Multidimensional Frailty,Quality of Life and Self-Management in Aging Hispanics Living With HIV

Abstract

An observational cross-sectional study was conducted to examine multidimensional frailty and its potential impact on quality of life (QOL) in aging Hispanic people living with HIV (PLWH) and assess the extent to which HIV self-management moderates this association. The sample included 120 Hispanic PLWH aged 50 years and older (M = 59.11; SD = 7.04). The structural equation modeling analyses demonstrated that multidimensional frailty was significantly related to QOL in its two dimensions, physical and mental (p < .001). The relationship between multidimensional frailty and mental and physical QOL remained significant even after controlling for confounders (age and gender). The moderator analyses indicated no statistically significant moderator effect of HIV self-management on multidimensional frailty and mental or physical QOL. These study results have practical implications that highlight the need for early screening for frailty with a multidimensional focus. Age-appropriate and culturally tailored interventions to prevent or mitigate multidimensional frailty may improve QOL.

Keywords

frailty older HIV quality of life self-management Hispanic

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References

Administration for Community Living . (2022). 2021 profile of older Americans. Administration for Community Living. https://acl.gov/sites/default/files/Profile_of_OA/2021_Profile_of_OA/2021ProfileOlderAmericans_508.pdf

Araya

A. X.

Iriarte

Padilla

(2019). Reconocimiento de la fragilidad en personas mayores que viven en la comunidad: Un desafío pendiente [Recognition of frailty in primary health care: A challenge for the elderly]. Gerokomos, 30(2), 61–66.

Areri

H. A.

Marshall

Harvey

(2022). Self-efficacy for self-management and its influencing factors among adults living with HIV on antiretroviral therapy in northwest Ethiopia. AIDS Care, 34(12), 1595–1601. Advanced online publication. https://doi.org/10.1080/09540121.2021.2007839

Blanco

J. R.

Barrio

Ramalle-Gómara

Beltran

M. I.

Ibarra

Metola

Sanz

Oteo

J. A.

Melús

Antón

(2019). Gender differences for frailty in HIV-infected patients on stable antiretroviral therapy and with an undetectable viral load. PLoS One, 14(5), Article e0215764. https://doi.org/10.1371/journal.pone.0215764

Boateng

G. O.

Neilands

T. B.

Frongillo

E. A.

Melgar-Quiñonez

H. R.

Young

S. L.

(2018). Best practices for developing and validating scales for health, social, and behavioral research: A primer. Frontiers in Public Health, 6(149), 1–18. https://doi.org/10.3389/fpubh.2018.00149

Brañas

Torralba

Antela

Vergas

Ramírez

Ryan

Dronda

Galindo

M. J.

Machuca

Bustinduy

M. J.

Cabello

Montes

M. L.

Sánchez-Conde

FUNCFRAIL Study Group . (2023). Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV. BMC Geriatrics, 23(1), 4. https://doi.org/10.1186/s12877-022-03719-8

Centers for Disease Control and Prevention . (2021). Estimated HIV incidence and prevalence in the United States, 2015–2019. HIV Surveillance Supplemental Report, 26(1), 1–81. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-26-1.pdf

Centers for Disease Control and Prevention . (2022). HIV in the United States by age. Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/age/olderamericans/index.html#:∼:text=In_2018%2C_over_half_(51,2018_were_in_this_group

Chandran

Benning

Musci

R. J.

Wilson

T. E.

Milam

Adedimeji

Parish

Adimora

A. A.

Cocohoba

Cohen

M. H.

Holstad

Kassaye

Kempf

M. C.

Golub

E. T.

(2019). The longitudinal association between social support on HIV medication adherence and healthcare utilization in the Women's Interagency HIV Study. AIDS and Behavior, 23(8), 2014–2024. https://doi.org/10.1007/s10461-018-2308-x

10.

Cooper

Clatworthy

Harding

Whetham

Emerge Consortium . (2017). Measuring quality of life among people living with HIV: A systematic review of reviews. Health and Quality of Life Outcomes, 15(1), 220. https://doi.org/10.1186/s12955-017-0778-6

11.

Desquilbet

Jacobson

L. P.

Fried

L. P.

Phair

J. P.

Jamieson

B. D.

Holloway

Margolick

J. B.

Multicenter AIDS Cohort Study . (2007). HIV-1 infection is associated with an earlier occurrence of a phenotype related to frailty. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(11), 1279–1286. https://doi.org/10.1093/gerona/62.11.1279

12.

Falutz

Brañas

Erlandson

K. M.

(2021). Frailty: The current challenge for aging people with HIV. Current Opinion in HIV and AIDS, 16(3), 133–140. https://doi.org/10.1097/COH.0000000000000677

13.

