Social support is among the most significant factors in preferences for short-term care among older adults with HIV, according to a study recently published in AIDS Care. This preference was not associated with long-term care, underscoring the potential vulnerability of those with limited social networks.
Researchers recruited participants from clinics in Los Angeles and New Orleans and provided optional surveys, which collected data on gender, race or ethnicity, employment, living arrangement, recent CD4 range, detectability of viral load, age, sexual orientation, education, relationship status, and years since first diagnosis of HIV. Descriptive statistics summarized characteristics and outcomes of participants, and differences between groups were examined using chi-squared tests and t-tests.
This cross-sectional study included 154 participants, 33.6% of whom were at risk for social isolation. For short-term care ranging from several days to several weeks, 73.4% of individuals reported informal support as their preferred care method. Individuals who preferred formal support were more commonly single (90.2% vs 65.5%; P=.04) and had more limited social networks (social support scores of 12.1 vs 15.8; P =.01). The preference for informal support lowered to 66.2% for long-term care. Those preferring formal support for long-term care were more likely to be Hispanic/Latino (34.7% vs 13.9%; P <.01), single (81.6% vs. 66.7%; P =.04), and homosexual or bisexual (56.5% vs 32.0%; P <.01). Preference for type of care did not vary by gender, employment status living arrangements, health status, depression/anxiety, physical functions, HIV features, relationship status, education, or age.
Living wills or advance directives were present among 26.0% of participants, which also corresponded with improved scores for social support (17.0 vs 14.1; P =.03), physical function (25.4 vs 22.8; P =.03), and anxiety (5.1 vs 7.6; P =.02). In addition, 13.2% of participants could not identify an individual who he/she could call for emergency care assistance; 53.3% of participants listed 1 person as an emergency contact, and 33.6% of participants listed >2 people. Participants who had zero emergency contacts had lower support scores compared to participants who listed >1 emergency contact (9.3 vs 15.7; P < .01).
The study researchers found “social support to be a significant determinant for short-term caregiving preferences and access to emergency caregivers but not long-term care preferences and advance care planning. For older adults living with HIV with limited social networks, this highlights vulnerability in terms of access to caregivers in sudden or unexpected health situations. Cultural differences by race/ethnicity, gender, and sexual orientation may play important roles in long-term caregiving preferences and advance care planning.”
Nguyen AL, Seal D, Bruce O, et al. Caregiving preferences and advance care planning among older adults living with HIV [published online August 25, 2018] AIDS Care. doi: 10.1080/09540121.2018.1515472