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Empowering Older PWH
Empowering Patients to “Age Healthy” With HIV

Released: October 25, 2022

Expiration: October 24, 2023

Cristina Mussini
Cristina Mussini, MD
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Key Takeaways:

  • Caring for older people living with HIV should not solely focus on HIV management, but also on other health issues that are relevant to their age.
  • As healthcare professionals, we need to empower our older patients to care for themselves, including discussing how to maintain a healthy weight by staying mobile and eating healthy.
  • For women with HIV—who often care for others before themselves—we need to promote self-care that is focused on self-esteem and preventive care.

One of our roles as healthcare professionals is to address with our patients how to live well while aging with HIV. With HIV management, however, the problem is that we often focus on monitoring CD4 cell count and HIV-1 RNA, but we need to remember to address other health issues and be cognizant of our patients’ needs at specific ages. For example, when a patient is younger, we should counsel them to consider contraception or safe sex. Similarly, when a patient is in their 50s or 60s, we should ask them how they want to age.

Living Healthy With HIV
Terminology is starting to shift from “patients with HIV” to “people living with HIV,” emphasizing that HIV is no longer a terminal disease, which is further proven by the growing aging population. This is much different from when I was a young doctor. 

Chronic inflammation from HIV can have a deleterious effect on aging, but there are things we can do to promote healthy aging, such as staying active and eating well. People living with HIV need to understand that it is not just managing their HIV, but also their overall lifestyle, that helps them age well.

Maintaining a Healthy Weight
While working in the hospital during the COVID-19 pandemic, I observed many frail patients in their 60s and 70s with numerous health problems. It reminded me how crucial it is to talk about living healthy with patients early to help them avoid becoming frail before it is too late.

As people living with HIV age, they lose mobility and become more rigid. It is important to maintain a healthy weight because being overweight can be harmful to the joints and increase the risk for cardiovascular disease. Patients need to remain mobile and exercise. Exercise does not need to be too strenuous—it can be as simple as going on a walk. Tracking steps with a watch, a smartphone, or another method can help.

Diet is another component to maintaining a healthy weight, and this should be done in a nonobsessive way. For instance, if the patient had a heavy lunch one day, they should have something lighter, like a salad, the next day to maintain balance. Alcohol consumption should be limited, too. It is important to make achievable goals for patients that fit within their lifestyle and daily routine.

Sometimes I find that patients are unaware of the need to exercise and eat healthier. I think that is because of a lack of perception. This highlights why it is important for us as healthcare professionals to bring up these issues during care visits.

Promoting Self-care in Women
Women tend to be caregivers their entire lives, but we need to emphasize the importance of self-care and empower our patients to take care of themselves. First, they should focus on their well-being—their self-esteem and how they want to age.

Next, we should promote preventive screenings. For example, for cancer prevention, we should recommend a mammography, an annual Pap smear, and a colonoscopy for older women living with HIV. With that in mind, it is also crucial to discuss any interventions that could reduce their chance of developing cancer (eg, smoking cessation) and other ailments. 

Stigma and Mental Health
There are 2 types of stigma. One is related to society and associated with ignorance or unconscious bias. This may explain why people do not disclose their HIV status. Another is self-stigma, where patients may internalize stigma from society and fear they are being judged or rejected. It may feel as though they are carrying a 100-kg weight. This can negatively impact their mental health. Our patients need to learn to love themselves—if not, that can be a major barrier to aging well.

For our patients with HIV, we should do everything we can to monitor medical issues related to aging, such as managing their HIV, ensuring they have an undetectable HIV-1 RNA, managing comorbidities, monitoring bone and kidney health, and promoting cancer screenings. Beyond these medical issues, it is important to make sure our patients feel valued and know we truly care for them. I usually tell my patients that to age well, it is critical to eat well, exercise routinely, quit smoking, limit alcohol consumption, and—above all—learn to love yourself.

Your Thoughts?
How do you empower your patients with HIV to age healthy? How early do you start these conversations with your patients? Join the discussion by posting a comment.