Managing the Triple Threat: Strategies for Older Gay Men with HIV
The latest edition of the journal, Achieve, is devoted to HIV over fifty. I contributed on stigma entitled: Managing the Triple Threat: Strategies for Older Gay Men with HIV. Here is the link to the publications page where you can download volume 7, number 3.
The AHA Project (Action for HIV and Aging)
When a woman with HIV realizes that she’s lived longer than she ever expected and begins to rebuild her life, that’s an aha moment.
When a doctor and patient sort through the complexities of HIV, the medications used to treat the virus, and the realities of aging to identify an effective treatment, that’s an aha moment.
When a group of gay men acknowledge how the AIDS epidemic has impacted every aspect of their lives and start the healing process together, that’s an aha moment.
When a politician recognizes that AIDS is not over and funds programing to meet the challenges of HIV and aging, that’s an aha moment.
In the past two years since the release of Aging with HIV I’ve met many amazing men and women who are living with HIV longer than they ever expected. Throughout the country we’ve created conversations that have expanded our understanding of aging with HIV. Together we’ve exchanged information, shared experiences, processed feelings and built communities. It’s been a real learning experience filled with aha moments.
That’s why I’ve decided to start the AHA Project (Action for HIV and Aging) to facilitate discussions that empower people to define for themselves what it means to optimally age with HIV.
In the coming weeks agingwithhiv.wordpress.com will become ahaproject.org. I appreciate your patience as I develop the site to reflect its developing mission.
New Guidelines For Medical Management of Older Patients Living with HIV Released
Last week the American Academy of HIV Medicine, the American Geriatrics Society and the AIDS Community Research Initiative of America (ACRIA) published recommended treatment strategies for clinicians managing older patients with HIV. This is a major step in the medical treatment of HIV recognizing the unique and complex medical issues faced by this growing population. It is the first time best practice guidance has ever been developed for HIV practitioners and other health care providers who treat diagnose and refer older patients with HIV disease.
The report contains specific guides provided for Diabetes, Cancer, Hypertension, HepC etc. as well as HIV testing and Sexual Health and more. While it is directed at practitioners, people living with HIV may want to familiarize yourselves with the recommendations and discuss their relevance to your care. The full report is 76 pages, but an executive summary outlines the treatment recommendations in each area.
To view the overview, executive summary, or full report go to the American Academy of HIV Medicine webpage.
When Lapses Are Not Just Signs of Aging: New York Times
Earlier this week Jane Brody published an article in the New York Times on the difficulty distinguishing mild cognitive impairment from the effects of normal aging. She explains, “While most people experience a gradual cognitive decline as they get older (only about one in 100 lives long without cognitive loss), others experience more extreme changes in cognitive function, the neurologist wrote in The New England Journal of Medicine in June. In population-based studies, mild cognitive impairment has been found in 10 percent to 20 percent of people older than 65, he noted.”
For people living with HIV over the age of fifty, cognitive impairment is a serious concern, and many wonder if occasional memory lapses and subtle forgetfulness are signs of normal aging or the first stages of serious cognitive impairment or dementia.
The article explains how diagnoses are made and strategies one can use to preserve cognitive functioning, including: medical management (when appropriate); lifestyle changes (such as reducing cardiovascular risk and blood sugar); practicing cognitive improvement exercises; and physical exercise.
To read the full article go to the New York Times.
Springtime and Play Time
I walked past the elementary school and saw the teachers taking the kids out of the class to explore the neighborhood. I remember the feeling that started to set in this time of year. The weather is getting nicer; The school year is coming to an end; And, I just wanted to get outside and play. In the springtime I am reminded of the need to take time out of my schedule to play.
Play time is not just a luxury. Recreation is an integral part of a healthy lifestyle. And, being able to play is one of the 10 steps to optimal aging with HIV. Playful activities can keep us socially involved as well as physically, intellectually, and creatively stimulated – all of which can counteract stagnation and increase adaptation at midlife and beyond.
