Differences in Coping Strategies Among Older Persons Living with HIV Disease and AIDS
Graduation Date
1-2009
Document Type
Master's Thesis
Document Form
Degree Name
Master of Science
Department
Nursing
Department or Program Chair
Luanne Linnard-Palmer, EdD, RN
Thesis Advisor
Barbara Ganley, PhD, RN, HNC
Abstract
Human immunodeficiency virus (HIV) and aging were once mutually exclusive conditions. Traditionally HIV has been seen as a disease that occurs among younger people. The advent of highly active antiretroviral therapy (HAART) in 1996 and the efficacy of these medications, the connection between aging and HIV has become more direct. While the number of persons diagnosed with HIV or acquired immunodeficiency syndrome (AIDS) over the age of 65 years has grown from 1,008 to 10,002 in the past ten years (Justice et al., 2001), it is estimated that over 112,447 persons over the age of 50 are living with HIV in the United States (Emlet, 2006; Emlet & Poindexter, 2004). Throughout the world, women represent the largest percentage of newly infected HIV individuals (Gray & Berger, 2007).
Several studies exist that identify coping strategies and symptom management of men living with HIV and AIDS. However, more research is needed to understand the role specific coping strategies play in the lives of HIV-positive men and women over the age of 55 years. Although limited, the available research on those older men and women living with HIV makes it clear that successful aging is possible (Vance, Coon, & Linsk, 2007). Older adults living with HIV disease face a number of factors likely to complicate their coping and adjustment. Older individuals often have few systems of community support, lack older siblings or parents to care for them, and frequently confront the stigma of ageism while living with a variety of comorbid conditions that often accompany old age (Heckman et al., 2001). Much of the research on coping with HIV and AIDS has been guided by Lazarus and Folkman’s (1984) cognitive model of stress and coping (Heckman et al., 2001) and has been focused on younger males living with these diseases. A review of the literature revealed that middle-aged and older persons living with HIV and AIDS have unique needs.
Participant recruitment into this comparative, cross-sectional project, guided by Orem’s self-care deficit theory of nursing was done using the following agencies: The San Francisco AIDS Foundation, Black Coalition on AIDS, and Shanti Project. The purpose of this project was to examine the stressors of age, gender, and race related to differences in coping strategies among older men and women living with HIV and AIDS. Furthermore, this project examined whether differences in coping strategies of older men and women living with HIV and AIDS exist compared with persons less than 55 years of age.
Two instruments were used in this project: the Medical Outcomes Study Social Support Survey (MOS-SSS) and the Jalowiec Coping Scale (JCS). The MOS-SSS is a tool to measure the perceived satisfaction with social support received by chronically ill persons (Sherboume & Stewart, 1991). The JCS consists of 60 items describing coping behaviors that are classified into eight different types of coping styles: Confrontive, Evasive, Optimistic, Fatalistic, Emotive, Palliative, Supportant, and Self-reliant (Jalowiec, 2003). The intent of this project was to add to the body of research needed for clinicians to understand the role coping strategies play in the lives of HIV-positive men and women over the age of 55 years compared to their younger cohorts. The objective was to (1) identify the types of coping strategies used by older persons living with HIV to cope with this chronic illness, and (2) determine whether specific differences in coping strategies are related to gender differences in older persons living
with HIV/AIDS.
Several coping strategies were demonstrated to be used equally by both the participants in this study who were younger and older than age 55, no significant difference in coping strategies was revealed related to age. Although, both groups equally expressed pessimism, hopelessness, and feelings of little control over situations related to their disease (Pessimistic Coping), both also equally expressed and released emotions or ventilated feelings (Emotive Coping) when faced with a problem related to their disease. Most importantly, both age groups revealed that they were able to depend on themselves rather than on others in dealing with HIV or AIDS health related situations (Self-reliant Coping). However, the data does support the literature that women with HIV and AIDS report using more social support networks than do men. Although based on this study, previous statements in the literature that women focus more on their emotional response to the disease and stigma associated with HIV (Gray & Berger, 2007) were not supported.