Frailty among HIV-infected persons in an urban outpatient care setting

Önen, Nur F.; Agbebi, Abayomi; Shacham, Enbal; Stamm, Kate E.; Önen, Alev R.; Overton, Edgar Turner

doi:10.1016/j.jinf.2009.08.008

Cited by 117 publications

(145 citation statements)

References 33 publications

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“…15 Multiple co-morbidities and aging-related processes such as worsening immune function, sensorineural impairment, gait instability, and general functional decline may also lead to frailty and disability among older HIV-positive adults. [16][17][18][19] Multi-disciplinary teams-already in place at many HIV treatment centers-may, therefore, need to expand and include specifically trained professionals to address patients' functional and home-care needs, and to provide outreach to engage (or reengage) patients. Also, community-based and primary care providers are strategically located to help implement expanded HIV testing and education programs to raise HIV/AIDS awareness among older adults.…”

Section: An Epidemic In Evolution: the Need For New Models Of Hiv Carementioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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Since the beginning of the AIDS epidemic, models of HIV care have needed to be invented or modified as the needs of patients and communities evolved. Early in the epidemic, primary care and palliative care predominated; subsequently, the emergence of effective therapy for HIV infection led to further specialization and a focus on increasingly complex antiretroviral therapy as the cornerstone of effective HIV care. Over the past decade, factors including (1) an aging, long-surviving population; (2) multiple co-morbidities; (3) polypharmacy; and (4) the need for chronic disease management have led to a need for further evolution of HIV care models. Moreover, geographic diffusion; persistent disparities in timely HIV diagnosis, treatment access, and outcomes; and the aging of the HIV provider workforce also suggest the importance of reincorporating primary care providers into the spectrum of HIV care in the current era. Although some HIV-dedicated treatment centers offer comprehensive medical services, other models of HIV care potentially exist and should be developed and evaluated. In particular, primary care-and community-based collaborative practices-where HIV experts or specialists are incorporated into existing health centers-are one approach that combines the benefits of HIV-specific expertise and comprehensive primary care using an integrated, patient-centered approach.

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Section: An Epidemic In Evolution: the Need For New Models Of Hiv Carementioning

confidence: 99%

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

2011

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“…18 Low activity was defined as self-report of being ''limited a lot'' in vigorous physical activities such as running, lifting heavy objects, or participating in strenuous sports. [19][20][21] One point was given for each abnormality, with ''frailty'' requiring three or more points.…”

Section: Definitionsmentioning

confidence: 99%

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

Erlandson

Allshouse²,

Duong³

et al. 2012

Journal of Palliative Medicine

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Introduction: Studies of advance care planning (ACP) completion rates in HIV-infected persons pre-date the ''graying'' of the HIV epidemic. We sought to examine current ACP completion rates and factors influencing completion among HIV-infected persons. Methods: HIV-1-seropositive persons aged 45-65 years on effective antiretroviral therapy for a minimum of 6 months were enrolled in a cross-sectional survey. Likelihood of ACP was assessed by demographic and clinical characteristics, tested with odds ratios (OR) and 95% Wald confidence intervals (CI), and adjusted for gender. Results: Of 238 participants, 112 (47%) completed ACP. Persons ‡ 55 years of age (OR 2.8; CI 1.6,5.0; p < 0.001), males (OR 4.1; CI 1.8,9.3; p = 0.004), and persons with higher education (OR 2.2; CI 1.3,4.0; p = 0.007) were more likely to have completed ACP. Persons with a cardiac event were more likely to have completed ACP (OR 5.5; CI 1.6,25; p = 0.03), although this effect was diminished after adjusting for gender (OR 4.5; CI 0.95,21.4; p = 0.06). HIV infection diagnosed for greater than 5 years was not associated with ACP completion (OR 1.3; CI 0.7,2.7; p = 0.4). Current CD4+ cell counts were similar between those completing and not completing documentation (588 cells/lL and 604 cells/lL, respectively; p = 0.7). The likelihood of ACP did not significantly differ with other comorbidities. Discussion: Less than 50% of middle-aged patients in HIV care had documented ACP. In particular, women and those with lower education were at greatest risk of non-completion and may need interventions to improve ACP.

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“…In a very interesting recent prospective study, Onen et al 20 evaluated 445 persons with a mean age of 41.7 years, 71% of whom were male and 63% African American, with a mean 8.4 years of HIV diagnosis. Frailty prevalence was 9%.…”

Section: Common Problems In Elderly Hiv-infected Patientsmentioning

confidence: 99%

A Dedicated Screening Program for Geriatric HIV-Infected Patients Integrating HIV and Geriatric Care

Ruiz

Cefalu

Ogbuokiri

2010

Journal of the International Association of Physicians in AIDS

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Background: Clinicians caring for HIV-infected patients >60 years old encounter multiple clinical challenges. The use of a functional geriatrics screening for detection of significant comorbidities is important in this population. Methods: The geriatrics screening evaluated functional capabilities, depression, cognitive dysfunction, nutrition, mobility, medicines used, and interactions. Results: As of July 2009, 57 patients were screened (average age 62.6, 39 males and 18 females). A total of 17 patients (9 males and 8 females) were referred to the geriatrics/HIV program because of identified problems in multiple domains: 10 with cognitive dysfunction, 8 with problems in basic or instrumental activities of daily living, 6 with nutritional issues, 5 with depression, 5 with mobility problems, 4 with visual issues, and 2 with hearing difficulties. The average age was 62.9. Median CD4 count and viral load were 285 (15-714) cells/mm 3 and 30 505 copies/mL (0-407 697), respectively. Conclusions: The functional yearly screening of patients >60 years with HIV needs to be part of regular care of patients infected with HIV as multiple functional problems can be diagnosed and addressed.

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Frailty among HIV-infected persons in an urban outpatient care setting

Cited by 117 publications

References 33 publications

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

An Epidemic in Evolution: The Need for New Models of HIV Care in the Chronic Disease Era

HIV, Aging, and Advance Care Planning: Are We Successfully Planning for the Future?

A Dedicated Screening Program for Geriatric HIV-Infected Patients Integrating HIV and Geriatric Care

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