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1AGEING WITH HIV: HOUSING AND NURSING CARE
Ageing with HIV: Housing and Nursing Care
Name of the Student
Name of the University
Author Note

2AGEING WITH HIV: HOUSING AND NURSING CARE
Ageing with HIV: Housing and Nursing Care
In recent times, the Human Immunodeficiency Virus (HIV) infection has taken the
form of a global pandemic. Despite the huge progress in combating HIV, more and more new
cases of infection are coming up every year. While the rate of infection is relatively lower in
the developed countries, but there was an 11.6% more reported cases in Canada in the year
2016. Among people aged 50 years or older, the rate of infection has been increasing
(Bourgeois, Edmunds, Awan, Jonah, Varsaneux & Siu, 2017). Ageing by itself is a pretty
stressful process with many psychological implications. When this is combined with the
consequences of HIV infection, it takes a huge toll on the mental and physical state of the
patient. The importance of proper care for such individuals is undeniable. This report focuses
on the subpopulation of older adults who have been diagnosed with AIDS/HIV, the issues
they face, how nursing can help them, and measures to be taken for their comfortable living.
Discussion
Ageing Adults with HIV (The subpopulation)
In Canada, around 15.6 per cent of Canadians were found to be of ages 65 or older,
which was 6 million Canadian citizens. It has been estimated that this number has the
potential to double over the course of less than a couple of decades (Canada.ca, 2020). The
reported number of HIV positive diagnoses among the older crowd is on a rise. This may be
due to the fact that some citizens receive a diagnosis later in life (Canadian AIDS Society,
2020). According to a surveillance report in 2017, a rise in positive diagnosis was noticed
people aged 50 or older, which was around 24.3 per cent in 2016. The highest rate of HIV
infection was found in homosexual men. In recent times, the number of older individuals with
a positive HIV diagnosis has been increasing, mainly thanks to Antiretroviral therapy (ART).
Another reason is that the older crowd is not as aware of the risks and precautions against

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HIV. This increases their chances of getting infected. This report focuses on aged men who
have a positive diagnosis of HIV. This includes patients who live independently, or under
special care.
Literature Review
The Issues of Ageing with HIV
The main issues with respect to living with HIV are related to the physical
consequences of AIDS (Acquired Immunodeficiency Syndrome). Ageing in itself is a process
when a person’s immunity is lowered, as their body ages and deteriorates. The main
symptoms of AIDS relate to the breaking down of the patient’s immune system so they are
much more prone to catching an infection that they would not have suffered from with a
stronger immune system. Here the body cannot protect itself from any pathogens as the
immune response does not occur. The chronic illnesses that usually occur due to old age,
combined with the reduced immunity of AIDS, takes a huge toll on health. These are known
as comorbid diseases. It has been observed that elders suffering from HIV have a 50%
increased chance of heart attack. Some other issues included weaker bones, neurological
disorders, renal and liver disorders as well as cognitive abilities (WING, 2017). These have a
much higher rate of occurrence in patients with AIDS due to accelerated health deterioration.
It has been observed that among HIV positive individuals, around 30 to 60 per cent
experience some sort of mental deterioration. As a person becomes older, the volume of
thymus decreases, resulting in a reduction of naïve T cell production. HIV on the other hand
also tends to inhibit the production of naïve T-cells. This combined effect causes the
progression rate of HIV in elder patients much more pronounced compared to that of younger
patients. A similar effect falls on the production and functions of that of B-cells. Thus
antibodies are produced to a lesser extent, causing an overall reduction in the body’s immune
response. Along with that, the ill-effects of the treatments are also much more pronounced.

