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Veterans Aging Cohort Study (VACS) Index, Functional Status, and Other Patient Reported Outcomes in Older HIV-positive (HIV+) Adults in SF.....Poor Outcomes in HIV+ Aging age 53-61
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Reported by Jules Levin
IDSA Oct 8-12 2014 Philadelphia, PA
Malcolm John, MD, MPH1; Nancy A. HessolMSPH1; C. Bradley Hare MD1,2; Catherine Lyons NP, MPH1; Roland Zepf1, MS, RN; Terrence Marcotte1, NP; Amanda Hutton Parrott DPT, MS, NP1; Robert Whirry, BA3; Cameron Foreman, BA1; Monica Gandhi, MD, MPH1; Meredith Greene, MD1.
median age 57....mean CD4 count 507...40% reported falls in the previous year.....32% had severe/moderate loneliness, 50% low degree of perceived social support, 49.9% low physical social support, 26% moderate/severe depression, 33% possible cognitive impairment, 26.8% anxiety, 12.5% PTSD, 11% poor/very poor/fair adherence, 30% fair/poor health, 60% income <20,000, 30% illicit drug use......"On cognitive screening, 40% had MOCA (mental/cognitive) scores < 26; 58% had findings of loneliness; 60% the lowest levels of perceived social support; 55% depression; 50% anxiety; 12% PTSD (Table 2).....On functional screening, 26% (91) reported difficulty with ≥1 ADL, 39% (136) reported they needed assistance with ≥1 IADL, and 40% reported falls in the previous year (Table 2).....slower gait speed and chair-to-standing times (p=0.002, p=0.003). They also had lower anxiety (p = 0.013) and less alcohol use (p=0.009)"
Program abstract:
Background: Aging HIV+ patients present challenges to overburdened health systems.
To better understand this, we assessed results of comprehensive geriatric screenings in this
population. We also hypothesized that age and the Veterans Aging Cohort Study (VACS) index,
a validated measure of organ system dysfunction predictive of mortality, would be associated with
patient-reported outcomes in older HIV+ patients
Methods: Cross-sectional survey-based study performed December 2012 - January 2014 of >50 year old HIV+ patients at two UCSF affiliated San Francisco clinics. We evaluated multiple aspects of four basic functional domains using validated measures: physical function (Activity of Daily Living/ADL, Instrumental ADL/IADL, Falls, Short Physical Performance Battery/SPPB), social support (perceived support, loneliness), mental health (depression, anxiety, post-traumatic stress/PTSD), cognitive function (Montreal Cognitive Assessment/MOCA) as well as adherence. Descriptive statistics and ANOVA analyses assessed associations between these domains with age and VACS Index scores.
Results: 359 patients were screened (median age 57; 85% males; 57% Caucasian, 30% African-American, 11% Latino; 72% >high school education). Mean CD4 count was 507 cells/mm3, 83% had undetectable viral load, and 85% were HIV-positive > 10 years.
On functional screening, 26% (91) reported difficulty with ≥1 ADL, 39% (136) reported difficulty with ≥1 IADL, and 40% reported falls in the previous year.
On cognitive screening, 40% had MOCA scores < 26. In addition, 58% had findings of loneliness, 60% the lowest levels of perceived social support, 55% depression, 50% anxiety, and 12% PTSD. Older age was associated with lower CD4 counts, increased difficulty with IADLs, and chair stand component of SPBB. VACS Index score was associated with IADL and medication adherence.
Conclusion: We are the first to report an association between VACS index and functional status in older HIV+ patients. Our surveys also revealed a high prevalence of functional, social and cognitive deficits in this population. More comprehensive assessment tools, incorporating the VACS index, are likely to improve predictive models and management paradigms for older HIV-infected individuals.
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