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High Prevalence of Geriatric Conditions Among HIV+ People Over Age 50 in San Francisco

Older HIV-positive people have a high prevalence of multiple age-related problems, investigators reported in the March 29 online edition of the Journal of Acquired Immune Deficiency Syndromes. The research involved people aged 50 years and older receiving outpatient care in San Francisco. Overall, 40% reported difficulties with daily activities, most reported loneliness, many had mild cognitive impairment, and 30% had only poor to fair quality of life.

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"This is one of the first studies to have evaluated a wide range of geriatric assessments among HIV-infected individuals in an outpatient clinical setting and provides a comprehensive overview of the health needs faced by the aging HIV-positive population," wrote the authors. "We observed a high burden of clinically-concerning deficits in older HIV-infected adults across multiple domains, including functional impairment, falls, depression, and social isolation."

The investigators believe their findings have implications for patient care, commenting, "our results highlight the importance of systematically providing functional, social, and mental health support for the aging HIV-infected population."

Improvements in treatment and care mean that many people with HIV are now living well into old age. Over half of HIV-positive adults in the U.S. are now age 50 years and over. Previous research has shown that these individuals frequently have multiple health problems and develop conditions associated with old age earlier than the traditional cut-off for old age -- 65 years.

The Veterans Aging Cohort Study (VACS) Index, a prognostic tool based on markers associated with HIV and other health conditions, can be used to identify older HIV-positive people with a high risk of illness and death. The VACS Index score has also been associated with risk of fragility fractures, cognitive impairment, and reduced exercise capacity. However, less is known about its association with geriatric conditions, such as functional status.

Investigators therefore designed a cross-sectional observational study assessing the physical, cognitive, social, and behavioral health of a large sample of older HIV-positive adults receiving outpatient care at 2 clinics in San Francisco. A combination of geriatric and other assessments were used to assess psychosocial issues observed in older patients with HIV. The investigators hypothesized that both age and VACS Index score would be associated with the geriatric conditions identified in the assessments.

Recruitment occurred between December 2012 and December 2014 and English-speaking patients aged 50 years and older were eligible to participate.

Assessments included questions on physical, social, mental, and cognitive health. The investigators used a combination of assessments that addressed traditional geriatric conditions and also specific issues faced by older HIV-positive people.

The researchers assessed 4 broad areas of health:

• Physical health and functioning, falls, and walking speed (Activities of Daily Living and Instrumental Activities of Daily Living);
• Social support, including physical and perceived support and loneliness;
• Mental health, including depression, anxiety, and post-traumatic stress disorder (PTSD);
• Behavioral and general health, including adherence to HIV therapy and overall quality of life.

A total of 359 patients were assessed. Most (85%) identified as men, two-thirds were in the men who have sex with men (MSM) risk category, and approximately 60% were white. Approximately three-quarters had attended college. Half were receiving disability benefits and the majority had an annual income below $20,000. Most (85%) had been living with diagnosed HIV infection for 10 years or more. As regards HIV-related markers, 82% had an undetectable viral load and over half had a CD4 cell count above 500 cells/mm³.

The median age was 56 years and two-thirds of patients were in their fifties. Patients aged 60 years and older were more likely to be white, college educated, and to have a higher annual income when compared to younger participants.

The patients had a high burden of conditions associated with older age, with 41% reporting a fall in the previous year, almost 60% reporting loneliness, half reporting low levels of social support, and over a third met the criteria for mild cognitive impairment.

Patients aged 60 and older were more likely to report problems with balance than patients in their fifties (47% vs 33%). Prevalence of problems with physical health and functioning was similar in the 2 age groups (12%), but people in their sixties had slower walking speed.

However, the older patients reported less anxiety and had higher levels of adherence to their HIV treatment. Although older patients were more likely to rate their health-related quality of life as "good," fewer reported that it was "very good" or "excellent" compared to people in their fifties.

A higher VACS Index score -- indicative of higher mortality risk -- was associated with greater levels of dependence and Instrumental Activities of Daily Living scores, i.e., falls and slower gait speed.

"Our data add to the growing body of evidence that older HIV-infected adults are facing increasing medical, psychiatric, and social complexity and help to provide insight into how this complexity varies in different age groups in older adults," concluded the authors. "Our findings highlight the importance of taking a comprehensive approach to identify health issues facing older HIV-positive patients and the critical need to develop interventions to improve the quality of life and address the multifaceted needs of older HIV-infected patients."

5/10/16

Reference

M John, M Greene, NA Hessol, et al. Geriatric Assessments and Association with VACS Index Among HIV-Infected Older Adults in San Francisco. Journal of Acquired Immune Deficiency Syndromes. March 29, 2016 (online ahead of print).