Nursing Home Residents by Human Immunodeficiency Virus Status: Characteristics, Dementia Diagnoses, and Antipsychotic Use

Abstract

Objectives: Given an aging human immunodeficiency virus (HIV) population, we aimed to determine the prevalence of HIV for long-stay residents in US nursing homes (NHs) between 2001 and 2010 and to compare characteristics and diagnoses of HIV-positive (HIV+) and negative (HIV-) residents. Also, for residents with dementia diagnoses, we compared antipsychotic (APS) medication receipt by HIV status.

Design: A cross-sectional comparative study.

Setting: NHs in the 14 states accounting for 75% of persons living with HIV.

Participants: A total of 9 245 009 long-stay NH residents.

Measurements: Using Medicaid fee-for-service claims data in the years 2001 to 2010, together with Medicare resident assessment and Chronic Condition Warehouse data, we identified long-stay (more than 89 days) NH residents by HIV status and dementia presence. We examined dementia presence by age groups and APS medication receipt by younger (aged younger than 65 years) vs older (aged 65 years or older) residents, using logistic regression.

Results: Between 2001 and 2010, the prevalence of long-stay residents with HIV in NHs increased from 0.7% to 1.2%, a 71% increase. Long-stay residents with HIV were younger and less often female or white. For younger NH residents, rates of dementia were 20% and 16% for HIV+ and HIV- residents, respectively; they were 53% and 57%, respectively, for older residents. In adjusted analyses, younger HIV+ residents with dementia had greater odds of APS medication receipt than did HIV- residents (AOR = 1.3; 95% confidence interval [CI] = 1.2-1.4), but older HIV residents had lower odds (AOR = 0.9; 95% CI = 0.8-0.9).

Conclusion: The prevalence of long-stay HIV+ NH residents has increased over time, and given the rapid aging of the HIV population, this increase is likely to have continued. This study raises concern about potential differential quality of care for (younger) residents with HIV in NHs, but not for those aged 65 years and older. These findings contribute to the evidence base needed to ensure high-quality care for younger and older HIV+ residents in NHs.

Keywords: Alzheimer's disease; antipsychotics; dementia; human immunodeficiency virus; nursing homes.

Figure 1.

Annual Proportion of Long-Stay Nursing Home Residents with HIV: By States with Lower to Higher Prevalence of HIV in Nursing Homes. Note: States were categorized into three groups based on their prevalence of HIV in Nursing Homes: <=0.5%: Pennsylvania, Ohio, Virginia, Massachusetts, North Carolina; >0.5% & <=1%: Texas, California, Illinois and Georgia; and >1%: New Jersey, Louisiana, Florida, New York and Maryland

Figure 2.

Prevalence of Alzheimer’s Disease (AD) or Non-Alzheimer’s Disease (Non-AD) Dementia^a by Age Group and HIV Status: Long-stay Nursing Home Residents in Years 2001 to 2010. ^a These diagnoses were identified by using the resident assessment (MDS) diagnosis checkboxes of “Alzheimer’s Disease” and “Dementia other than Alzheimer’s disease.”