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The Significance of the Missed Assessment: HIV/AIDS in the Older Adult

by Sarah L. Jameson, Student Nurse
Carol A. Eliadi EdD, JD, APRN
Assistant Dean and Associate Professor, School of Nursing
Massachusetts College of Pharmacy and Health Sciences

Introduction

Human Immunodeficiency Virus (HIV) came into the public view in June of 1981 (Goodroad, 2003). Since that time the health care system has faced many struggles related to the understanding the virus itself and in caring for those affected and likely to be affected by this life threatening communicable disease. The initial struggle involved identifying, naming, and determining the vehicle of transmission for the virus. After this information became known, the focus shifted to treatment modalities and preventative education strategies and recommendations.

In all people, regardless of age, HIV and Aquired Immune Deficiency Syndrome (AIDS) affects CD4+ T cells. The role of the CD4+ T cells is to engage other types of T cells to rid the body of invading micro-organisms and viruses. When HIV is contracted, the action of CD4+ T cells is inhibited and the regeneration of CD4+ T cells is slowed.The Human Immunodeficiency Virus utilizes the CD4+ T cells normal replication process to replicate itself. Once the production of unaffected CD4+ T cells cannot keep up with the HIV virus invasion, the number of T cells decreases to two-hundred or less, yielding an AIDS diagnosis. A normal CD4+ T cell count is between six-hundred and twelve hundred. Immunity typically declines with age as part of the normal aging process and as such, places the older adult who is infected with HIV at increased risk for a rapidly declining CD+ T cell count, severe opprtunistic infections, other viral infections, and subsequently, an increased morbidity and mortality. While older adults are certainly at risk for other sexually transmitted diseases as a result of engaging in high risk behaviors as is the general adult population, this paper focuses on the often overlooked risk of HIV in this special population.

Despite a societal belief that older adults are outside of the stereotypical risk population for HIV, the elderly are most certainly at risk for and do contract and transmit the Human Immunodeficiency Virus. As this at risk population is not typical, it often is ignored in terms of education regarding sexually transmitted diseases. This factor compels the healthcare provider caring for this at risk population to be vigilant regarding conversations about sexual practices and teaching to prevent the infection and transmission of HIV in the older adult population. HIV is transmitted through sex and other methods of sharing body fluids such as sharing needles for medications, illicit drugs, and tattoos. HIV can be passed from mother to baby during pregnancy, birth and through breast milk. The most prevalent route of transmission is sexual activity, and most commonly sexual activity between two men.

In the United States there appears to be a problem of perception and stereotypes. When people think of the elderly, they do not think of sex (Mueller, 1997). It is often perceived that people lose their inborn natural sex drive as they age. Contrary to this ageist belief, people continue to have desires and engage in sexual behaviors with increasing age. It is a normal and typically healthy human drive. One study of 3005 older adults found that sexuality is closely linked to the perception of health and the majority of the participants not only have intimate relationships, but regard this expression of sexuality as important to life (Lindau, Schumm, Laumann, Levinson, Muircheartaigh, & Waite, 2007). It was discovered that 73% of participants between the ages of fifty-seven and sixty-four, 53% of those between sixty-five and seventy-four, and some 26% of participants between seventy-five and eighty-five reported being sexually active in the prior year (Lindau et al., 2007). Another study reported that 82% of people over age fifty have had one or more sexual partners in the previous five years (Gott, 2001)

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