Support Services Needed for Older, Minority HIV-Positive Adults

Results of a recent survey find that older adults with HIV are in need of comprehensive care because of comorbidities and lack of support.

Older, minority adults living with HIV carry a higher risk of being unable to live independently at an earlier age due to multiple medications, forgetfulness, comorbidities, and falls, according to a study presented at IDWeek 2016 in New Orleans, Louisiana.1

Oluwatoyin Adeyemi, MD, of the Department of Infectious Diseases at the Ruth M. Rothstein CORE Center, Cook County Health and Hospitals System and Rush University Medical Center in Chicago, Illinois, and colleagues used the CORE Healthy Aging Initiative (CHAI) 63-question survey to gather data from 389 HIV-positive patients >50 years old at the Ruth M. Rothstein CORE Center. The median age of respondents was 56 years; 72% were African American, 15% were Hispanic, and 10% of respondents were white. Ten percent of patients completed the survey in Spanish.

The survey results showed that 73% of respondents were diagnosed with HIV >10 years ago and 41% were diagnosed >20 years ago. Eighty-one percent said they were their own main caregiver and 46% lived alone.

Participants were enrolled by peer educators and completed paper surveys while waiting for primary care appointments. They were asked to rate their general health and to respond to social issue questions involving financial, housing, and mental health status; HIV-disclosure/stigma; retirement planning; old age care; memory issues; and sexual health.

The highest concern reported was money (63%), followed by living with HIV (62%). Patients listed housing (44%) and mental health (40%) as third and fourth concerns, respectively.

Participants reported a history of hyperlipidemia (27%), hypertension (27%), diabetes (14%), and cancer (14%). Thirty-two percent of the respondents reported sustaining a fall within the prior year, and 8% reported sustaining more than 3 falls.  Forty-four percent of participants reported being current smokers.

In an interview with Infectious Disease Advisor, Dr Adeyemi said that researchers “are working with the administration on starting some initiatives in-clinic, including nutrition counseling, exercise training, smoking cessation, and monthly CHAI meetings with presentations and hands-on participation in topics selected by the patients.” Social isolation is common in older adults with HIV and “settings like these provide a network for these patients, many of whom live alone,” she added.

Dr Adeyemi described plans for the creation of an advisory board to address the challenges experienced by this population. Plans are also underway for a multidisciplinary health fair to address the needs of older adults with HIV.

“Caring for older patients with HIV requires a comprehensive approach. [Physicians] need to think beyond CD4 count and viral suppression and think about the whole patient,” Dr Adeyemi noted. In addition, health care practitioners need to address comorbidities and other social needs.

“Smoking cessation needs to be a priority, as it drives a lot of other morbidities we see in our patients. With the high use of text messaging by our patients, we have opportunities to deliver brief health messages outside of clinic settings,” Dr Adeyemi said. 

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  1. Adeyemi O, Catrambone J, Rebolledo J, et al. Assessing the needs of older HIV+ adults; initial data from the CORE Healthy Aging Initiative (CHAI). Presented at: IDWeek 2016. New Orleans, LA; October 26-30, 2016. Poster 2126.