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New SF General clinic treats older HIV patients / Aging Clinic 'Golden Compass'
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"It's all about living until you're 90 and living well.....Growing older with HIV can be confusing....The new clinic, called Golden Compass....The clinic is a long-needed addition to Ward 86, where 1,600 of its 2,500 patients are 50 years or older...with classes, consultations and support groups for people with HIV age 50 and older. It opened with a $100,000 donation made last year by AIDS Walk, which recently committed another $75,000. Ideally, clinic leaders hope to get permanent funding from the city.....The services offered through the clinic cover a wide array of physical and mental health ailments that are largely related to aging. A cardiologist who focuses on HIV and heart health regularly consults with doctors.....A key component of the clinic is incorporating mental health care and social support, Greene said. In studies she's done of older people with HIV, she found that most experienced loneliness or depression, or reported low levels of social support from friends and family. More than 1 in 10 have symptoms of post-traumatic stress disorder......."We've been concerned that gerontologists didn't know about HIV, and HIV docs were unfamiliar with issues people face in their older years,".....Simply making HIV doctors aware of the potential mental health complications of longtime survival can improve patients' access to services, which can include a psychiatric referral or an invitation to a social or support group....."People I've seen who are long-term survivors, who survived the '80s and '90s, that comes up over and over," she said. "Sometimes even getting an emergency contact number can be hard."
By Erin Allday, San Francisco Chronicle
February 2, 2017
http://www.sfchronicle.com/health/article/New-SF-General-clinic-treats-older-HIV-patients-10904711.php
When Ward 86 opened at San Francisco General Hospital, on the sixth floor of a faded red-brick building, the patients who came and went were mostly young gay men, and they were dying of AIDS.
Nearly 35 years later, the ward has made a remarkable new addition: a geriatric clinic.
As Ward 86's patients grow older, and as AIDS no longer looms as an imminent death threat, their medical needs are changing. Instead of worrying primarily about HIV and its related infections, they are now facing heart disease, cognitive decline, bone weakness and hearing and vision problems.
They're struggling with symptoms of aging that no one — not the patients or their caregivers — ever thought they'd live long enough to experience.
"This is all still new. We're still figuring out how to think about the chronic conditions people are facing and not just their viral load or T-cell count," said Dr. Meredith Greene, associate director of the geriatric clinic. "We're starting to recognize that things have changed."
The new clinic, called Golden Compass, started in January and is growing, with classes, consultations and support groups for people with HIV age 50 and older. It opened with a $100,000 donation made last year by AIDS Walk, which recently committed another $75,000. Ideally, clinic leaders hope to get permanent funding from the city.
Greene, a UCSF physician who specializes in geriatric care and HIV and has been consulting part-time at Ward 86 for more than a year, said the project is among the first of its kind in the United States. In the weeks since it opened, she said, people have been calling from around the country to express interest in launching similar programs.
The clinic is a long-needed addition to Ward 86, where 1,600 of its 2,500 patients are 50 years or older, and where many have lived with HIV for at least two decades, said Dr. Monica Gandhi, medical director of the ward.
"It thrills me every day that we are talking about thriving, not just surviving," Gandhi said. "It's all about living until you're 90 and living well. It used to be that palliative care was all we had. Now we can talk about HIV and aging."
The services offered through the clinic cover a wide array of physical and mental health ailments that are largely related to aging. A cardiologist who focuses on HIV and heart health regularly consults with doctors.
The HIV specialists in the ward, meanwhile, use the clinic to check on bone health, cognitive problems and mobility issues. In addition, the clinic provides weekly dental, vision and hearing assessments, and classes on fitness and brain health. A patient support group meets once a month.
Even before the clinic opened, a full-time pharmacist began meeting with older patients to go over their medication load, looking for problematic drug interactions and reviewing prescriptions that may need to be updated or even stopped. It's not unusual for older Ward 86 patients to be on 20 drugs to treat everything from HIV to high blood pressure and diabetes. Sometimes their health can be improved just by juggling their meds.
"Recently we had a patient who had nausea during the day," said Janet Grochowski, t
he Ward 86 pharmacist. "So we looked through his medication list and saw that he was taking many medications in the morning, before he ate. We moved them to the evening so he could take them with dinner, and that helped quite a bit."
A key component of the clinic is incorporating mental health care and social support, Greene said. In studies she's done of older people with HIV, she found that most experienced loneliness or depression, or reported low levels of social support from friends and family. More than 1 in 10 have symptoms of post-traumatic stress disorder.
The effects of social isolation are especially profound among longtime HIV survivors who might have lost many friends during the AIDS epidemic, Greene said.
"People I've seen who are long-term survivors, who survived the '80s and '90s, that comes up over and over," she said. "Sometimes even getting an emergency contact number can be hard."
Simply making HIV doctors aware of the potential mental health complications of longtime survival can improve patients' access to services, which can include a psychiatric referral or an invitation to a social or support group, Greene said.
Chip Supanich, a longtime HIV survivor who has worked as an advocate for the survivor community, said the clinic is "exactly what we like to see."
"We've been concerned that gerontologists didn't know about HIV, and HIV docs were unfamiliar with issues people face in their older years," said Supanich, 56, who is not a Ward 86 patient. "We wanted to bring the two together."
Growing older with HIV can be confusing, said Supanich, who tested positive for HIV in 1985 but believes he became infected in 1981. Patients and their doctors can have difficulty understanding whether a new symptom is related to HIV or is just a normal part of growing older, which can complicate treatment.
Though he's generally pretty healthy, Supanich said he's had some recent problems with spinal stenosis and neurological issues. "It's challenging, but it goes with the territory, I guess," he said.
"I have had 30 extra years than they thought I would," he added. "I live in gratitude for that pretty much every day."
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