Loneliness and Frailty Among Middle-Aged and Aging Sexual Minority Men Living With or Without HIV: A Longitudinal Cross-Lagged Panel Analysis

Paula Meireles; Deanna Ware; Ana Henriques; Karen Nieves-Lugo; Valentina Stosor; Mark Brennan-Ing; Steven Meanley; Sabina Haberlen; Chukwuemeka N Okafor; Steve Shoptaw; M Reuel Friedman; Michael Plankey

doi:10.1093/geroni/igad113

Loneliness and Frailty Among Middle-Aged and Aging Sexual Minority Men Living With or Without HIV: A Longitudinal Cross-Lagged Panel Analysis

Innov Aging. 2023 Oct 21;7(9):igad113. doi: 10.1093/geroni/igad113. eCollection 2023.

Authors

Paula Meireles^{1

2}, Deanna Ware³, Ana Henriques^{1

2}, Karen Nieves-Lugo⁴, Valentina Stosor⁵, Mark Brennan-Ing⁶, Steven Meanley⁷, Sabina Haberlen⁸, Chukwuemeka N Okafor⁹, Steve Shoptaw¹⁰, M Reuel Friedman¹¹, Michael Plankey³

Affiliations

¹ EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.
² Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, Porto, Portugal.
³ Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA.
⁴ Latino Health Research Center, Department of Psychology, The George Washington University, Washington, District of Columbia, USA.
⁵ Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
⁶ Brookdale Center for Healthy Aging at Hunter College, City University of New York, New York, New York, USA.
⁷ Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
⁸ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
⁹ Department of Medicine, Division of Infectious Diseases, Long School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
¹⁰ Departments of Family Medicine and Psychiatry and Family Medicine, University of California Los Angeles, Los Angeles, California, USA.
¹¹ Department of Urban-Global Public Health, School of Public Health, Rutgers University, Piscataway, New Jersey, USA.

Abstract

Background and objectives: Loneliness is associated with frailty among older adults (60+), and there is evidence suggesting that this association may be bidirectional. However, there is limited evidence of this relationship over time among middle-aged and aging sexual minority men. We explored the bidirectional relationship between loneliness and frailty over 2 years among sexual minority men living with or without human immunodeficiency virus (HIV) from the Healthy Aging substudy of the Multicenter AIDS Cohort Study.

Research design and methods: We used data from 1 118 men (561 living with HIV; 557 living without HIV) aged 40 years or older with measurement of frailty or loneliness at Times 1 (September 2016 to March 2017) and 2 (September 2018 to March 2019). Descriptive statistics were generated. We used autoregressive cross-lagged panel analysis to examine the bidirectional association between frailty and loneliness at both time points while adjusting for time-stable and time-dependent covariates at Time 1. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were generated.

Results: The estimated prevalence of loneliness at both time points was 35.5%. The estimated prevalence of frailty at Times 1 and 2 were 7.8% and 12.1%, respectively. Participants reporting loneliness at Time 1 had greater odds of being frail at Time 2 (aOR = 2.14; 95% CI: 1.23-3.73). Frailty at Time 1 was not associated with loneliness at Time 2 (aOR = 1.00; 95% CI: .44-2.25). The autoregressive effects of frailty (aOR = 23.43; 95% CI: 11.94-46) and loneliness (aOR = 13.94; 95% CI: 9.42-20.61) were large.

Discussion and implications: Men who felt lonely had higher odds of being frail 2 years later while the reciprocal association was not shown. This suggests that loneliness preceded frailty and not the other way around. Early and frequent assessments of loneliness may present opportunities for interventions that minimize the risk of frailty among sexual minority men living with and without HIV.

Keywords: Aging; Frailty; Loneliness; Multicenter AIDS cohort study; Sexual minority men; United States.

Abstract

Grants and funding