Some issues in the assessment of HIV among older adult patients

Due to the burgeoning numbers of older adults in our population and to older adults' increased participation in high-risk behaviors, clinicians can expect to see an increase in HIV infection among this age group. The assessment of HIV among older adult patients is often difficult, however, and complicated by a lack of knowledge, implicit ageist stereotypes, and negative responses in the countertransference. A review is presented of the questions for patient interviewing, neuropsychological indicators of HIV-induced dementia versus Alzheimer's dementia, typical responses in the countertransference, and techniques that promote effective patient interviewing. Methods of coping with the difficulties commonly experienced when dealing with a potential diagnosis of HIV among older adults are highlighted. Case examples that illustrate phobic countertransference in response to assessment of HIV among three elderly patients also are presented.