There are many opportunities for finding play time:
Organized sports can be great forms of play, when they are not taken too seriously, and are not beyond your physical capabilities. When you are involved in a strenuous sport you get much needed exercise and increase your endorphins. In team sports, such as basketball, you stay connected to others. You can play golf alone or with friends. And, bowling is a lower energy sport that can still work up a sweat. Even if you are not an athlete, you can find a sport that isn’t too intimidating. Jogging, rowing, bicycling, and kayaking are all independent sports that have meditative qualities. Less conventional sports such as ballet, ballroom dance, fencing, and yoga are all forms of play. Games such as cards, scrabble, and board games have the same opportunities for competitive activity, intellectual challenge, and socialization without the strain of physical activity.
Creative activities can be done alone or with others. Making art, writing, woodworking, and gardening are all creative activities in which you participate in making something new. Do you enjoy listening to music? Dancing to rock and roll or drums? Cooking, needlework, collecting? You can take a class to learn a new hobby or skill. Join an improvisation group. Care for animals. Any of these activities can broaden your sense of creative play.
If you need help developing your ability just spend time with a child. My biggest pleasure is watching a child who has just opened a present make a toy out of the box it came it. You can invent play from your imagination, too.*
There are many social clubs for gay and HIV positive people that offer ongoing recreation activities. Check out the list of resources on this site to find an organization near you where you can participate in an event or join an ongoing program. You can also take a retreat with organized activities. Blogger, Mark S. King has compiled a list of vacations and retreats (some at low cost) for people living with HIV. Follow the link to learn more.
Now, I’m going to listen to my own advice and get outside to enjoy a bit of this day!
*excerpt from Aging with HIV: A Gay Man’s Guide
The Issue of Comorbidities
HIV, Aging and Cognitive Impairment
I’ve been spending some time lately on the relationship between cognitive impairment and older age in people living with HIV. The research is inconclusive. Recent findings suggest that there could be an increased risk for HIV-associated dementia and minor cognitive motor disorders in this population. However, as I pointed out in last week’s post, research in this area is new and the findings are complex. While older age may be a contributing factor in cognitive impairment, other issues to consider are: HIV itself, treatments for HIV, other age-related diseases and their treatments, as well as heredity and lifestyle.
A first step in optimizing your health is to identify the factors that you can control. In order to do that, older people living with HIV must consider the issue of co-morbid conditions.
Comorbidities and Cognition
Aging with HIV can create a complicated health-related picture. In addition to the effects of HIV itself, people taking medications to treat HIV and its symptoms may experience co-morbid conditions from those drugs, such as heart disease and diabetes.
This population also faces non-HIV- related illnesses common to older persons in the general population including: diabetes, hypertension, arthritis, and coronary artery disease. These comorbidities may affect HIV disease progression and may play a role in cognitive impairment.
Depression and other untreated mood disorders can also impact cognition and affect quality of life. In addition, alcohol and substance use can negatively affect one’s cognitive functioning.
Finally, illness can set in motion a negative feedback loop when physical limitations cause reductions in social involvement, depression and further complications of illness.
Developing an accurate picture of your health involves appreciating the complex and changing impact of HIV-disease progression, medications, mood, lifestyle and heredity. That means routine general health maintenance and appropriate diagnosis, treatment, and prevention of non-HIV-related medical and neuro-psychiatric conditions*
There is a great deal you can do to optimize your health outside of your doctor’s office. Your daily health care regimen can include activities that prevent, treat or modify the presence of comorbid conditions. Factor’s such as diet, exercise, participating in alternative therapies (such as meditation, acupuncture, yoga and massage), and maintaining an active social life have all been demonstrated to improve quality of life. Optimal aging with HIV involves working within your limitations to maximize your day-to-day life.
What one step can you take today to enhance your well-being?
*Goodkin, K. & Stoff, D., “Older Age and HIV Infection.” In Cohen M, Gorman J, eds. Comprehensive Textbook of AIDS Psychiatry. New York, NY: Oxford University Press, 2008, pp. 357-376.
Resolutions Gone Awry
Its that time of year. The end of January. Snow is falling. (A lot of it in New York!) And, your New Year’s Resolutions are on the verge of becoming history.
This week I’d like to encourage you to reconsider those resolutions. Perhaps they need to be altered. But, it may not be time to put off those goals for New Year’s Eve 2012.
What do Resolutions have to do with Aging and HIV?
