Ageing with HIV: an investigation of the health and well-being of older people in a rural South African population with a severe HIV epidemic

Abstract

This study aims to describe the living and informal care circumstances of older people in an area of rural South Africa severely affected by HIV, and examine how those circumstances may influence the physical health, emotional well-being and survival of older people. Using longitudinal surveillance and cross-sectional survey data this thesis is built around four separate but related papers. Specific study objectives were to: 1) investigate household living arrangements and informal care (financial, physical or emotional assistance) by or towards older people in rural South Africa; 2) describe the self-reported health and emotional well-being status of older people by HIV status; and 3) examine the association between self-reported health, emotional well-being and informal care and mortality in older people.

Surveillance data for 2005-2010 showed living arrangements remained stable, with over 85% of older people aged 60 years and above living in multi-generational households; over this period employment rates in both older and young people declined, but government grants receipt increased. Being co-resident with own children, household structure and size were important determinants of whether financial support flowed downward (from older to younger) or upward (from young to older person); while peer support (from one older person to another) was rare. Adjusting for age, marital status, education, place of residency and household socio-economic status, exchanges of financial resources in the study population are most likely to be downward or at best reciprocal (bidirectional with young people). Of the cross-sectional study participants (n=422) aged 50+, over 60% were care-givers (provided help with activities of daily living) to at least one adult (18-49 years) or child (below 18 years); around 84% (n=356) of older people were care-receivers; of whom over 92% (n=329) were receiving assistance with fetching water. Spouse, adult child, and grandchildren were the main sources of physical or emotional care for care-recipients. As expected health deteriorated with advancing age and women were less likely to be in good health. Further, care-giving was associated with improved functional ability but decreased emotional well-being. HIV-infected older participants reported better functional ability, quality of life and overall health state than HIV-affected (had an HIV-infected or HIV-related death of adult child) study participants. These differentials in health and well-being were also evident in mortality patterns over three years of follow-up. Mortality was higher among non-care-givers than in care-givers, in older people with poor self-rated health and in participants who had experienced a major depressive episode.

Findings suggest there is an intricate relationship between living arrangements, informal care and health, emotional well-being and survival of older people in severely HIV-affected settings. More crucially, with the considerable resources devoted to HIV Care and Treatment programmes, uninfected older persons may be highly vulnerable to poor health. A multifaceted intervention to improving older people’s health and well-being is urgently required.

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Identifiers

ORCID for Jane Falkingham: orcid.org/0000-0002-7135-5875

ORCID for Maria Evandrou: orcid.org/0000-0002-2115-9358

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