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There is a significant decline in the clearance of creatinine as a person becomes older. This
negatively affects the metabolism of drugs that are excreted via the renal pathway. There are
also chances of treatments for one disease adversely reacting to the drugs administered for
another. The basic consequences of course also included extreme weakness, hampered
functionality and other age-related issues which were more apparent than ever
(Mpondo,2016). Most patients suffer from age-related issues around 10 to 20 years earlier
than usual. Apart from physical repercussions, there are mental effects of ageing with HIV as
well. Around 49 per cent of ageing adults felt deprived by society. It was seen that they did
not receive support from the social workers either. The uncertainty regarding the symptoms,
treatments, and results may also cause adverse mental reactions in aged patients (Solomon,
O'Brien, Wilkins & Gervais, 2014). HIV and its treatment definitely have a severe effect on
brain function. HIV-related Dementia is very common in elder people. It has been observed
that elders with HIV experience more loneliness and isolation than their younger counterparts
(National Institute on Aging, 2020).
Issues Related to Housing
With the progress in modern medicine, the rate of survivors with HIV has increased
rapidly; hence the number of aged adults with HIV positive diagnosis has also increased.
However, owing to the various social stigmas relating to HIV, the patients, especially the
elders face various troubles in there family and overall social life. This was related to finding
a place at old age homes, apartments and even being homeless. Many people are ashamed of
the disease, thus they do not inform their families or friends about the disease. This results in
a lack of people who can support them emotionally and socially. Around two-thirds of them
live alone, and many have been abandoned by their families and friends thanks to the toxic
effects of stigmas surrounding the disorder. Many do not receive the proper support from
social workers either, which results in them facing a lack of proper services (Enel et al.,

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2019). This leaves them to seek expensive housing facilities or old-age care homes. Since
many of them are already overburdened with expenses for the treatments, many of them
cannot afford such facilities (Brennan-Ing, Seidel, London, Cahill, & Karpiak, 2014). There
are some long-term care facilities for older patients; however it has been seen that they lack
proper understanding for dealing with the patients. Ageing adults with HIV have unique
needs, and most staff fall short of that. Very small research is available on HIV positive
patients exceeding the age of 75. There is a severe lack of studies done on aged HIV positive
people living in nursing homes and long term care facilities. Since HIV positive elders face
many comorbidities and likely take a large number of drugs, it is important that the staff at the
facilities are aware of how to care for them optimally. In a study conducted at Allegheny
County, it was seen that very few long term care facilities were aware of HIV organizations
and very few providing HIV training to their staff (Schaffer, 2019). A report showed that at
Philadelphia, the rate of using a shelter by HIV positive people was three times higher than
that of HIV negative people. It was estimated that among the sheltered people, 4.6 per cent
males and 2.7 per cent females were HIV positive (Metraux, 2017). A report by CDC showed
that 6.2 to 35 per cent of the homeless elderly population were HIV positive. They tended to
be in poorer health due to the combined infection of ageing and HIV and special training of
service providers for the elderly suffering from AIDS was highly required (Aminbakhsh,
Strong, Chau, Vafadaran, & Faroughi, 2018).
Intervention of Nurses
Ageing patients with HIV require special care that normal HIV networks cannot
provide to the fullest, as their struggles are much different from that of their younger
counterparts. According to a study conducted in France, around one-third of nursing home
staff has some mental reservations about admitting ageing patients with HIV in their facilities.