Living with HIV into midlife and beyond requires adaptation to a great deal of change. There have been changes to your body, career, family, your friendship networks, and to the world around you. Optimal aging with HIV involves flexibility as you develop new strategies to cope with aging. Often this means discarding old patterns that no longer work for you and beginning the difficult task of learning new ways to care for yourself.
You may have used the new year to reflect on what has and hasn’t worked for you in the past, and developed some ideas about what you want for yourself in the year ahead. You may have made an intention to change the way you eat, to exercise more, to address your drinking, to make new friends, to join an organization, to look for a new job, or get yourself out there in the dating world. You may even have come up with a plan to reach those goals.
Well, now is the time to review how that plan is going. If you are still on target, then read this post in order to help you look for warning signs that your resolution is going awry. But, if you are anything like me, your commitment to change is starting to waver, and you are at risk for giving up altogether. If that is the case, let me tell you about my New Year’s Resolution.
At the end of December I realized that I had been gaining weight. In fact, a step on the scale revealed that I was the heaviest I had ever been. So, I resolved to lose weight in the new year.
I had helped many others through similar challenges and knew what pitfalls to avoid. For example, I knew that I needed a reasonable goal. If I tried to lose too much, too quickly, I would just feel deprived and give up. So, I decided that I would set a goal of 1-2 lbs per week. I also knew that I should not only change my eating habits, but also increase my exercise, so I joined a gym.
Great plan. (Do you see where I’m going with this story?) Well, its the end of January, and as of yesterday I have lost 1 lb.
This is where I want to say, “what’s the point? My metabolism has slowed and no matter what I do, I won’t be able to lose that weight!”
But, since I’m writing this post to help you, I have to take the following advice:
Don’t Give Up!
When a plan doesn’t succeed, it just means there’s something wrong with the plan. In every failure there is a learning opportunity.
So, first, before you dismiss the commitment you made to yourself, remind yourself what you wanted to accomplish, and why.
Do your reasons to meet that goal still seem rational? Then, you have to find a way to make it work.
Next, assess the steps you took to meet that goal. Did you do what you said you were going to? If not, ask yourself, why you didn’t.
Maybe the goal makes sense, but the way you are going about it is faulty. For example, I could have joined a gym near my apartment. But I don’t get home until late every evening, and am usually too tired to exercise then. It would be better for me to find a gym near work, where I can go during a break in the day.
Once you know why your plan hasn’t worked, you can make changes to the plan and try again.
I often hear clients who have given up on their resolutions only to discover that the goal they set for themselves was unreachable. In my case, I set a very reasonable goal, but I got a cold and missed one week of exercise. I also didn’t consider that I would have to build my stamina slowly, having been away from the gym for some time. And, there was a learning curve, as far as my diet was concerned. It took me some time for me to learn what foods I could, and couldn’t eat, in order to stay on target for my weight goal.
Backing off is different from giving up. Its being honest with yourself about what you are, and are not, willing to do to accomplish your goal.
Ask for Help
There may be obstacles in your way that you are unaware of. If you have rethought your plan and are still getting nowhere, it may be time to get some help. Talk about your goals with a friend, your doctor or a counselor.
Change is hard. We develop patterns of taking care of ourselves and relating to others. Sometimes those rituals are deeply ingrained in our sense of ourselves, our memories of friends, and our families. Food, for me, is one of those issues. I still eat the same meal for breakfast that I did as a child. Changing my diet means changing my relationship to food, and that can have emotional meaning, as well.
Sometimes you just need a buddy. Share your resolution with a friend. (And, they can share theirs with you.) By including someone else in your plan, you have someone to support you, encourage you, and to hold you accountable when you want to give up.
On the resources link (above) there are a list of agencies that may be able to help you reach your goal.
I hope that this post helps you to recommit to your resolution, reassess your objectives, and get the help you need to achieve your goal. Please let me know if you set an intention for the new year, and how you are progressing on that goal.
Dr. Schmidtberger on Aging with HIV
Dr. James Schmidtberger, co-author of Aging with HIV: A Gay Man’s Guide was recently interviewed about his two decades experience working as a physician with people living with HIV. Read the article at the New York City Health and Hospitals Corporation website.
