| |
HRSA Aging/HIV Medicare Paper - "need for personalized care & maximizing functional status....training medical professionals....increased coordination & integration of services, geriatric services "
|
| |
| |
Download the PDF here
"we found that older people with HIV have a higher overall hazard of mortality as well as a higher odds of having depression, chronic kidney disease, COPD, osteoporosis, colorectal cancer, lung cancer, hypertension, ischemic heart disease, diabetes, chronic hepatitis, and end-stage liver disease compared to those without HIV
minorities and dual Medicaid enrollees overall had higher hazards of mortality as well as higher odds and incidence of many conditions"
"While much attention is currently being devoted to ending the HIV epidemic, which is an important initiative, a cure does not yet exist for those currently living with HIV, and so it is also important that efforts continue to be made to improve health outcomes and quality of life for this population. Our findings of markedly higher odds of comorbid conditions, in combination with previous work linking comorbidities with decreased quality of life among older people with HIV [62, 63], highlights the need for further efforts to improve care for these individuals."
"These results are also important for clinicians caring for people with HIV, who are most likely to be treated by primary care physicians or infectious disease specialists [61] and therefore may not have the same level of experience with caring for older adults as specialists in gerontology or geriatrics. This suggests a need for training of medical professionals on the intersecting issues of aging and HIV, particularly in how to deal with multi-morbidity, polypharmacy, and the need for personalized care and maximizing functional capacity. It also points to the need for increased coordination and integration of services, including HIV services and geriatric services, as well as an increased focus by providers on prevention, screening, and treatment for other conditions for which older people with HIV are at higher risk. The Ryan White HIV/AIDS Program's AIDS Education and Training Centers are one important mechanism by which medical professionals can share information with each other on lessons learned in treatment and coordinating care for older people with HIV.
Understanding the degree to which individuals living with HIV may have different healthcare needs, regardless of the underlying causes of differences in health status for these individuals, is of policy interest. Future research should study the underlying reasons for differences in health status, as well as at what age these differences begin to appear, to better understand particular clinical interventions that may be applicable to treating comorbidities in this population."
Assessing the health status and mortality of
older people over 65 with HIV
GinaTurriniID1*, StephanieS.Chan1, PamelaW.KleinID2, StacyM.CohenID2,AntigoneDempseyID2, HeatherHauck2, LauraW.Cheever2, Andre R. Chappel ID11 U.S .Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, United States of America, 2Division of Policy and Development, U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville,Maryland, United States of America
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241833
This paper analyzed a large, nationally representative sample of Medicare beneficiaries aged 65 and older from 2011 to 2016 to compare the health and survival status of older people with HIV to an older US population not living with HIV. Prior research has found that older people with HIV have high adherence to treatment which results in high levels of viral suppression [25, 26]. Adherence to treatment and viral suppression are both associated with better health outcomes [51]. Nonetheless, we found that older people with HIV have a higher overall hazard of mortality as well as a higher odds of having depression, chronic kidney disease, COPD, osteoporosis, colorectal cancer, lung cancer, hypertension, ischemic heart disease, diabetes, chronic hepatitis, and end-stage liver disease compared to those without HIV, even after adjusting for demographic characteristics. Some of these differences were quite large in magnitude, particularly for hepatitis and end-stage liver disease. Finally, we found that the incidence of diagnosis over time of every condition analyzed is higher for people with HIV, after accounting for the competing and differential risk of mortality.
Our results differed significantly by population subgroup. We found that older people with HIV are more likely to be from potentially underserved populations, including minorities (49% of older people with HIV) and dual Medicaid enrollees (43% of older people with HIV). We also found that minorities and dual Medicaid enrollees overall had higher hazards of mortality as well as higher odds and incidence of many conditions (even without an HIV diagnosis), and that an HIV diagnosis is associated with even larger disparities.
While our data do not allow us to analyze the underlying factors contributing to these outcomes, our results nonetheless raise important questions regarding the role of social determinants of health for people with HIV. People with HIV are disproportionately more likely to be from underserved and vulnerable groups, including men who have sex with men, transgender people, people of color, and those with lower socioeconomic status [55], and these disparities may affect HIV prevention; testing; and access to care, treatment, and support services, leading to potentially worse health outcomes and poorer survival. Stigma and social isolation are widely documented challenges for many people with HIV, particularly for men who have sex with men and transgender individuals, and older people with HIV tend to be particularly isolated with limited social networks [18, 56-58]. As these individuals age and develop more chronic conditions and increasingly complex care needs, they often have fewer resources and family members to rely on [59]. Thus, older people with HIV may be more dependent on formal care but may also facesignificant barriers to access, including having fewer personal resources relative to their healthcare needs and stigma. Compounding these challenges, older people with HIV also have higher rates of mental health conditions, including depression, as well as higher rates of substance use and homelessness, all of which can contribute to challenges in accessing and adhering to care [18].
In addition to the personal health and social implications for older people with HIV, these results have important implications for community partners and programs as they plan for an aging population, including Medicare, Medicaid, and the Health Resources and Services Administration's Ryan White HIV/AIDS Program, which provides a comprehensive system of care to low-income people with HIV in the United States, including over 230,000 people with HIV aged 50 and older (approximately half of all people with HIV aged 50 years and older in the United States) [1, 60].
These results are also important for clinicians caring for people with HIV, who are most likely to be treated by primary care physicians or infectious disease specialists [61] and therefore may not have the same level of experience with caring for older adults as specialists in gerontology or geriatrics. This suggests a need for training of medical professionals on the intersecting issues of aging and HIV, particularly in how to deal with multi-morbidity, polypharmacy, and the need for personalized care and maximizing functional capacity. It also points to the need for increased coordination and integration of services, including HIV services and geriatric services, as well as an increased focus by providers on prevention, screening, and treatment for other conditions for which older people with HIV are at higher risk. The Ryan White HIV/AIDS Program's AIDS Education and Training Centers are one important mechanism by which medical professionals can share information with each other on lessons learned in treatment and coordinating care for older people with HIV.
Understanding the degree to which individuals living with HIV may have different healthcare needs, regardless of the underlying causes of differences in health status for these individuals, is of policy interest. Future research should study the underlying reasons for differences in health status, as well as at what age these differences begin to appear, to better understand particular clinical interventions that may be applicable to treating comorbidities in this population.
While much attention is currently being devoted to ending the HIV epidemic, which is an important initiative, a cure does not yet exist for those currently living with HIV, and so it is also important that efforts continue to be made to improve health outcomes and quality of life for this population. Our findings of markedly higher odds of comorbid conditions, in combination with previous work linking comorbidities with decreased quality of life among older people with HIV [62, 63], highlights the need for further efforts to improve care for these individuals.
|
|
| |
| |
|
|
|
