Larry Z. Slater

The impact of inflammation on cognitive function in older adults: Implications for healthcare practice and research

ABSTRACT Accumulating evidence suggests that levels of inflammation, an immune response, increase with age throughout the body and the brain. The effects of inflammation on the brain, both acute and chronic, have been associated with cognitive decline and risk of dementia in older adults. Factors believed to increase inflammation include certain health-related behaviors, such as smoking, poor diet, and inactivity as well as health conditions like diabetes, hypertension, and chronic obstructive pulmonary disease, most of which require medical intervention and monitoring. As such, nurses and healthcare professionals are likely to encounter patients who are at a high risk for future development of inflammation-related cognitive decline. A review of inflammatory processes and their relation to cognitive function in older adults is provided, along with factors that may increase or reduce inflammation. Implications for practice and research are discussed.

Support, Stigma, Health, Coping, and Quality of Life in Older Gay Men With HIV

&NA; As life expectancy for persons living with HIV has increased due to antiretroviral therapy, quality of life (QOL) has become an emerging issue for older gay men with HIV, who comprise more than 50% of older adults living with HIV in the United States. The purpose of this study was to determine predictors of QOL in older gay men with HIV. Sixty gay men ages 50–65 participated. Age, social support, and problem‐focused coping were significantly and positively correlated with QOL, while medical comorbidities, social stigma, and emotion‐focused coping were all significantly and negatively associated with QOL (p < .01). In stepwise linear regression analysis, emotional/informational support remained as a significant positive predictor, and medical comorbidities, HIV stigma, and emotion‐focused coping remained as significant negative predictors, accounting for 64% of the variance in QOL. Study findings may help researchers develop interventions aimed at increasing QOL in this population.

The Multiple Stigma Experience and Quality of Life in Older Gay Men With HIV

&NA; Older HIV‐infected gay men may experience multiple forms of stigma related to sexual orientation (homonegativity), HIV (HIV stigma), and age (ageism), all of which can negatively impact quality of life (QOL). Our purpose was to determine predictors of homonegativity, internalized HIV stigma, and ageism, and stigma experiences that were predictive of QOL. Sixty HIV‐infected gay men, ages 50–65 years, participated. Younger age and emotion‐focused coping were significantly predictive of homonegativity, accounting for 28% of variance. Younger age, support group participation, medications per day, social support, and emotion‐focused coping predicted internalized HIV stigma, accounting for 35% of variance. Problem‐focused coping predicted ageism, accounting for 7% of variance. In regression analysis, the three types of stigma accounted for 39% of variance in QOL (homonegativity 19%, internalized HIV stigma 19%, ageism 0.5%). Study findings may help researchers develop interventions to alleviate multiple stigma experiences of HIV‐infected older gay men, thus improving QOL.

Predictors of Cognition in Adults with HIV: Implications for Nursing Practice and Research

The objective of this study was to identify predictors of cognitive performance among adults with HIV. Participants completed demographic, psychosocial, and mental and physical health questionnaires as well as cognitive measures of speed of processing, psychomotor ability and visuomotor coordination, attention and working memory, reasoning, and executive function. Hierarchical regression analyses were used to examine predictors of cognitive performance for each cognitive measure. Possible predictors included age, gender, socioeconomic status, Wide Range Achievement Test 3 Reading score (quality of education), social networks score, hardiness score, mood disturbance score, medical problems composite score, psychoactive drug use composite score, HIV chronicity, CD4+ lymphocyte cell count, and HIV medication usage. Model 1 examined demographic factors, and model 2 examined the contribution of the remaining variables on cognitive performance. Results revealed that several factors were predictive of cognitive functioning, with the individual regression models for each measure explaining 8% to 48% of the variability in performance. Overall, this study posits that among adults with HIV, the most consistent predictors of poorer cognition included older age, poorer reading ability, more depressed mood, CD4+ lymphocyte cell count less than 200, and lack of HIV medication usage. Results suggest that those aging with HIV are subject to decreases in cognitive functioning.