Fried

L. P.

Tangen

C. M.

Walston

Newman

A. B.

Hirsch

Gottdiener

Seeman

Tracy

Kop

W. J.

Burke

McBurnie

M. A.

Cardiovascular Health Study Collaborative Research Group . (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56(3), 146–156. https://doi.org/10.1093/gerona/56.3.M146

14.

Gobbens

Luijkx

Wijnen-Sponselee

Schols

(2010). Towards an integral conceptual model of frailty. The Journal of Nutrition, Health & Aging, 14(3), 175–181. https://doi.org/10.1007/s12603-010-0045-6

15.

Gobbens

R. J.

Uchmanowicz

(2021). Assessing frailty with the Tilburg Frailty Indicator (TFI): A review of reliability and validity. Clinical Interventions in Aging, 16, 863–875. https://doi.org/10.2147/CIA.S298191

16.

Greene

Covinsky

K. E.

Valcour

Miao

Madamba

Lampiris

Cenzer

I. S.

Martin

Deeks

S. G.

(2015). Geriatric syndromes in older HIV-infected adults. Journal of Acquired Immune Deficiency Syndromes (1999), 69(2), 161–167. https://doi.org/10.1097/QAI.0000000000000556

17.

Iacobucci

(2010). Structural equations modeling: Fit indices, sample size, and advanced topics. Journal of Consumer Psychology, 20(1), 90–98. https://doi.org/10.1016/j.jcps.2009.09.003

18.

IBM Corp . (2019). IBM SPSS statistics for windows, version 26.0. IBM Corp.

19.

Iriarte

Cianelli

De Santis

(2021). Frailty in the context of older people living with HIV: A concept analysis. ANS. Advances in Nursing Science, 44(4), 340–356. https://doi.org/10.1097/ANS.0000000000000384

20.

Iriarte

Cianelli

De Santis

J. P.

Baeza

M. J.

Alamian

Castro

J. G.

Matsuda

Araya

A. X.

(2022). Frailty among older Hispanics living in the United States: A scoping review. Geriatric Nursing (New York, N.Y.), 48, 287–295. https://doi.org/10.1016/j.gerinurse.2022.10.011

21.

Jones

H. T.

Levett

Barber

T. J.

(2022). Frailty in people living with HIV: An update. Current Opinion in Infectious Diseases, 35(1), 21–30. https://doi.org/10.1097/QCO.0000000000000798

22.

Karimi

Brazier

(2016). Health, health-related quality of life, and quality of life: What is the difference? PharmacoEconomics, 34(7), 645–649. https://doi.org/10.1007/s40273-016-0389-9

23.

Kim

G. S.

Chu

S. H.

Park

Choi

J. Y.

Lee

J. I.

Park

C. G.

McCreary

L. L.

(2015). Psychometric properties of the Korean version of the HIV self-management scale in patients with HIV. Journal of Korean Academy of Nursing, 45(3), 439–448. https://doi.org/10.4040/jkan.2015.45.3.439

24.

Kline

R. B.

(2016). Principles and practice of structural equation modeling (4th ed.). The Guilford Press.

25.

Linley

Prejean

Chen

Hall

H. I.

(2012). Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US states, 2005–2008. American Journal of Public Health, 102(8), 1527–1534. https://doi.org/10.2105/AJPH.2011.300431

26.

Mackinnon

D. P.

(2011). Integrating mediators and moderators in research design. Research on Social Work Practice, 21(6), 675–681. https://doi.org/10.1177/1049731511414148

27.

Muthén

L. K.

Muthén

B. O.

(1998–2017). Mplus user’s guide (8th ed.). Muthén & Muthén.

28.

Muthén

L. K.

Muthén

B. O.

(2002). How to use a Monte Carlo study to decide on sample size and determine power. Structural Equation Modeling: A Multidisciplinary Journal, 9(4), 599–620. https://doi.org/10.1207/S15328007SEM0904_8

29.

Pathai

Bajillan

Landay

A. L.

High

K. P.

(2014). Is HIV a model of accelerated or accentuated aging? The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 69(7), 833–842. https://doi.org/10.1093/gerona/glt168

30.

Piggott

D. A.

Erlandson

K. M.

Yarasheski

K. E.

(2016). Frailty in HIV: Epidemiology, biology, measurement, interventions, and research needs. Current HIV, 13(6), 340–348. https://doi.org/10.1007/s11904-016-0334-8

31.

Polit

D. F.

Yang

F. M.

(2016). Measurement and the measurement of change. Wolters Kluwer.

32.

Rubtsova

A. A.

Sabbag

Sundermann

Nguyen

A. L.

Ellis

R. J.

Moore

D. J.

Letendre

Jeste

D. V.

Marquine

M. J.

(2020). Frailty and neurocognitive impairment: Impacts on quality of life in HIV. Journal of the Association of Nurses in AIDS Care, 31(3), 290–300. https://doi.org/10.1097/JNC.0000000000000142

33.