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The staff working for caring ageing adults were not really aware of the medical and
psychological aspects of caring for an ageing person with HIV (Naudet et al., 2017).
In Nursing facilities, nurses need to administer special care to the HIV positive elderly
as they suffer from comorbidities along with the reduced immunity of HIV. However, the
biggest intervention required is definitely the emotional support as the main issue in most
patients are the social isolation and lack of proper support system. It is important that the
nurses convey the three main themes to such patients in order to help them psychologically.
Firstly, they need to remind them that there is absolutely possible t successfully age with HIV,
especially because newly diagnosed patients often suffer from the taboo factor of the disease
and are a victim of the social stigma. Giving them hope provides them with the motivation
that taking care of themselves is important and all is not lost yet. Secondly, it is important to
make them understand that importance of medication and explain to them how the drugs
actually work against the infection. This will inspire them to take their medications seriously
and not skip them. Finally, nurses must explain to them the basic ways of keeping themselves
fit such as eating healthy, exercising such as taking a walk and sleep properly. The best way
to combat the disease and live healthy, physically and mentally is to incorporate the positivity
and healthy practices in their lifestyles.
From a more physical point of view, the nurses must keep a close look at the patient
throughout the days. Noticing small symptoms such as missing phone calls or appointments,
sleeping less, getting irritable, forgetting medications, can indicate more serious clinical
conditions which if not diagnosed early, can cause problems and interfere with the treatments
of HIV. The nurses must make regular doctor appointments for the patients ensuring regular
full body checkups as that is vital to catch anything that may be abnormal. In the case of
patients at their homes, the nurses must convey all of the above to the family or caregivers.

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It is important to remember that social isolation and loneliness can often lead the
patient to have self-harming or suicidal thoughts. So it is important to show them that they are
important and that they are cared about. This can be achieved by talking to them, encouraging
them to converse and spending time with them in general. In more serious cases, referring
them to medical professionals, therapists or counsellors must be done (Lowther et al., 2015). It
is important to constantly support them and make them feel more stable and stronger
mentally. It was observed that more resilient ageing adults had a more optimistic view and a
better quality of life while living with HIV (Fang et al., 2015)
Larger System Implications (Palliative care)
Even though HIV patients have a far better chance of leading a good quality life than
they had before, having a disease that makes them immunologically compromised is no doubt
a serious issue. Many of them struggle to get proper care, medications or support from closed
ones. As mentioned before, HIV positive elder patients face significant problems regarding
acquiring good quality housing as well. Despite these setbacks, many of them refuse to or are
apprehensive of the idea of seeking palliative care. This is often because of the association
hospice or palliative care with the prospect of immediately dying. It is important to explain
that seeking palliative care does not equate to dying immediately. The aim of palliative care is
to reduce the suffering of a seriously ill patient and provide them with the best quality of life
they can possibly have with their clinical condition. Palliative care hence can be extremely
beneficial towards caring for aged patients with HIV who suffer from various comorbidities.
It is extremely important that HIV professionals associate with the staff from palliative care to
find the best possible methods that can be used to care for the patient. HIV positive patients
who are terminally ill may be successfully aided with palliative care to give them the best
support possible. However, the concept of hospice or palliative care is still not very popular or
well-understood in many countries and thus not implemented to the fullest extent. According

8AGEING WITH HIV: HOUSING AND NURSING CARE
to WHO, palliative care is a necessary tool to successfully ageing with HIV, but it is still not
fully understood or utilized. (Shorthill & DeMarco, 2017). It has been seen that seeking
palliative care often improves the life expectancy of ageing adults with HIV as they get the
professional care and treatment that is a must in a disease like HIV, especially combined with
the comorbidities (Levett, Wright, & Fisher, 2014). In the long run, the importance of
palliative care must be well-explained to the common people and the nursing facilities refer
patients for the same when required. It is essential that palliative care be well understood and
implemented (Slomka, Prince-Paul, Webel & Daly, 2016).
Conclusion
From this report, we can conclude that a huge percentage of HIV positive populations
are ageing adults and they face many obstacles in their daily lives in terms of social stigma,
housing, diseases, comorbidities, getting proper medical care and social support. Their
struggles are profound and must be taken seriously in order to provide them with a good
quality of life. The issues of being socially isolated and devoid of support from loved ones can
seriously affect them psychologically, leading to suicidal thoughts. So it is important that the
nurses in charge of caring for such patients support them mentally by encouraging them,
explaining the importance of treatment, spending time with them along with the usual clinical
care that must be provided. Finally, it is also important to explain and publicize the
importance of palliative care to the general public and encourage the patients to seek hospice
care when necessary.

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