AIDS is generally considered a disease of the young, but one in 10 cases occur in people over 50, reported a recent study.
Of the 139,765 cases of AIDS reported as of June 30 by the Centers for Disease Control, most are in people between the ages of 30 and 39. However, 1 0% of AIDS cases occur in people over 50 years of age. Of these, about 24% are in people over age 65. If the present age distribution holds, more than 1,000 new cases of AIDS are expected in people aged 65 years and older during 1991.
Blood transfusion is the most frequent cause. Although improvements in blood screening, preparation of blood components, and the treatment of hemophilia should lower the incidence of transfusion-acquired AIDS in the future, the benefits from these advances may not become apparent for several years because of the latency of human immunodeficiency virus (HIV) infection, which may be 7 to 10 years from contact to disease.
A thorough health history of nursing home residents can help uncover individuals at risk. This resident interview should include past illnesses and treatment, sexual practices, history of substance abuse, surgeries, and any blood transfusions that the elder has received, particularly between the years 1976 to 1985.
AIDS in the elderly might be confused with Atzheimer's disease. AIDS dementia or subacute encephalitis, which may be found in 25% to 50% of persons with AIDS, may look like Alzheimer's disease or other forms of degenerative dementias. In many cases, AIDS encephalopathy may be distinguishable from these other entities only by its more rapid downhill course. The fact that the signs of AIDS, particularly those that are neurological or pulmonary related, are nonspecific only complicates the diagnosis of AIDS in elderly individuals.
Nursing home residents that test positive for the HIV antibody should be informed and counseled on the meaning of the test results, educated about how to prevent spreading the virus, and reassured that they have a right to have the test results kept confidential. If dementia or other disorders prevent understanding, the person's legal guardian should be notified.
Specific advice to health-care workers on how to safely deal with the problem includes continued education about HIV and the use of universal precautions on all residents.
For more information, contact the American Journal of Nursing Company, 555 West 57th Street, New York, NY 10019; 212-582-8820.