Effects of frailty, geriatric syndromes, and comorbidity on mortality and quality of life in older adults with HIV

Abstract

Background To understand the effects of frailty, geriatric syndromes, and comorbidity on quality of life and mortality in older adults with HIV (OAWH). Methods Cross-sectional study of the FUNCFRAIL multicenter cohort. The setting was outpatient HIV-Clinic. OAWH, 50 year or over were included. We recorded sociodemographic data, HIV infection-related data, comorbidity, frailty, geriatric syndromes (depression, cognitive impairment, falls and malnutrition), quality of life (QOL) and the estimated risk of all-cause 5-year mortality by VACS Index. Association of frailty with geriatric syndromes and comorbidity was evaluated using the Cochran-Mantel-Haenszel test. Results Seven hundred ninety six patients were included. 24.7% were women, mean age was 58.2 (6.3). 14.7% were 65 or over. 517 (65%) patients had ≥3 comorbidities, ≥ 1 geriatric syndrome and/or frailty. There were significant differences in the estimated risk of mortality [(frailty 10.8%) vs. (≥ 3 comorbidities 8.2%) vs. (≥ 1 geriatric syndrome 8.2%) vs. (nothing 6.2%); p = 0.01] and in the prevalence of fair or poor QOL [(frailty 71.7%) vs. (≥ 3 comorbidities 52%) vs. (≥ 1 geriatric syndrome 58.4%) vs. (nothing 51%); p = 0.01]. Cognitive impairment was significantly associated to mortality (8.7% vs. 6.2%; p = 0.02) and depression to poor QOL [76.5% vs. 50%; p = 0.01]. Conclusions Frailty, geriatric syndromes, and comorbidity had negative effects on mortality and QOL, but frailty had the greatest negative effect out of the three factors. Our results should be a wake-up call to standardize the screening for frailty and geriatric syndromes in OAWH in the clinical practice. Trial registration NCT03558438.

The impact of geriatric syndromes on quality of life among older people living with HIV in Kampala, Uganda

“…While the presence of multiple NCDs is generally burdensome for PLWH and negatively impact their QoL and mortality risk ( 12 ), our study found that having >2 NCDs increased QoL in the ‘past, present, and future activities’ domain. This odd result suggests a potential influence of specialized clinic care ( 20 ), frequent visits, and proactive healthcare-seeking behavior among OPWH with co-morbidities in our setting, warranting further exploration.…”

A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study

“…On the other hand, more than half of the non-robust participants in our study became robust after the 12-week MEP which makes the results particularly significant. The interest and scientific evidence on frailty and HIV have grown markedly over the past 10 years, but the bulk of the published material has focused on the prevalence of frailty in different countries and settings ( 20 ), on its ability to predict adverse health events ( 21 ), on its relationship with biomarkers ( 22 , 23 ), and/or with other health conditions ( 24 ), nevertheless, until now, no evidence has been available concerning treatment. Some scientific societies recommend frailty screening in people over 50 years of age with HIV ( 25 ), however, health professionals had no evidence-based intervention to offer until now beyond extrapolating on the interventions that have proven effective in the overall population ( 6 ).…”

Frailty and health-related quality of life among older people living with HIV pre- and post-COVID-19 pandemic onset: A cross-sectional study

“…Our study confirmed the association between worse HQoL and frailty among PWH, as reported previously. 20 , 35 , 36 The ACTG SF-21 instrument used measured eight HQoL domains. 27 Other studies have also shown associations of frailty with the domains of HQoL evaluated here, including neurocognitive impairment association with increased risk of frailty in an observational cohort evaluating aging and HIV, the ACTG A5322 study.…”