Sematlane

N. P.

Knight

Masquillier

Wouters

(2021). Adapting to, integrating and self-managing HIV as a chronic illness: A scoping review protocol. BMJ Open, 11(6), Article e047870. https://doi.org/10.1136/bmjopen-2020-047870

34.

Smit

Brinkman

Geerlings

Smit

Thyagarajan

Sighem

A. V.

de Wolf

Hallett

T. B.

ATHENA observational cohort . (2015). Future challenges for clinical care of an ageing population infected with HIV: A modelling study. The Lancet Infectious Diseases, 15(7), 810–818. https://doi.org/10.1016/S1473-3099(15)00056-0

35.

Sopper

(2022). The free statistics calculators - Calculator: A-priori sample size for structural equation models. https://www.danielsoper.com/statcalc/calculator.aspx?id=89

36.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) . (2022). 90-90-90 an ambitious treatment target to help end the AIDS epidemic. United Nations Programme on HIV/AIDS (UNAIDS). https://www.unaids.org/en/resources/909090

37.

The WHOQOL Group . (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667

38.

United States Census Bureau . (2021). QuickFacts United States. United States Census Bureau. https://www.census.gov/quickfacts/US

39.

Van de Velde

De Zutter

Satink

Costa

Janquart

Senn

De Vriendt

(2019). Delineating the concept of self-management in chronic conditions: A concept analysis. BMJ Open, 9(7), Article e027775. https://doi.org/10.1136/bmjopen-2018-027775

40.

Vrotsou

Machón

Rivas-Ruíz

Carrasco

Contreras-Fernández

Mateo-Abad

Güell

Vergara

(2018). Psychometric properties of the Tilburg Frailty Indicator in older Spanish people. Archives of Gerontology and Geriatrics, 78, 203–212. https://doi.org/10.1016/j.archger.2018.05.024

41.

G. T.

Tran

B. X.

Hoang

C. L.

Hall

B. J.

Phan

H. T.

G. H.

Latkin

C. A.

(2020). Global research on quality of life of patients with HIV/AIDS: Is it socio-culturally addressed? (GAPRESEARCH). International Journal of Environmental Research and Public Health, 17(6), 2127. https://doi.org/10.3390/ijerph17062127

42.

Ware

J. E

(2000). SF-36 health survey update. Spine, 25(24), 3130–3139. https://doi.org/10.1097/00007632-200012150-00008

43.

Webel

A. R.

Asher

Cuca

Okonsky

J. G.

Kaihura

Dawson Rose

Hanson

J. E.

Salata

R. A.

Burant

C. J.

(2012). Measuring HIV self-management in women living with HIV/AIDS: A psychometric evaluation study of the HIV Self-management Scale. Journal of Acquired Immune Deficiency Syndromes, 60(3), 72–81. https://doi.org/10.1097/QAI.0b013e318256623d

44.

Wleklik

Uchmanowicz

Jankowska

E. A.

Vitale

Lisiak

Drozd

Pobrotyn

Tkaczyszyn

Lee

(2020). Multidimensional approach to frailty. Frontiers in Psychology, 11(564), 1–11. https://doi.org/10.3389/fpsyg.2020.00564

45.

Wolf

E. J.

Harrington

K. M.

Clark

S. L.

Miller

M. W.

(2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 76(6), 913–934. https://doi.org/10.1177/0013164413495237

46.

Yamada

Kobayashi

Condo

Sangarlangkarn

Taniguchi

Kojima

(2022). Prevalence of frailty and prefrailty in people with human immunodeficiency virus aged 50 or older: A systematic review and meta-analysis. Open Forum Infectious Diseases, 9(5), 129. https://doi.org/10.1093/ofid/ofac129

47.

Yeoh

H. L.

Cheng

Palmer

Crowe

S. M.

Hoy

J. F.

(2018). Frailty in men living with HIV: A cross-sectional comparison of three frailty instruments. Antiviral Therapy, 23(2), 117–127. https://doi.org/10.3851/IMP3185

48.

Zeballos

Lins

Brites

(2019). Frailty and its association with health-related quality of life in older HIV patients, in Salvador, Brazil. AIDS Research and Human Retroviruses, 35(11–12), 1074–1081. https://doi.org/10.1089/AID.2019.0103

49.

Zhang

Yin

Wang

Han

Wang

Liu

Chen

(2021). Identification of self-management behavior clusters among people living with HIV in China: A latent class profile analysis. Patient Preference and Adherence, 15, 1427–1437. https://doi.org/10.2147/PPA.S315432

50.

Zuñiga

J. A.

Sales

Jang

D. E.

West Ohueri

Burkholder

Moore

Davy-Méndez

Christopoulos

García

A. A.

(2022). Self-management model fails to predict quality of life for people living with dual diagnosis of HIV and diabetes. AIDS and Behavior, 26(2), 488–495. https://doi.org/10.1007/s10461-021-03405-7