Geriatric Care

The HIV-treating physician is spending almost 80% of their time managing age-related non-HIV/AIDS illnesses. Older adults with HIV are experiencing chronic “non-AIDS” conditions that are typically associated with aging, like heart disease, cancers, lung and bone diseases and others. HIV is now classified as a chronic disorder. If a person has two or more chronic illnesses, they are said to have multimorbidity.

PLACING EMPHASIS ON SUSTAINING FUNCTION

Older adults with HIV are developing more of the comorbidities of aging when compared to other older adults of the same age. Many believe that older adults with HIV can benefit from care models developed by geriatricians who are trained to manage multimorbidity. Geriatricians focus on sustaining the patient’s function rather than trying to target and manage each illness. By emphasizing function, the patient can sustain their independence and age in place thereby experiencing a better quality of life.

MORE PILLS DOES NOT MEAN BETTER HEALTH

Geriatricians know that as a person develops more disorders, the number of medications being taken increases. This increases the risk for adverse medication effects. Too many pills also increase the likelihood of falls as well as dangerous drug-drug interactions. This is called polypharmacy (see Polypharmacy). Geriatricians know that when polypharmacy occurs, adherence to all medications often decreases, including ART. Most research reports show that older adults with HIV experience polypharmacy at significantly higher rates than those without HIV. They are aware of conditions like frailty, dementia, compromised mobility, risk for falls and polypharmacy. When making treatment decisions geriatricians give a high priority to factoring in the social supports the patient can get from family members, friends and neighbors. They are keenly aware of the impact of social isolation and unaddressed mental health issues can have on health outcomes.

What you can do with your doctor

 

Patients with multimorbidity often discover that there is too little or no communication between their primary care physician (HIV treating physician) and specialists to whom they have been referred. This underlines the need for a person who can coordinate the care among providers and the patient. Without a care coordinator, the patient needs to inform the primary care physician of what happened when referred to a specialist. What treatments and new medications have been prescribed? Are they all needed? Alert your doctor when there are any changes in medications or dosages.

What you can do yourself

You are likely taking many medications. Make sure you take them at the time and frequency listed. Create pill boxes with daily doses lined up. Remember that Over the Counter (OTC) drugs are potent. Inform your physician if you are taking any OTC drugs. If you think you are taking too many pills or are experiencing side effects which impact your day to day activities or cause you not to eat report to your physician.

The most knowledgeable person about drugs and their interactions is you pharmacist. Engage your pharmacist. Ask the pharmacist to review your medications – all of them, especially those being received from other pharmacies. In fact, it is best to have all pills dispensed from the same pharmacy.

Unfortunately, there are not enough geriatricians in the USA. In fact, their numbers are declining even as our larger society is aging for the first time in history.   Consequently, it is unlikely that an older adult with HIV will have as their primary care physician a geriatrician. Some geriatricians are providing consultations when requested by the HIV treating physician. Reports show that the HIV treating physicians are not following all the recommendations that were given by the geriatric consultation. Make sure you know what was in the consultation report and why your HIV treating physician did not follow what was recommended.

Adapting geriatric care principles to the aging HIV+ adult needs to be embraced. The patient will need to advocate for the geriatric approach toward managing one’s health.

Adapted from Assessing Frailty and Functional Capacity: Managing the Care of Older Adults with HIV (2018) at http://www.hiv-age.org/ by Amy Justice MD, PhD and Stephen Karpiak PhD.

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