- EMLET Charles A., SHIPPY R. Andrew
- Journal article citation:
- Journal of Gerontological Social Work, 50(S1), 2008, pp.131-149.
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Although the number of people being diagnosed with HIV AIDS continues to decline in the USA, the numbers living with the condition rise. Older people are likely to comprise an increasing proportion of the HIV AIDS population, and include two sub-groups: those infected in later life; and those ageing with HIV disease. The major psychosocial challenges posed by HIV AIDS (stigma, support, coping) may be exacerbated by the effects of ageing, including a natural decline in immune system responsiveness and the presence of co-morbid conditions. This paper reviews empirical evidence on psychosocial interventions with HIV AIDS patients aged 50 or over. Only three studies met the inclusion criteria, indicating the embryonic nature of research in this area, but all three provided some positive results. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
- Extended abstract:
EMLET Charles A.; SHIPPY R. Andrew;
Journal citation/publication details
Journal of Gerontological Social Work, 50(supplement 1), 2008, pp.131-149.
Only three studies met the inclusion criteria for this review of psychosocial interventions for adults over 50 suffering from HIV/AIDS, although all three do provide some positive results in respect of well-being and coping abilities. Further research is clearly needed.
Although the numbers of people being diagnosed with HIV AIDS are falling in the USA, more people are surviving for longer. Older people with the condition may suffer additional psychosocial challenges in relation to stigma, social support and coping because of the ageing process. This review accordingly looks at evidence on psychosocial interventions to help those over 50.
What sources were used?
The databases searched were: CINAHL (Cumulative Index to Nursing and Allied Health Literature); PsycINFO; PubMed; and Social Work Abstracts. One researcher with work on the verge of publication was also contacted.
What search terms/strategies were used?
Search terms are not specifically reported, but it appears from the text that they were: HIV/AIDS; older adults; stigma; social support; coping.
What criteria were used to decide on which studies to include?
Eligible studies were empirical evaluations of psychosocial interventions for adults over 50 with HIV AIDS.
Who decided on their relevance and quality?
The yield from the searches is not reported but the authors make clear that most papers were overviews or, if empirical, did not deal with psychosocial interventions. All reviews in this issue of the Journal of Gerontological Social Work judged the quality of evidence on the basis of a common framework: meta-analysis or systematic review of all relevant randomised controlled trials (RCTs) (Level I); at least one properly designed RCT (Level II); well designed controlled but non-randomised studies (Level III); non-controlled studies (Level 4a); and consensus reviews of expert opinion based on clinical experience or reports of expert committees (Level 4b).
How many studies were included and where were they from?
Three studies, summarised in Table 1, met the inclusion criteria. No geographical settings are reported but it seems likely that all were in the USA.
How were the study findings combined?
The review is narrative.
Findings of the review
The first of the three studies focused on a group intervention designed to improve coping strategies. The ten-session intervention for 16 participants was cognitive-behavioural in approach and focused on the identification and decomposition of stressors into more specific issues, the development of problem- and emotion-focused coping strategies, and the optimisation of social support. There was a particular focus on stressors peculiar to an older population, such as longer hospital admissions and the presence of co-morbid conditions. Results from surveys conducted at baseline and after the end of treatment showed improved problem-solving, better ‘confrontive coping’ and more optimism about the future. Participants also reported having more support from friends, higher perceptions of well-being and less stress.
A second study, with the same lead author and involving 90 participants, evaluated a 12-session coping intervention delivered by teleconference. On the verge of publication at the time the review was conducted, this study found that participants reported fewer psychological symptoms, less life stress burden and improved coping.
The last of the three studies, with only five participants in all, examined a psycho-educational telephone support group, co-facilitated by a social worker and a nurse. Session over a ten-week period lasted between 50 and 60 minutes, with an average of three participants. Qualitative findings suggest the value to participants of sharing multiple losses, although the telephone format was not always conducive to maintaining the ‘boundaries of respect’ or to effective communication (for those with hearing impairments).
The evidence base on psychosocial interventions for older people with HIV AIDS is ‘embryonic’, but given the inevitable increase in their numbers, health and social care workers need to have a greater understanding of the particular problems they face. In planning a future research agenda, it will be important to address the ageist barriers that exist towards the recruitment of older people to HIV intervention studies (e.g. that they are not sexually active, or do not engage in risky behaviours), and to understand the full implications of the additional stigma they have to face.
Implications for policy or practice
No specific implications are examined, but in discussing the future development and evaluation of psychosocial interventions, the authors emphasise that two separate groups of older HIV AIDS patients need to be considered: those who are aging with the condition; and those who have contracted it in later life. The paper concludes with a ‘treatment resource appendix’ directed at American social workers.
- Subject terms:
- HIV AIDS, older people, outcomes, psychosocial intervention, stereotyped attitudes, coping behaviour;
- Content type:
- systematic review
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