Everyday Functioning In Middle Aged And Older Adults With Hiv: Factors That Influence Everyday Functioning And Awareness Of Functioning

Authors

• Alexandra Elaine Jacob, University of Alabama at Birmingham

Advisor(s)

David Vance

Committee Member(s)

Despina Stavrinos
Michael Crowe
Pariya Fazeli Wheeler
Victor Del Bene

School

College of Arts and Sciences

Document Type

Dissertation

Department (new version)

Psychology

Date of Award

9-9-2024

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.

ProQuest ID

https://proquest.com/docview/3101842606