patients have a high prevalence of multiple age-related problems, investigators
from the United States report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The research involved patients 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.
“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,” write 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
treatment and care mean that many patients with HIV are now living well into
old age. Over half of HIV-positive adults in the United States are now aged 50
years and over. Previous research has shown that these patients 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 (VACS) Index, a prognostic tool based on markers associated with HIV and
other health conditions, can be used to identify older HIV-positive patients
with a high risk of illness and death. VACS Index score has also been associated
with risk of fragility fractures, cognitive impairment and exercise capacity.
However, less is known about its association with geriatric conditions, such as
therefore designed a cross-sectional observational study assessing the
physical, cognitive, social and behavioural health of a large sample of older
HIV-positive adults receiving outpatient care in San Francisco. A combination
of geriatric and other assessments were used to assess psychosocial issues
observed in older patients with HIV. The investigators hypothesised that both
age and VACS Index would be associated with the geriatric conditions identified
in the assessments.
Recruitment was between December 2012 and
December 2014 and English-speaking patients aged 50 years and older were
eligible to participate.
included questions on physical, social, mental and cognitive health. The
investigators used a combination of assessments that addressed traditional
geriatric conditions and also the issues faced by older HIV-positive patients.
Four broad areas
of health were assessed:
- Physical health and functioning;
falls and walking speed (Activities of Daily Living [ADL] and Instrumental
Activities of Daily Living [IADL]).
- Social support, including physical
and perceived support and loneliness.
- Mental health, including
depression, anxiety, post-traumatic stress disorder.
- Behavioural and general health,
including adherence to HIV therapy and overall quality of life.
A total of 359
patients were assessed. Most (85%) identified as male, 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 ten years or over. As
regards HIV-related markers, 82% had an undetectable viral load and over half
had a CD4 cell count above 500 cells/mm3.
Median age was 56
years and two-thirds of patients were in their 50s. 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% reported loneliness, half reported receiving
low levels of social support and over a third met the criteria for mild
Patients aged 60
years and older were more likely to report problems with balance than patients
in their 50s (47% vs. 33%). Prevalence of problems with physical health and
functioning was similar in the two age groups (12%), but patients in their 60s
had slower walking speed.
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 patients in their 50s (p = 0.04).
A higher VACS
Index score – indicative of higher mortality risk – was associated with greater
levels of dependence and IADL scores, i.e. falls and slower gait speed (p =
“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,” conclude 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.”