The third post in the December Self-Care series is about staying fit. For me, the challenge of exercising is getting started. I never want to exercise, but I always feel better after. My strategy to compensate for my inertia is to include some form of physical activity into my weekly routine, that way I don’t have to think about it, I just do it.
The benefits of exercise are multi-fold. A balance of aerobic exercise, strength training, and stretching helps cardiovascular health while maintaining muscle mass, balance, and flexibility. Regular exercise is not only an integral part of physical health for people aging with HIV, but exercise can also help you reduce stress, manage anger, and improve your mood. In addition, there is evidence that regular physical exercise can actually forestall the onset of non-HIV-related dementia.
Calisthenics, rapid walking, jogging, dancing, and hiking are aerobic activities. Strength training––using weights or other forms of resistance––is increasingly found to be important for building muscle mass lost with aging. Stretching is an important part of any exercise routine, and it is especially important to increase flexibility as we age. Yoga is an ancient form of exercise involving the mastery of postures that increase flexibility and strength. I recently heard one yoga instructor refer to spinal flexibility as, “the fountain of youth.”
Your exercise routine should include aerobics, strength training and stretching. Exercise does not need to be strenuous. Start slow with achievable goals and respect your limits. You may want to consider getting started with a fitness professional. Before starting an exercise program be sure to discuss it with your doctor.
Next post: Staying Connected
In the second installment to the December’s Self-Care posts, I wanted to discuss healthy eating. Well, actually, I do not want to discuss healthy eating, because I have to admit to everyone that I have not been eating well lately. With the release of the book, the stress of the holidays, and my inclination to eat more than I should at this time of year, I have put on a few pounds. So, I need to revisit this topic for myself and will bring you along for the ride.
You may have already made adjustments to your diet to adapt to HIV-related changes in your metabolism and the effects of medication. Aging, too, creates shifts in our body, and as we age we need to alter our diets to compensate.
I consulted with Dr. James Schmidtberger, from the Leicht Clinic, an HIV-clinic in New York City to get some guidance on eating well and aging with HIV. He offered some general suggestions in order to get us started. He also suggested following up with a doctor or nutritionist to respond to changes in your specific physical condition.
Here is what he had to say:
When we age we lose muscle mass and require fewer calories daily. Uncontrolled HIV can accelerate the loss of muscle mass. If you are concerned about HIV wasting you may be tempted to overeat. Without adequate exercise, this may result in excess fat which raises the risk of developing (or worsening) other chronic conditions such as diabetes and heart disease. This is why nutrition and exercise are so important to help you maintain your muscle mass. Nutrition is particularly important if you have other medical problems (such as high blood pressure, high cholesterol, diabetes, or prediabetes) or lipodystrophy. A balanced diet is important to help your body fight HIV and control (or prevent) those other conditions.
A good place to start is to assess your overall dietary habits. In general, you want to eat a balanced diet with plenty of fresh fruits and vegetables. A good rule of thumb is called the “plate method.” This is a simple way to devise a healthy meal and is recommended by the American Diabetes Association. Take your dinner plate and divide it in half. Fill one half with nonstarchy vegetables (such as spinach, broccoli, cauliflower, greens, salad, tomato, cucumber). Divide the remaining half again into two quarters. Fill one quarter with starchy foods (such as rice, pasta, corn, peas, whole grain breads/cereals). Fill the remaining quarter with proteins (lean meats, skinless poultry, seafood, tofu, eggs). Add a glass of nonfat or 1% milk or yogurt and a piece of fresh fruit. You can bring the plate method to the breakfast, lunch, or dinner table.
Consider the following small modifications. If you eat too much, try to limit your portions. If you drink soda, switch to seltzer or diet sodas. Avoid fast food. Switch to healthy oils, olive oil or canola oil, and avoid food with trans fats.
Depending on your situation, your nutritional needs may differ. For example, if you are fighting an opportunistic infection, your calorie requirements may be higher than usual. If you have heart disease, diabetes, or other complications, you may have specific dietary restrictions. Ask about nutrition. You may also want to consult with a nutritionist to assess your dietary needs.
Next week’s blog: Staying Fit