“My Body’s a 50 Year-Old but My Brain Is Definitely an 85 Year-Old”: Exploring the Experiences of Men Ageing With HIV-Associated Neurocognitive Challenges.

“My body’s a 50 year-old but my brain is definitely an 85 year-old”: exploring the experiences of men ageing with HIV-associated neurocognitive challenges.

J Int AIDS Soc. 2013; 16: 18506
Hopcroft L, Bester L, Clement D, Quigley A, Sachdeva M, Rourke SB, Nixon SA

Introduction: Research investigating HIV, neurocognition and ageing is well developed using neuropsychometric or other quantitative approaches; however, little is known about individuals’ subjective experiences. The purpose of this article is to explore the experiences of men aged 50 and older who self-identify as having HIV-associated neurocognitive challenges. In particular, this study uses the Episodic Disability Framework (EDF) to explore participants’ perceptions regarding: 1) symptoms/impairments, difficulties with day-to-day activities, challenges with social inclusion and uncertainty; 2) ageing as related to their HIV-associated neurocognitive challenges, and 3) the episodic nature of their HIV-associated neurocognitive challenges. Methods: This qualitative, interpretive study involved in-depth, semi-structured interviews with 12 men aged 50 years and older who self-identified as having HIV-associated neurocognitive challenges. Participants were recruited from a neurobehavioural research unit (NBRU) at a large hospital in Toronto, Canada. Data were analyzed thematically and with reference to the EDF. Results: Participants’ experiences reflected all concepts within the EDF to some extent. Difficulties with daily activities were diverse but were addressed using similar living strategies. Participants described challenges with work and social relationships resulting from neurocognitive challenges. Participants downplayed the significance of uncertainty in their lives, which they attributed to effective living strategies. Most men reported confusion regarding the link between their neurocognitive challenges and ageing. Others discussed ageing as an asset that helped with coping. Conclusions: This is the first study to use a disability framework to examine the subjective experiences of men ageing with HIV-associated neurocognitive challenges. Findings reframe the episodic disability experienced by these individuals as being predictably linked to certain triggers. As such, support for managing neurocognitive challenges could focus on triggers that exacerbate the condition in addition to the impairments themselves. The study also describes ageing as not only a source of problems but also as an asset among men growing older with HIV. HubMed – rehab

Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months follow up.

Crit Care. 2013 Jul 24; 17(4): R156
Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, Gough K, Hoorn SV, Morris ME, Berney S

The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during intensive care (ICU) admission and continuing into the outpatient setting compared with usual care on physical function and health related quality of life in survivors of ICU.This was a single center assessor blinded randomized trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in ICU >= 5 days and had no permanent neurological insult. The intervention group received intensive exercises in the ICU, ward and outpatients. Participants were assessed at recruitment, ICU, hospital discharge and 3, 6 and 12 months. Physical function was evaluated using the 6 minute walk test (6MWT) (Primary outcome); timed up and go test and the physical function in intensive care test. Patient-reported outcomes were measured with Short form 36 version 2 (SF36v2) and Assessment of Quality of Life (AQoL) instrument. Data were analysed using mixed models.The apriori enrolment was not reached. There were no between group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) [APACHE II: 21v19; Hospital LOS: 20v24 days]. No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12months post ICU discharge. However, exploratory analyses showed the rate of change over time and mean between group differences in 6MWT from first assessment were greater in the intervention group.Further research examining the trajectory of improvement with rehabilitation is warranted in this population.Trial registration: The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606. HubMed – rehab

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