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Cost of Care in Older Aging patients with Increased Comorbidities......Non-HIV care provider....Aging, Worse Still to Come?
  ....Aging Clinic at Weill-Cornell, NYC; aging $costs in HIV skyrocket.......

from Jules: survival studies which suggest almost normal lifespans are only projections & based on bad predictions without data. Most of these studies cannot account for what is unpredictable - how comorbidities will in the future affect lifespan in older, >65 year old patients. Many patients experience multiple falls which along with osteoporosis can result in fracture which in and of itself can shorten lifespan. On the increase with aging >65 is kidney disease, heart disease, diabetes, hypertension, worsening neurologic & cognitive function which predict & cause falls & cancers, and worsening of the capacity to perform independent living activities; increased substance & drug use & suicidal ideation is a concern. Polypharmacy where patients often take 10-15 medications perhaps encouraging non-adherence to ART is on the rise. The survival studies do not & cannot account for the how this will affect mortality but it is likely to affect mortality, to suggest otherwise or minimize this potential is a disservice to patients and the entire field. At the Comorbidities Workshop in NY European researchers
http://www.natap.org/2016/AGE/AGE_18.htm predict:"In 15 years time the HIV geriatric population [65-67 yo] will increase from 4% to 37%"
34% will be disabled with frailty in 15 years and need to be in home
"In 15 years time the most frail HIV population will increase from 24% [now, 2016] to 48%"
"In 15 years time 34% of PLWH will be disabled" [burden of IADLs - independent activities of daily living]
see graph below - appears to predict 30% will experience a fall in 15 years, up from 20% now
"we were able to demonstrate that the total direct cost increases two-fold moving from the <40 years age strata of HIV-infected patients (US$10,588.45) to those older than 60 years (US$21,280.72).
It is now clear that NICMs are not simply the result of direct ART toxicity but rather a complex interplay of host virus and drug-risk factors resulting in Pp and translating to a premature aging process affecting HIV-infected patients.20,41-43 It is quite striking that, in the logistic regression analyses, Pp accounted for a cost expenditure three times higher than that of HIV infection per se."
HIV+ >65 on Medicare Have 2 Times More Comorbidities vs HIV-neg AND Blacks & Latinos Have 4-Fold Increased Risk for the 5 Comorbidities Examined vs Whites - CDC Report Chronic health conditions in medicare beneficiaries 65 years and older with HIV infection. - (10/08/16)......"HIV+ beneficiaries were approximately twice as likely as those without HIV infection to have chronic condition flags indicating hypertension, hyperlipidemia, ischemic heart disease, rheumatoid arthritis/osteoarthritis, or diabetes (Table 2)."





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