What Problems Associated With Ageing Are Seen in a Specialist Service for Older People Living With HIV?

Howell T. Jones; Alim Samji; Nigel Cope; Joanne Williams; Leonie Swaden; Abhishek Katiyar; Fiona Burns; Aisha McClintock-Tiongco; Margaret Johnson; Tristan J. Barber

Disclosures

HIV Medicine. 2022;23(3):259-267. 

In This Article

Results

The records of the 35 attendees (nine clinics) were reviewed for demographics and the issues identified and addressed within the appointments.

Demographics

The median age of attendees was 69 years, with a preponderance of white men who have sex with men. Most patients had well-controlled chronic HIV, with 97% being virally suppressed. Full demographics including HIV markers and antiretroviral therapy (ART) regimes are outlined in Table 3.

Issues Identified During the Consultations

Eighteen discreet issues related to ageing with HIV were identified with a median of three per person (range 1–7) with the full list and frequency outlined in Table 4.

Depression was the most common problem reported by over half of the sample (51%). Other common issues included memory problems (37%), falls (29%) and unexplained weight loss (20%). Polypharmacy (classified as five or more medications excluding ART) was present in 24 cases (69%) but only modifiable in three (9%).

Problems not directly related to ageing were also identified, such as smoking, alcohol use disorder, financial insecurity and immigration issues, but these are relevant as they can cause physical or psychological morbidity leading to frailty.

Objective Outcome Measures

Thirty (86%) patients engaged with frailty scoring (Figure 1) with the majority (83%) being identified as frail, 10% as pre-frail and only 7% assessed as being robust (range 0–5).

Figure 1.

Distribution of Fried Frailty Scores

Thirty-one (89%) attendees completed the PHQ-9 assessment with a median score of 11 [interquartile range (IQR): 11], and is consistent with the qualitative findings where approximately half of attendees reported feeling depressed. The GAD-7 assessment was completed by 30 (86%) patients with a median score of 6 (IQR: 7), illustrating that this was less prevalent than depression and again mirroring the subjective results. Seventeen people met the criteria for depression and eight for GAD, respectively.

Cognitive screening was performed for the first seven patients but was often impacted by the presence of affective symptoms which prevented engagement, and patients reported they found it tiring. It often took half of the consultation with the geriatrician to complete the MoCA, resulting in less time to explore more dominant problems. The MDT discussed this unforeseen challenge and subsequently a MoCA was only completed if memory loss was a predominant symptom. A total of eight (23%) were completed with a median score of 21 (IQR: 11). Six people had results suggesting cognitive impairment.

The WHOQOL-HIV-BREF was completed by 30 (86%) attendees, demonstrating worse QOL across the physical, psychological, level of independence and social domains (Table 5) when compared with results from previously described cohorts.[18,20,21] Twenty-six (74%) patients completed the WHODAS 2.0 assessment with a median score of 36 (IQR 32), approximately correlating to the 90% population percentile demonstrating a high level of disability within the cohort.[19]

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