Everyday Functioning In Middle Aged And Older Adults With Hiv: Factors That Influence Everyday Functioning And Awareness Of Functioning
Abstract
With combination antiretroviral therapy (cART), the population of older people living with HIV (PLWH) is growing. There is a need to better understand everyday functioning, including instrumental activities of daily living (IADLs), to improve real-world outcomes for this clinical population. This dissertation attempts to (1) characterize factors related to self-report and performance of IADLs in PLWH, (2) examine correlates of self-awareness for functional abilities, and (3) apply a theoretical model to examine complex relationships between factors that impact self-awareness for functional abilities. Participants in these retrospective analyses included 260 PLWH who completed a comprehensive neurobehavioral evaluation including neuropsychological tests, measures of premorbid cognitive abilities, and depressive symptoms, as well as self-report and performance-based measures of IADL function. Global cognitive function, as well as processing speed, working memory, HIV disease burden (i.e., CD4 T-cell count and viral load), and estimated premorbid cognitive abilities were associated with worse performance of IADLs on objective measures. In contrast, greater depressive symptoms were associated with worse self-reported IADL function. Performance of IADLs on objective tasks was not significantly associated with self-reported IADL function. Impaired self-awareness was observed in 20 – 51% of the sample depending on the specific IADL. Of those participants who had impaired self-awareness, the majority under-reported functional difficulties. Although there was variability across IADLs, lower scores on measures of executive function/attention and lower estimated premorbid cognitive abilities increased the likelihood of under-reporting of difficulties, while greater depressive symptoms increased the likelihood of over-reporting of difficulties. When examining complex relationships between variables known to impact self-awareness, worse executive function was associated with more impaired self-awareness. Lower estimated premorbid cognitive abilities were a predictor of worse executive function and self-awareness in a mediation model. In sum, cognitive function is an important factor that contributes to performance of IADLs as well as self-awareness for functional abilities. Depressive symptoms appear to be related to a sense of disability, rather than objective IADL problems. Further, impaired self-awareness for functional abilities is not uncommon in PLWH. Everyday functioning in PLWH is impacted by a variety of factors that could represent targets for interventions aimed at improving the aging process.
