older adult patients compared to uninfected elders and those who have survived 20 years living with HIV/AIDS. This reality is troublesome given that neuropsychiatrie symptoms, including depression, cognitive impairment and substance abuse are common in individuals infected with HIV, according to Watkins in the Journal ofNeuroVirology (18:4,2012).

Current drug abuse-dependence (but not current alcohol abuse-dependence) has been associated with sub-optimal medication adherence, which is a large part of managing HIV/AIDS disease, according to Hinkin et al. in Acquired Immune Deficiency Syndrome (18:Supp.l, 2004). Decreased social support, increased multimorbidity, financial difficulties from years of being unable to work and prepare for retirement, regret, depression and anger all fuel the potential appearance of mental health or substance use issues in older HIV-infected adults, according to Vance et al. in Clinical Interventions in Aging (6:101-9,2011).

Drug use accounts for more than 16 percent of infections of people older than age 50, and older people generally have more problems with cognition when they have HIV/AIDS. In response to issues of mental health or substance abuse, being religious and spiritual can have either positive bio-psycho-social outcomes or negative stressful outcomes that subsequently influence self-care behavior. Noteworthy literature reveals that levels of spirituality are higher in older adults with HIV than in younger adults with HIV, according to Lorenz et al. in the Journal of Palliative Medicine (8:4,2005).

Useful Interventions and Therapies

Some therapeutic interventions that may be used with older HIV-positive adults are psychotherapy or counseling (with or without medication); Cognitive Behavioral Therapy (CBT); Motivational Interviewing (which supports change from within, consistent with interviewees' values); and Dialectical Behavior Treatment (a cognitive behavioral approach emphasizing the psycho-social aspects of treatment).

Additionally, HIV/AIDS experts have published literature on the use of a stressor support-coping model, according to Goodkin et al. …

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