Cognitive Functioning and Driving Simulator Performance in Middle-aged and Older Adults With HIV

&NA; Nearly half of people living with HIV experience cognitive deficits that may impact instrumental activities of daily living. As the number of people aging with HIV increases, concerns mount that disease‐related cognitive deficits may be compounded by age‐related deficits, which may further compromise everyday functions such as driving. In this cross‐sectional pilot study, during a 2.5‐hour visit, 26 middle‐aged and older adults (40 + years) were administered demographic, health, psychosocial, and driving habits questionnaires; cognitive assessments; and driving simulator tests. Although CD4+ T lymphocyte count and viral load were unrelated to driving performance, older age was related to poorer driving. Furthermore, poorer visual speed of processing performance (i.e., useful field of view) was related to poorer driving performance (e.g., average gross reaction time). Mixed findings were observed between driving performance and cognitive function on self‐reported driving habits of participants. Implications for these findings on nursing practice and research are posited.

Church Attendance in Men Who Have Sex With Men Diagnosed With HIV Is Associated With Later Presentation for HIV Care

We demonstrate an interdependent relationship between sexual behavior and church attendance on timing of human immunodeficiency virus (HIV) diagnosis and presentation for care. Men who have sex with men (MSM) and who attend church are more likely to present with lower CD4(+) T-lymphocyte counts than MSM who do not attend church.

The role of neuroplasticity and cognitive reserve in aging with HIV: recommendations for cognitive protection and rehabilitation.

ABSTRACT By and large, the immune systems of people infected with HIV are being protected and maintained by advances in highly active antiretroviral therapy; as such, this is extending the lives of people into old age. Unfortunately, for many living with this disease, HIV is associated with neuroinflammation, co-morbidities, and accelerated aging which can compromise brain function, resulting in cognitive deficits. The purpose of this article is to highlight how to interpret these deficits within the framework of neuroplasticity and cognitive reserve for this clinical population. We suggest several recommendations for cognitive rehabilitation and mitigation such as addressing lifestyle factors, psychostimulants, cognitive remediation therapy, and treatment of depression and anxiety. Implications for nursing research and practice are posited.

An overview of the biological and psychosocial context surrounding neurocognition in HIV.

The presence of a psychiatric illness increases the risk of exposure to HIV and disease complications; however, effective treatments have substantially reduced mortality in adults with HIV. Despite such effective treatments, nearly half of adults with HIV experience neurocognitive deficits that can affect job-related and everyday tasks, thus reducing their quality of life. This article provides an overview of the context in which neurocognitive deficits occur in adults with HIV; it also includes implications for treatment and mitigation of such neurocognitive deficits. Understanding the underlying neurocognitive changes related to HIV can help psychiatric nurses provide better care to patients that may improve medication compliance and everyday functioning.

Honors Programs: Current Perspectives for Implementation.

The changing demographics of the nursing workforce, including large numbers of impending retirements, highlight the need for innovative programs to attract the next generation of nursing leaders, educators, and researchers. Nursing honors programs provide an enhanced educational experience for high-achieving and highly motivated students, developing them as future nursing leaders. This review describes the current perspectives, characteristics, and values of nursing honors programs, opportunities for implementation, and recommendations for integration within nursing education.

A Qualitative Study of Underutilization of the AIDS Drug Assistance Program

&NA; In our previous work, we demonstrated underutilization of the AIDS Drug Assistance Program (ADAP) at an HIV clinic in Alabama. In order to understand barriers and facilitators to utilization of ADAP, we conducted focus groups of ADAP enrollees. Focus groups were stratified by sex, race, and historical medication possession ratio as a measure of program utilization. We grouped factors according to the social‐ecological model. We found that multiple levels of influence, including patient and clinic‐related factors, influenced utilization of antiretroviral medications. Patients introduced issues that illustrated high‐priority needs for ADAP policy and implementation, suggesting that in order to improve ADAP utilization, the following issues must be addressed: patient transportation, ADAP medication refill schedules and procedures, mailing of medications, and the ADAP recertification process. These findings can inform a strategy of approaches to improve ADAP utilization, which may have widespread implications for ADAP programs across the United States.