title: Synergistic effects of HIV infection and older age on daily functioning.
abstract: OBJECTIVE
  To determine whether HIV infection and aging act synergistically to disrupt everyday functioning.
  
  
  METHODS
  Cross-sectional factorial study of everyday functioning in the context of HIV serostatus and age (≤40 years vs. ≥50 years).
  
  
  METHODS
  One hundred three HIV+ and 87 HIV- participants were administered several measures of everyday functioning, including self-report indices of health-related quality of life (HRQoL) and instrumental and basic activities of daily living (IADLs and BADLs), and objective measures of functioning, including employment and Karnofsky Performance Scale ratings.
  
  
  RESULTS
  Significant interaction effects of HIV and aging were observed for IADL and BADL declines, and for Karnofsky Performance Scale ratings (Ps < 0.05), independent of potentially confounding factors. Follow-up contrasts revealed significantly worse functioning in the older HIV+ group for most functional outcome measures relative to the other study groups (Ps < 0.05). A significant interaction effect was also observed on the emotional functioning HRQoL subscale, and additive effects of both age and HIV were observed for the physical functioning and general health perceptions HRQoL subscales (Ps < 0.05). Significant predictors of poorer functioning in the older HIV+ group included current major depressive disorder for all outcomes, and comorbid medical conditions, lower estimated premorbid functioning, neurocognitive impairment, and nadir CD4 count for selected outcomes.
  
  
  CONCLUSIONS
  Findings suggest that older age may exacerbate the adverse effects of HIV on daily functioning, which highlights the importance of evaluating and monitoring the functional status of older HIV-infected adults. Early detection of functional difficulties could facilitate delivery of compensatory strategies (eg, cognitive remediation) or assistive services.
authors.affiliation: Department of Psychiatry, University of California, San Diego, CA 92103, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Morgan
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Iudicello
authors.forename: Erica
authors.initials: E
authors.lastname: Weber
authors.forename: Nichole A
authors.initials: NA
authors.lastname: Duarte
authors.forename: P Katie
authors.initials: PK
authors.lastname: Riggs
authors.forename: Lisa
authors.initials: L
authors.lastname: Delano-Wood
authors.forename: Ronald
authors.initials: R
authors.lastname: Ellis
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
authors.forename: Steven P
authors.initials: SP
authors.lastname: Woods
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000375:Aging / Q000523:psychology; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004651:Employment; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life