Loneliness in older HIV-positive adults is associated with reduced
cognitive function as well as poorer mental and physical health, according to
Canadian research presented to the recent Aging and HIV Workshop in New York. Approximately
two-thirds of study participants reported loneliness, which was associated with
both HIV-related and lifestyle factors.
“The results support that physical symptoms (e.g. pain,
fatigue), apathy, stigma, and restricted social network contribute to
loneliness,” concluded Marianne Harris and colleagues. “Loneliness has
consequences for reduced activity, poor lifestyle choices, impaired cognition,
stress, and depression, all of which contribute to poor quality of life.”
Loneliness has been associated with poor health in the
general population, especially in older individuals. However, little is known
about the prevalence of loneliness, its risk factors and impact on health and
quality of life in people with HIV. People with HIV may be at increased risk
of loneliness because of stigma, depression, substance use, lack of social
connections and physical symptoms.
To establish a clearer understanding of these issues,
investigators analysed cross-sectional data from participants in the Positive Brain Health Now cohort.
Participants were HIV-positive people aged 35 years and older who received
outpatient care between 2013 and 2016 at five HIV outpatient clinics in
Vancouver, Toronto, Hamilton and Montreal.
Data were collected using interviews and self-report
questionnaires. Loneliness was assessed using a single question, “Do you find
yourself feeling lonely: quite often, sometimes or almost never?” Cognitive
function, mental health, self-rated health and quality of life were measured
using validated tests.
All the participants had been diagnosed with HIV for at least
one year. Individuals with dementia or a central nervous system disorder were
excluded. A total of 836 people were included – most (85%) were men,
approximately three-quarters were Caucasian and the mean age was 52 years.
Almost two-thirds (64%) reported loneliness, including 18%
who said they were quite often lonely and 46% who were lonely some of the time.
People were more likely to report loneliness if they were not
having enough money to meet basic needs (p < 0.001). Loneliness was more
common in individuals with a higher number of HIV-related symptoms (p <
0.001), more severe symptoms (p < 0.001), weakness as a symptom (p <
0.001) or lung disease (p < 0.05).
Several lifestyle factors were also associated with
loneliness, including reduced physical activity (p < 0.001), watching more
hours of TV (p < 0.05) and opioid use (p < 0.05).
Loneliness was associated with poorer cognitive function and
more self-reported cognitive concerns (both p < 0.001). On four different
validated scales, people who were quite often lonely had poorer mental health and
wellbeing (all p < 0.001), including symptoms of depression, stress and
anxiety.
Relatively few people who were often lonely rated their health
as very good or excellent (25.0%), compared to those who were never lonely
(61.3%). Similarly, quality of life was rated as very good or excellent by
37.8% of those who were quite often lonely and 89.8% of those who were never
lonely.
The investigators developed a model to better understand how
loneliness was associated with poorer health in people with HIV:
- Contributors to
loneliness: stigma, having fewer than five close friends or relations,
pain, fatigue, and not working or volunteering.
- Consequences of
loneliness: reduced physical activity, more hours spent watching TV, opioid
use, reduced cognitive function, increased stress, and poorer mental health.
- Downstream effect:
poorer self-rated health and poorer quality of life.
The investigators acknowledge that their findings are
limited by the composition of the study population (mostly male and white). The
cross-sectional design meant they were unable to definitively determine the
direction of the association between loneliness and poorer outcomes.
They call for more research, especially qualitative studies
assessing experiences of loneliness from the perspective of patients.
The authors also believe their findings have clear
implications for models of HIV care, showing the importance of enhanced social
care for people with HIV, especially older individuals. Interventions to engage
people in socially meaningful activities should be developed for older adults
living with HIV, they say.