Exploring Risk Factors for Falls and the Application of the Model of Human Occupation for People Living with HIV

This dissertation desired to understand the association between risk factors and falls among people living with HIV. In paper one, we explored how compliance with anti-retroviral treatment and activities of daily living dysfunction may lead to falls among people living with HIV. We performed a case-control analysis of 204 people living with HIV who received occupational therapy (OT) services at a large academic hospital. Our results found that persons less likely to fall were ART compliant, female, and lacked insurance; persons more likely to fall had balance deficits. In a second multivariate regression model, people living with HIV were more likely to fall if they had moderate ADL dysfunction and balance deficits, women and the uninsured were less likely to fall. In paper two, we examined the relationship between falls and the risk factors frailty and incontinence among people living with HIV. We performed a case-control analysis of 204 people living with HIV who received OT services at a large academic hospital. When examining the association between falls and frailty, persons more likely to fall were pre-frail and had balance deficits while women and the uninsured were less likely to fall. When examining the association between falls and incontinence, the results were not statistically significant. In paper three, we sought to understand how people living with HIV and OTs perceive and experience the management of chronic HIV through the application of the Model of Human Occupation (MOHO). Based on our analysis, we developed an application for MOHO to be used with people living with chronic HIV. In all, this dissertation was aimed at identifying modifiable risk factors to falls among people living with HIV. These analyses demonstrate that the use of OTs at the onset of diagnosis may improve health outcomes and the quality of life for people living with HIV, and reduce burden of care costs over time. Further analysis can test our application with a larger population of OT clients living with HIV informing future clinical and research practices aimed at improving health outcomes and reducing falls among people living with HIV