Frailty in Older People Living With HIV

The current ANS featured article is titled “Frailty in the Context of Older People Living With HIV: A Concept Analysis” by Evelyn Iriarte, MSN, BSN, RN; Rosina Cianelli, PhD, MPH, RN, IBCLC, FAAN; and Joseph De Santis, PhD, APRN, ACRN, FAAN. While this article is featured you can access it on the ANS website at no charge here

I am currently a PhD candidate at the School of Nursing and Health Studies at the University of Miami. My dissertation is entitled “Impact of HIV Self-Management on Multidimensional Frailty and Quality of Life among Hispanic/Latinx People Living with HIV Infection Aged 50 and above”.  In the context of developing my dissertation, I wrote this concept analysis aimed to analyze the concept of frailty in the context of older people living with HIV (PLWH). The reasons to start writing this article were that despite advances in knowledge about older PLWH, frailty remains a challenge to HIV care. Numerous studies have documented its impact; however, the concept remains unclear. This knowledge is needed to promote an increased understanding and recognition of frailty among PLWH due to its potential preventive role within health care services. However, there is still much debate about the concept and its’ measurement, as this concept has not been clearly explored and defined within the context of older PLWH.  

This concept analysis provides an initial framework for understanding frailty in the context of older PLWH that includes attributes such as older age, inflammatory, hormonal, and immunological dysregulation, HIV-specific factors, comorbidities, and social, structural, and behavioral factors. Furthermore, frailty is evidenced as a state of vulnerability to HIV infection stressors, unintentional weight loss, exhaustion/fatigue, slower gait speed, decreased physical activity level, and muscle weakness. This state is manifested through several adverse outcomes that can impact health and quality of life.

In light of the current potential impact on health care, frailty requires further empirical and conceptual work. It is critical to continue developing research to advance the knowledge about frailty among older PLWH, principally regarding its assessment and interventions to prevent or treat frailty centered in holistic care.