What is “successful ageing” for people living with HIV?

When Canadian researchers asked HIV-positive people over the age of 50 how they would define “successful ageing”, six key themes emerged – accepting limitations, staying positive, maintaining social support, taking responsibility, living a healthy lifestyle, and engaging in meaningful activities.

Writing in the International Journal of STD & AIDS, Patricia Solomon and colleagues note the emphasis on individual control. Clinicians and service providers should work with people living with HIV to understand their values and aspirations and help them identify their personal goals, the researchers say.

In relation to the general population, there are numerous definitions and models of successful ageing. For example, some authors have said it has three components: avoidance of disease, maintenance of cognitive and physical function, and social engagement. However, the concerns and priorities of people with HIV may be different. The experience of stigma and discrimination may mean that social isolation is a particular concern. Having already dealt with health issues over many years, people with HIV have different feelings about their physical health.

For a qualitative study on HIV, ageing and disability, researchers in Ontario, Canada conducted a series of in-depth interviews with older adults living with HIV. Each person was interviewed on four separate occasions, over an 18 month period.

The 24 interviewees were aged between 50 and 73, with a mean age of 57. Fourteen were male and 10 were female. The length of time since their HIV diagnoses ranged from 6 to 30 years, with a mean of 18 years. While three-quarters had an undetectable viral load, three-quarters also reported that they experienced at least six “bothersome” symptoms. Only one in five was employed and incomes tended to be low.

At the end of the fourth interview, participants were asked how they would define successful ageing and to reflect on whether they considered themselves to be ageing successfully. The six key themes that emerged are described below.

Accepting limitations

The interviewees talked about the importance of coming to terms with the realities of ageing, of not expecting to be able to do as much as when they were younger and of setting limits. When one man was asked if he considered himself to be ageing successfully, he responded:

“I’m in a happy place. I could be happier but I mean I’m sort of accepting. I’m accepting what my life is.”

Staying positive

While many participants talked about being positive and happy, they defined this in a variety of ways – avoiding depression, having dreams and aspirations, and maintaining a sense of humour.

“Having a sunny disposition on life, don’t let things drive you down, don’t sweat the small stuff. That’s a big one. Don’t sweat the small stuff.”

Maintaining social support

Connectedness with others was recognised as an essential element of successful ageing. This could be with friends, family, other people with HIV, and other social networks. Interviewees recognised the practical (as well as emotional) support that they sometimes needed.

“I’ve learned, this was a hard one for me, I’ve learned to ask for help.”

Taking responsibility

Being involved in managing one’s own healthcare was important to many participants.

“We’re dealing with HIV and it’s not going to go away, so we have to be self-reliant and we have to be good managers of our health and our psyche so that we don’t fall into the doldrums.”

Healthy lifestyle

Many interviewees recognised the importance of a healthy lifestyle. They spoke about eating healthily, abstaining from drugs and smoking, getting rest and sleeping well, minimising stress and regular exercise.

“If you want to live a full and long, healthy life, you can… Adherence to your medications is paramount, but coupled with that is the changes you will make in your personal life.”

Engaging in meaningful activities

A key element was the ability of people to take part in activities that were meaningful to them. These could be maintaining existing activities or finding new ones, including taking care of oneself, taking care of other people, volunteering or employment.

“Everyday I just keep going, I’m not going to stop working. And that helps the mind and the body to keep going.”

Conclusion

While academic and professional models of successful ageing tend to emphasise physical health and the absence of disease, the researchers say that their interviewees were less concerned about this – only one interviewee mentioned living to an old age – and were more concerned about the psychological and social aspects of getting older.

“Our participants appeared to focus on components of successful aging that emphasised individual control,” the researchers say. “From a clinical perspective this highlights the importance of working with PLWH [people living with HIV] to understand their values and aspirations, and create patient-centered goals that are meaningful to the individual.”